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"Help, My Baby's Head Is Flat!"

You're not alone. Flat spots on the back of an infant's head are fairly common these days. Why? Blame back sleeping. While putting babies to sleep on their backs has saved many lives (national rates of sudden infant death syndrome, or SIDS, have decreased more than 50 percent since the American Academy of Pediatrics originally launched the nationwide "Back to Sleep" campaign in 1992), there has been a corresponding increase in the number of babies diagnosed with "positional" skull deformities, usually a flat spot on the back of the head. Flat spots can develop when a baby continually rests her head in the same place, whether it's a crib, a car seat, or a carrier. The problem is usually only cosmetic and does not affect your child's brain growth or cause developmental delays, but be sure to consult your pediatrician.

To help prevent and treat head shape abnormalities, the AAP's revised recommendations for reducing the risk of SIDS also include the following guidelines:

Continue to place your baby to sleep on his back  -- rather than his side or tummy  -- at every naptime and when you put him to bed at night. Last October, the AAP further strengthened the "Back to Sleep" message when we revised our SIDS policy to recommend against side sleeping  -- previously a less favorable, but accepted, alternative. Based on the latest research, we now believe putting babies to sleep only on their backs is the best way to reduce the risk of SIDS.

Vary your baby's sleeping position. Alternate which side you turn your baby's head to whenever you put her down to sleep. It's helpful to periodically change the direction that you lay her down in the crib (so that her head is where her feet usually are); most babies prefer to face the action of the room and will turn their heads in that direction.

Provide plenty of "tummy time." Allow your baby to lie on his stomach when he's awake and under your watchful eye. (These sessions should always be supervised in case your baby falls asleep in the prone position, a risk factor for SIDS.) Tummy time not only helps prevent flat spots on the head, it also strengthens the upper body muscles that infants will need for pulling up and crawling.

Limit time spent in infant seats. And unless she's riding in a vehicle, try not to leave her in the car seat. Infant seats and car seats can cause flat spots on soft skulls just like sleeping on her back can. The same goes for swings, carriers, strollers, and bouncy seats, where the back of your baby's head rests against them. Vary her position throughout the day while she's awake, including plenty of upright "cuddle time."

Visit your pediatrician regularly. If your pediatrician discovers any positional flattening, she may recommend adjustments or exercises to strengthen your child's neck muscles. With these changes, most flattening improves within two to three months. If it doesn't, you may be referred to a specialist to determine whether further treatment, such as a "skull-molding" helmet, is necessary.

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