Q.   “My friend’s baby has always slept on her back in her crib as her doctor recommended.  The back of her head is extremely flat and now they’re telling her mom that she may need a custom made band to reshape her head.  What happened and how to I avoid this for my baby?

A. The medical term for this is plagiocephaly and it can usually be avoided.  (Plagios is the Greek for oblique or slanted and cephale means head.

Most babies are born with some asymmetry of their heads caused both by intrauterine position and the process of being born.  Many parents don’t know that it can take six to eight weeks for the head to “round up” and that head shape is determined by the internal force of brain growth and the external forces from the way a baby lies as he sleeps. 

The junctions between the bones of the skull can fuse early and this is known as craniosynostosis.  Head flattening as a result of this premature “suture” closure is very rare. The only common cause of plagiocephaly is positional.  About 75% of head growth occurs in the first year of a baby’s life.  Some doctors have said that we should treat misshapen heads with more urgency than we shown in the past.

My best recommendation is still to have your baby in a safe Family Bed.

If you must have your baby in a crib, place your baby’s head at opposite ends of the crib on alternating nights and hang mobiles and place posters the she likes on the walls to get her to turn her head from one side to the other.

“DOC” bands—the custom made apparatus for remolding the skull—are rarely needed, but ask your pediatrician if you are worried about extreme or increasing flattening. I have always thought that babies sleeping on their sides are safer but I have to acknowledge that good statistics have been gathered showing that babies sleeping on their backs have fewer SIDS deaths.  Babies in the Family Bed are the safest of all.