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Tag: Emsworth Chiropractic

“Flat Head Syndrome”- not just a cosmetic issue

If your child has flat head syndrome, you might be wondering what to do about it and how to help your little one. Let’s find out more about the condition and the various gentle, conservative treatment options available for your baby.

What is flat head syndrome?

flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex

Flat head syndrome is a name commonly used to refer to brachycephaly and plagiocephaly- both conditions can also be referred to as “positional skull deformity”. Plagiocephaly is where one side of the back of the head becomes flattened, which may result in the front of the head protruding on the opposite side, and the ears positioned asymmetrically. Brachycephaly is symmetric flattening of the back of the head, which can cause the ears to appear prominent and the head appear wide.

There has been a significant increase in the number of babies presenting with flat head syndrome possibly due to the introduction of the “Back to Sleep” (now known as “Safe to Sleep”) positioning recommendations aimed at reducing the risk of Sudden Infant Death Syndrome.  Since the early 1990’s parents have been advised to let babies sleep on their backs, and whilst this has been successful in reducing the number of cot deaths, it has lead to an increase in the number of babies with deformational plagiocephaly and brachycephaly.

What causes flat head syndrome?

It can happen during your pregnancy with uterine constraint (when your baby doesn’t have enough room in the womb- especially common in the case of multiple births such as twins) or as a result of birth injury from forceps or vacuum assisted delivery.  More commonly, it occurs after birth and is associated with congenital torticollis (or ‘wryneck’), abnormalities of the bones in the spine, neurological impairment (problems affecting the nervous system) or forced sleeping position.

The associated torticollis can flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticollisoccur due to strains of the sternocleidomastoid, a muscle in the
front of the neck, which can occur during difficult deliveries. This muscle trauma the baby’s head into an awkward position, thus exacerbating (or in fact causing) the skull deformity. Wryneck may also cause issues with breastfeeding, as the baby is unable to comfortably turn the head to latch properly- if your baby can’t latch to one side or can’t turn their head to one side, they may have torticollis.

Premature babies are at a higher risk of developing skull deformities as the cranial bones become harder and stronger during the last 10 weeks of pregnancy. Premies may also spend longer periods of time in neonatal ICU on a respirator to help develop their lungs, as a result their heads are maintained in a fixed position.

More commonly, babies are born with a normal head shape which gradually becomes flattened or altered as a result of the position they lie in.

What we look for when diagnosing flat head syndrome

We don’t just look for flattening at the back of the head:

  • One ear may be placed slightly further forward than the other
  • One eye may appear larger than the other
  • One cheekbone may be more pronounced than the other
  • There may be a subtle (or not-so-subtle) head tilt
  • The child or baby may have reduced neck movement and are unable to rotate their neck themselves away from the flattened side of the occiput.
  • In older children, they may have delayed motor development or have failed to achieve certain developmental milestones

Why does it matter if my baby has a flat head?

It’s not just about appearance. Most advice seems to be that once baby’s hair grows out, skull deformities will be “hardly noticeable.” There is a growing body of research which suggests that children with plagiocephaly or brachycephaly need to be monitored for developmental delays or deficits. One study states that “Infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years.” Another study found that children with plagiocephaly were more likely to require special education services in school than their non-affected siblings (34.9% vs. 6.6%, respectively). The services they required included speech therapy, occupational therapy and physical therapy.

flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticollis
Source: Wikimedia commons author Wisewiki

Whilst it is important to note that these findings do not imply that developmental plagiocephaly causes developmental problems, it may instead serve as a marker for developmental risk.

In addition, skull deformities may contribute to headaches, migraines, painful teething, jaw and dental problems. It is therefore recommended that treatment takes place as early as possible, in order to restore normal head shape.

One of the most commonly reported concerns from parents of children with flat head syndrome is their physical appearance and the possibility that he or she will be teased, embarrassed or otherwise stigmatised because of their condition. Parents often first notice the condition through the appearance of uneven bald spots on the back of their little one’s head.

Treatment options

There are numerous treatment options available, and if you are looking for gentle, non-invasive options for your little one there are several to consider. Hands-on treatment and exercises will hflat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticolliselp to alleviate the strain to the sternocleidomastoid muscle causing the torticollis and encourage normal neck movement in addition to helping to correct the skull deformation. Monitoring for neurodevelopment problems helps to ensure your baby achieves all their developmental milestones.

