Anyone who’s surmised that putting babies to sleep on their backs has contributed to the increase in babies’ flat-headed noggins can’t be blamed for making the connection: the spike in plagiocephaly has largely coincided with the “Back to Sleep” campaign, launched in 1992 to lower infants’ risk of sudden death.
The most recent statistics find that 13% of healthy babies now have flattened skulls — it’s to the point that doctors are paying attention. But flat heads, while not desirable, are certainly better than the alternative, as neurosurgeon Joseph Piatt, who was chairman of the American Academy of Pediatrics’ (AAP) section on neurological surgery when its policy statement on plagiocephaly was drafted, told Healthland earlier this year: “The AAP perspective on this is that babies with funny-shaped heads are better than dead babies, from a public-health standpoint.”
The AAP’s “Back to Sleep” campaign, which encouraged parents to put babies to bed on their backs instead of their bellies as a way to decrease cases of sudden infant death syndrome (SIDS), has in fact helped drops SIDS cases by 50%. But as babies’ heads have simultaneously become curiously flatter, they’ve sparked an industry of expensive, unwieldy correctional helmets. (Despite the coinciding of Back to Sleep and plagiocephaly, some researchers believe that the rise in flat heads is due simply to increased awareness of the condition.)
Now an updated report released Monday by the AAP advises that in most cases, these scary-sounding “positional skull deformities” can be successfully treated with physical therapy and some other tweaks — no orthotic helmets needed.
Perhaps you’ve seen the occasional infant wearing such headgear; it looks like a football helmet with an opening at the top for tufts of silky baby hair. Lucky tykes have parents who rely on colorful paint, stickers and a healthy dose of Mod Podge sealant to transform the sad-looking medical devices into childhood murals (when my son was a baby, I spent hours creating an underwater scene and a safari theme on his two helmets. If this was something he had to wear 23 hours a day, I wanted it to look cute.)
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A lot has changed since my son was born in 2002. Experts now know that positional plagiocephaly can originate in utero, from growth restriction; at birth, particularly with a forceps or vacuum delivery; or in infancy if a baby spends too much time flat on his back. Most babies turn their heads often enough that no one spot flattens, but my son favored his right side to the extent that by the time he was four months, that segment of his head was nearly linear.
To compensate, we were advised to manually rotate his position in the crib, putting his head at one end for nap and the other for sleep to encourage him to turn his neck to see toward the interior of the room. Anyone who thinks handedness can’t evolve is wrong: my husband and I both re-learned how to change a diaper after we were instructed to put our son on the changing table in the opposite direction so that it forced him to turn his head to the left in order to see us. Parents can also manipulate a baby’s head from side to side, recommends James Laughlin, lead author of the AAP policy and a pediatrician in Bloomington, Ind. Speaking from personal experience, though, baby may not be too happy about that.
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Yet it turns out that these steps, plus at least an hour a day of “tummy time” — supervised time when baby is placed awake on his tummy to strengthen his neck and shoulders — are all most babies need in order to self-correct. “Most of these kids don’t need invasive intervention,” says Laughlin. “Helmets can be uncomfortable and expensive, and studies that have looked at kids after age 3 haven’t shown a persistent molding effect that’s cosmetically noticeable.”
That said, the AAP advises that more severe cases can benefit from an orthotic helmet; if repositioning doesn’t make a difference by six months, the group recommends seeking a specialist’s opinion. My son got his first helmet at 6 months old. Our pediatrician was skeptical; so were we, yet we also reasoned that the helmet couldn’t hurt — and it just might help reshape a skull so flattened on the right side that I worried how my son’s brain could grow normally.
The helmet did appear to help — even the doctor acknowledged that — although it’s impossible to know how much my son’s skull bones would have rearranged themselves on their own. At 9 years old, his head remains flat, although thanks to a generous dusting of sandy-brown hair, it’s likely unnoticeable to anyone other than his parents.
Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME‘s Facebook page and on Twitter at @TIME.