The safe sleeping campaign was implemented to guide families to position baby to sleep on the back. This recommendation has significantly reduced the risk of Sudden Unexpected Death in Infancy (SUDI). It is the safest environment for baby and is supported by evidence-based research demonstrating its effectiveness.

Newborn babies commonly display a preference for holding the head in certain positions. When positioned on the back, babies tend to turn their head to one side causing prolonged pressure on the part of the head that is in contact with the supporting surface. Some babies may develop flattening or asymmetry of the head due to the neck muscles being weak or tight, often associated with restricted movement and positioning in the uterus prior to birth. Persistent exposure to external forces pressing on the soft malleable bones can flatten the skull.

Plagiocephaly is the term used to describe a flat spot on one side of the head. Brachycephaly refers to flattening in the middle portion of the back of the head. Sometimes Plagiocephaly and Brachycephaly can co-exist. Typically, this flattening may be obvious and visible from the age of six to eight weeks. Minor flattening may resolve on its own with time as natural correction often occurs when baby develops better head control and mobility around four months of age. In more severe cases, asymmetry may be permanent or persist into late childhood, but research suggests this will not affect baby’s brain or development.

Parental awareness and knowledge encourage families to incorporate simple strategies into baby’s sleep and play routine. The goal of repositioning aims for baby to rest their head on the non-flat areas to aid weight distribution over the head surface. Stretching of the neck muscles naturally occurs by regular rotation of baby’s head.

The following techniques if used early and consistently can prevent or reduce flat spots forming:

• Play routines with varying positions can assist in avoiding prolonged pressure on one spot of the head. It also promotes opportunities for babies to strengthen their muscles and balance. Supervised play encourages bonding and interaction.
• Alternating side lying play positions reduces head pressure and aids spatial orientation experiences. Repositioning toys supports baby to turn the head to either side.
• Tummy time assists the shaping of baby’s head and involves placing an awake alert baby on the stomach for supervised play. This can also be attended by positioning a baby over the parent’s lap or chest. The primary purpose is to encourage the strength of the muscles that are necessary to lift and hold the head. Tummy time encourages upper body strength necessary for the development of the skills needed to crawl, roll, sit and stand.
• Incorporate the use of safe toys, moving them from side to side to encourage baby to reposition the head, focus eyes and maintain concentration.
• Babies spend many hours sleeping in the early months. Continue to adhere to safe sleeping guidelines and position baby to sleep on the back. Babies will often turn their head towards stimulation such as the door, light sources or the parent’s bed. Alternating baby’s position at either end of the cot will encourage repositioning of the head to different sides to minimise prolonged pressure exposure.
• Alternatively, parents can turn the baby’s head to a different side each time baby is placed in the cot for sleep. As a midwife and mother, I often suggest to families the use of a hair band on the wrist of the parent as a great way to remember what side to gently turn baby’s head. My memory was never the best during the early postnatal period! I would change the hair band on my wrist each sleep time for easy identification of the side baby’s head needed to be positioned. Right wrist, right side. Left wrist, left side.
• As adults, it is common to have a dominant hand to complete daily tasks. Parents often carry babies with their preferred arm. This may cause baby to constantly turn the head to one side. Alternating arms when carrying or nursing aims to prevent the development of head orientation preference.
• Breastfeeding babies are constantly alternating the head position each feed with the change of breasts. It is recommended that carers of bottle-fed babies also change the arm position for every feed.
• Avoid the use of wedge pillows or other devices to keep baby in a certain position. Any additional objects added to the cot are an extra hazard to baby and may obstruct breathing.
• Minimise prolonged periods in car seats, strollers, swings, and bouncers as this position places additional pressure on the back of the head.

Despite the implementation of the above strategies, if you notice a flat spot on the head or observe your baby displaying a strong preference to turn the head to one side, discuss your concerns with your paediatrician or family doctor.

Read the Mother Midwife Safe Sleeping and Tummy Time blogs for associated information.