A flat head, also known as plagiocephaly, describes an asymmetrical skull shape where a part of the head appears flattened or misaligned. Doctor Nguyen Do Trong, a specialist level two in pediatric surgery at Tam Anh General Hospital in TP HCM, explains that this condition can originate in the womb due to fetal position, multiple pregnancies, limited uterine space, or premature birth. In rare instances, it may stem from congenital malformations or other medical conditions.

After birth, a flat head becomes noticeable if an infant consistently lies on their back or keeps their head turned to one side for extended periods. During the first few months of life, a baby's skull remains soft and grows quickly, making it susceptible to deformation when continuous pressure is applied to one area of the head. This condition is often referred to as positional plagiocephaly.

Doctor Trong examining an infant's head. Photo: Minh Tam

Doctor Trong advises parents to regularly change their infant's lying, holding, and feeding positions. This helps prevent the baby from consistently lying or turning their head to one side for prolonged periods, which can improve head shape. Encouraging awake tummy time suitable for the infant's age also reduces pressure on flattened areas of the head, promoting balanced skull development.

If an infant's head is only mildly flattened and shows no further deformation, parents can continue to monitor the condition. Most cases gradually improve as the child reaches developmental milestones such as rolling over and sitting up, which naturally reduces the time spent lying in one fixed position.

Parents should seek medical attention if the head flattening is pronounced, asymmetrical, or if one side of the back of the head is significantly flatter than the other. Other signs include ear misalignment, an uneven forehead, or facial asymmetry. An infant who consistently turns their head to only one side also indicates an abnormality that requires assessment. These symptoms may suggest moderate to severe plagiocephaly or accompanying functional torticollis.

During an examination, a doctor will assess the degree of skull deformation and the range of neck motion, while also ruling out less common causes such as early craniosynostosis. If an infant shows signs of torticollis or limited head rotation, physical therapy will be prescribed. Exercises aim to stretch contracted neck muscles, improve balanced head rotation to both sides, and guide caregivers on adjusting holding and lying positions. Caregivers are also taught to provide appropriate stimulation to encourage the infant to actively turn their head towards the less mobile side.

If the flat head condition does not improve or worsens when the infant is around 4-6 months old, parents should consult a pediatrician. The "golden period" for treatment is between 3-12 months of age because the skull is still soft and flexible, and the brain and skull are undergoing rapid development, allowing for more effective positional adjustments.

Treatment approaches vary depending on the severity of the flat head. They may include monitoring, adjusting lying and holding positions, gentle head massage, and physical therapy if torticollis is present. In some cases of severe or prolonged deformation, specialized intervention may be considered as indicated by the doctor.

Early detection and intervention for flat head syndrome during an infant's developmental stage yield better results. Most infants with positional plagiocephaly have a good prognosis if closely monitored and if care positions are adjusted from the first months of life.

Minh Tam