Flat-Head Syndrome Linked to Developmental Delays

Children with deformational plagiocephaly (DP), or “flat-head syndrome,” have been more commonly seen ever since pediatricians recommended placing infants on their backs during sleep. It’s an accepted consequence of a maneuver that has been found to lower crib death (sudden infant death syndrome, or SIDS) by about 40 to 50%. So far it’s been thought of as merely a cosmetic problem, and various conservative repositioning measures are generally recommended.
 
However, in a recent study, children with DP at 36 months were found to be around 2 to 8 times more likely to receive “at-risk” scores compared to children without DP. Differences were largest in cognition, cognition and parent-reported maladaptive behavior, and smallest in motor development. As you may see, there can be a significant overlap in these developmental problems and common conditions like ADHD and autism.
 
In the conclusion, the authors point out that this study doesn’t prove that having DP leads to developmental problems. One possible explanation proposed was that children with developmental delays may be less likely to reposition themselves, thus leading to DP. 
 
Here’s another possible explanation: It’s been shown that back sleep lowers sleep quality in infants. One study from 1993 showed that prone body position was associated with a significant increase in sleep duration (+ 6%) and in non-REM sleep (+25%) and a significant decrease in number of arousals (–40%) and in their duration (-43%).
 
This is one possible way that being placed on backs during sleep can lower the rate of SIDS. By keeping children in a lighter stage of sleep, they are more easily arousable, if they obstruct. One obvious consequence of poor quality sleep is that it can negatively affect young children’s brain development. Proper amounts of REM and deep sleep is important for memory consolidation and optimal brain development.
 
Perhaps having poor sleep and slower brain development can lead to less optimal motor reflexes that allows the infant to roll over. In some infants that naturally want to roll over onto their tummies, parents are told to turn their infants on to their backs, or to use positioning devices to promote back sleep.
 
I’m not recommending that parents ignore pediatrician’s back sleep recommendation. This can be a very sensitive issue that needs further research and discussion. With advances in technology and current know-how, it would be relatively easy to do a study to answer these questions. 
 
Did your child have flat-head syndrome? If so, did he or she have any developmental issues later in life?

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4 thoughts on “Flat-Head Syndrome Linked to Developmental Delays

  1. there is something wrong with humans and human sleep if we have to choose between death and brain damage. seems to me that research dollars need to be re-prioritized.

  2. I’ve been saying this for 21 years. I have 5 children and insisted on sleeping all on their stomachs. The first child’s pediatrician said they needed to sleep on their back, the 2nd and 3rd -their sides, the last 2 — their sides with a pacifier so they would startle awake when the pacifier fell out. The point seemed to be to keep them falling into a deep sleep. That made no sense to me. The brain does massive amount of developing in those first couple of years and it would seem to me that a deep and continuous sleep would be important. If they tell us now that adults who do not get a good night’s sleep can suffer early dementia then why wouldn’t interrupting a baby’s sleep cause problems? I just slept my babies on their stomachs on a flat sheet with nothing to puff up around their noses. I really think this fear of sids and the counsel given to parents should be studied more. Could the consequence of “light’ sleeping babies be an increase in ADHD and Autism?

  3. Ms. Frosman,

    I do agree that more research is needed. However, it’s unlikely funds will be available to overturn a major tenant of pediatrics. SIDS is such a rare problem that it can be difficult to determine associations unless you study thousands or tens of thousands of children. I do think that parents should be counseled about the mechanisms of back sleep——to keep infants in a lighter stage of sleep.

  4. Its ridiculous to subject every single baby (millions of babies) to unnatural forced back sleeping, poor sleep, and flat heads as some sort of idiotic “shotgun” method to possibly (and partially) mitigate the risk of an already extremely rare thing- even SIDS when its cause is not known. We absolutely reject even light drinking by mothers to protect the developing brain, and yet we are fine with sleep deprivation during its fastest growth stage? This emotional position is completely irresponsible by ACP.