What is the AAP recommending at this time and why?
The American Academy of Pediatrics (AAP) has issued new recommendations for preventing and treating skull deformities in infants. These recommendations are needed because there has been an increase over the past several years in the number of babies with "positional" skull deformities.
What are positional skull deformities and what causes them?
A positional skull deformity is usually a flat spot on the back of the head. Positional deformities can develop when a baby continually rests his head in the same place such as in a crib, a car seat or an infant carrier.
Should I continue to place my baby on his back to sleep?
Absolutely! Despite the increased risk for skull deformity, you should always place your baby on his back at naptime and when you put him to bed at night.
If it increases his risk for developing a skull deformity, why is it so important to put my baby on his back to sleep?
It greatly reduces his risk of sudden infant death syndrome (SIDS). A little over a decade ago, researchers found that tummy and, to a lesser extent, side sleeping were linked with SIDS. In response, the AAP launched a nationwide "Back to Sleep" campaign in 1992, calling parents' attention to this danger and encouraging them to put their babies to sleep on their backs. Since that campaign was launched, SIDS rates in the United States have decreased more than 40%.
What about "tummy time"?
Providing "tummy time" is another way to help prevent the development of positional skull deformities. It also allows your baby to develop the upper body strength he'll need in order to push up and crawl when the time comes. Whenever your baby's on his tummy, however, you need to be with him at all times and make sure he's on a flat surface and awake.
So, what can I do to prevent my baby from developing a positional skull deformity?
You need to vary his sleeping position by alternating which side you turn his head to each night when you put him to bed. You should do the same at naptime. For example, the first time you put him to sleep, turn his head to the right side. Next time, turn it to the left, and alternate sides thereafter. Additionally, you may want to periodically move the crib around in his room so he'll have to turn his head in different directions in order to see what's going on around him.
You'll also want to limit the amount of time your baby spends in a car seat - unless he's actually riding in a vehicle. The same goes for other types of infant seats, such as swings, carriers or bouncy seats, where the back or side of your baby's head rests against them.
What happens if my baby does develop a positional skull deformity?
Your pediatrician will examine your baby's head at each health supervision visit. If any flattening is discovered, the doctor will determine whether it is due to repeatedly lying in the same position or some other cause. If there is flattening due to positioning, the pediatrician will discuss adjustments you can make in the way your baby lies and rests his head. If you follow these recommended changes, most flattening will improve within 2 to 3 months. If there is no improvement or if the condition worsens, your pediatrician may refer you to a physician with expertise in pediatric neurosurgery or craniofacial surgery to determine whether further treatment is needed. Such treatment could include a "skull-molding" helmet or surgery. Fortunately, surgery is rarely necessary.