There is evidence to support the use of chiropractic care in managing flat head syndrome, which states “there was both a statistically and clinically significant reduction in plagiocephaly measurement for this cohort of infants after a course of chiropractic care. As this was an observational study, this cannot be interpreted as cause and effect. However, these results encourage further research, particularly an RCT to investigate the effect of chiropractic care on plagiocephaly in infants.”

Products are available which can be helpful , including pillows for the cot (most are not recommended for use when baby is unsupervised) and car seat, beanie caps, slings and wraps to help reduce the amount of time baby spends on their back.

Cranial molding headbands or helmets are what is often recommended. Helmets can be expensive, uncomfortable (they need to be worn 23 out of 24 hours in the day) and can cause excessive sweating and skin problems due to pressure or friction spots. Fortunately the designs for these are being improved to help make them more comfortable for little one.

How can I help my baby at home?

  • Tummy time is of the utmost importance. This helps develop shoulder girdle strength which is important for motor milestones such as crawling and eventually walking. In addition, it reduces the time spent lying on their back.
  • Repositioning: This is best started as early as possible and is most effective with babies under four months of age. Alternating the position your baby lies in at night can also help. Babies tend to prefer to face outward into the room, and being creatures of habit we may be tempted to always place them the same end of the crib. As such, routinely changing this is important.
  • Place cot toys and mobiles on the opposite side to the ‘flat’ side to encourage your baby to spend time on the side that is not flattened.
  • Position your little on the opposite end of the changing table when changing nappies. This helps in the same way altering their position in bed does, by encouraging them to look to the opposite side whilst being changed.
  • Ask your practitioner to show you exercises to help baby at home, such as gentle neck stretches for the sternocleidomastoid for babies with torticollis.


Bialocerkowski AE, Vladusic SL, Wei Ng C (2008) Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol 50(8):577–586

Boere-Boonekamp MM, van der Linden-Kuiper AT (2001) Positional preference: prevalence in infants and follow-up after two years. Pediatrics 107:339–343

Cabrera-Martos I, Valenza MC, Benítez-Feliponi A, Robles-Vizcaíno C, Ruiz-Extremera A, Valenza-Demet G (2013) Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program. Childs Nerv Syst 29(10):1893–1898

Cabrera-Martos et al. (2016) Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study. Child’s Nervous System 32 (11) 2211-2217.

Collett et al (2012) Neurodevelopmental implications of “deformational” plagiocephaly. J Dev Behave Pediatr. 26 (5) 379-389.

Douglas et al (2016) Chiropractic care for the cervical spine as a treatment for plagiocephaly: a prospective cohort study. Journal of Clinical Chiropractic Pediatrics. 15 (3)

Knight, Sarah J., et al. “Early neurodevelopment in infants with deformational plagiocephaly.” Journal of Craniofacial Surgery 24.4 (2013): 1225-1228.

Korpilahti, Pirjo, Pia Saarinen, and Jyri Hukki. “Deficient language acquisition in children with single suture craniosynostosis and deformational posterior plagiocephaly.” Child’s Nervous System 28.3 (2012): 419-425.

Lessard S, Gagnon I, Trottier N (2011) Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract 17(4):193–198

Miller, R.I., Clarren, S.K. (2000) Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics. 105 (2)

Persing et al (2003) Prevention and management of positional skull deformities in infants. Pediatrics. 112 (1)

Schertz, Mitchell, Luba Zuk, and Dido Green. “Long-term neurodevelopmental follow-up of children with congenital muscular torticollis.” Journal of child neurology 28.10 (2013): 1215-1221.


Cover photo source: Wikimedia commons author Gzzz

Six back pain myths- busted!

It may or may not surprise you to find out there’s a lot of misleading information about back pain out there- more specifically, about what to do when back pain strikes and how to prevent it from recurring. This has not only over-simplified how to treat back pain but also lead to some weird and wonderful rehabilitation strategies.

Let’s bust a few of these back pain misconceptions.

1. Sit-ups will help improve your spinal health

Did you know that the average sit-up causes compression of the lower back that almost exceeds the safe limits set by the National Institute for Occupational Safety and Health (the unified set of manual lifting recommendations based on the convergence of medical, scientific, and engineering points of view which helps determine safe work practices)

Physical fitness does have an impact on our spinal health, but it is more important that we are getting fit in the right way. Studies have shown that increasing abdominal strength through sit-ups causes stress on the discs in our back and compresses the lumbar spine- enough for researchers to conclude that sit-ups may cause problems in almost anyone.

2. “Lift with your knees, not your back”

Have you ever tried to do this? Ever tried to do it all day long? It’s almost impossible to do this every single time we go to lift something. Forget the old squat technique, instead, the way you lift should depend on what you’re lifting, where you’re moving it to, your own build, how many items you have to lift and so on.

For more information on how to lift correctly (and give your knees a break) click here.

3. Strong muscles, strong back

Feet back pain chiropractic chiropractor osteopath physiotherapy massage back pain neck pain treatment injury recovery Hampshire Emsworth Chichester SussexNot so, my friends. Muscle strength doesn’t help us predict who will or won’t get back problems, and focusing too much on strength instead of stability will be sure to cause problems. Instead, focus on muscular endurance (i.e. how long your muscles can sustain an activity for). Remember, muscles have three main properties: flexibility, strength and endurance. Any issues that results in a lack of flexibility, strength or endurance will be enough to stimulate the nerves within your muscles and start telling your brain that something’s wrong. What’s the end result of that? Pain.

4. Tight hamstrings and unequal leg lengths cause back problems.

These types of issues are often given as easy diagnoses to simplify the cause of a patients’ complaint. Don’t be fooled. Some studies have shown that in athletes with ‘tight’ hamstrings, these muscles function almost like springs, to help jump higher or run faster. It rather appears that tight hamstrings aren’t the issue, it’s how well these tight hamstrings can cope with stretching that determines whether or not you’ll have back pain. Studies have found that people with chronic back pain tend to use their hamstrings instead of their gluteal muscles to extend the hip, which can increase the amount of force on the spine during squatting- correcting this is going to be a fundamental aspect of care.

Interestingly, back pain also wasn’t found to be definitively linked with leg length discrepancies even in cases where the difference in length was 5cm!

5. Scoliosis= A lifetime of back issues?back pain neck chiropractic scoliosis myth chiropractic chiropractor spine health acorn health emsworth chichester hampshire treatment therapy portsmouth southampton

Not true! We see so many adults who were abruptly diagnosed with a ‘scoliosis’ after being
asked to bend forwards and touch their toes by the school nurse back in the 1970’s.  The difficulty with this is that
the tests for assessing scoliosis have a false positive rate of at least 60%, and the statistical risk of having a scoliosis that requires treatment is only 0.2%.  Why are we telling you this? Because once we’re told we have a “condition” it becomes ingrained in us. Part of who we are. So time and time again we see adults who tell us they have a “scoliosis”, and have been plagued by a lifetime of avoiding activities because of their diagnosis, when mild scoliosis (less than 30 degrees deviation) may simply be monitored and treated with exercise.

6. Knees to chest- the ultimate back stretch

Sure, it feels good, lying on the floor pulling your knees into your chest. Depending on your diagnosis, it might even be the right exercise for you, but if you’re one of the many patients I see who doesn’t cope well with forward bending, this exercise isn’t ideal. Why? Because pulling the knees to the chest gives you the perception of relief from your lower back pain (because the stretch receptors in your erector spinae muscles are stimulated) but this type of exercises causes more cumulative damage to the discs, leading to increased pain and stiffness the next day. As practitioners, we know to eliminate these type of exercises and prescribe ones appropriate for your needs- in fact this bespoke rehabilitation plan is one of the main benefits of coming to see a chiropractor.


So where do we go from here?

As you can see, misleading information and advice regarding back pain can lead to us performing the very movements that worsen our back pain in our attempts to get it better. Ensuring you have an accurate diagnosis, treatment plan and rehabilitation strategy is vital to recovery.No treatment plan can be truly successful without incorporating spinal rehabilitation exercises that work to remove the faulty movement patterns that cause back pain problems.  We have to work with our clients to ensure that we incorporate exercises that help you build the capacity of the muscles in your back to cope with the tasks you ask of it each day. As you can imagine, each persons’ day is different, and so your treatment plan will be too.