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A toddler stands next to a young mother as she puts a fresh diaper on her newborn baby. “Too bad you had to get a bald-headed one,” says the toddler. And just like that Johnson & Johnson had a hit commercial on its hands and pop culture had another buzz line.

While bald-headed babies are still common today, it is the growing number of flat-headed babies that is causing a stir. Flat heads may indeed be used to describe this generation of babes, but results from a recent study suggest that more than appearances are at stake.

Researchers in Washington State reported that babies with flat areas on their heads scored lower on cognitive and motor development tests than infants with normal-shaped heads.

Method
A total of 472 babies ranging in age from 4-12 months participated in the study. One-half of the babies had been diagnosed with flat head syndrome, the other half were considered normal. In addition to taking three-dimensional photographs of each infant’s head, researchers measured cognitive and motor development using the Bayley Scales of Infant Development III (BSID-III), which are tests designed to measure language, problem-solving, memory, and motor skills.

Results
After controlling for age, gender, and socioeconomic status, infants with normal-shaped heads scored higher on all of the BSID-III scales compared to those with flat heads. To determine whether the differences persist into childhood, infants who participated in the study will be reevaluated at 18 and 36 months of age. Although these preliminary results clearly show an association between flat heads and developmental delay, there is no evidence that having a flat head actually causes the delay. Children with flat heads may simply be at increased risk for developmental delay for reasons unknown.

Although the incidence of flat-headed babies is unclear, data shows that the number of babies diagnosed with flat head syndrome has risen, and that the rise coincides with the launch of the national Back-to-Sleep campaign, an initiative designed to protect babies from sudden infant death syndrome (SIDS).

What causes babies to have flat heads?
In order to make room for a baby’s growing brain, the head or skull of newborns is made up of soft bones that slowly join together over a period of 9-18 months. When babies spend a lot of time in one position, for example, on their back, a flat spot can form on their head, and little or no hair may grow on that spot. This condition is called plagiocephaly— a fancy word for flat head. Once babies are able to turn from back to front and front to back (around 4 months of age), developing a flat head is less of a concern. But parents should continue to place babies on their backs to sleep throughout the first year.

Bottom line
Although placing babies on their backs to sleep is the best way to reduce the risk of SIDS, if babies spend too much time on their back they can get a flat head. To keep babies from getting a flat head, parents should be encouraged to put their babies on their stomach (tummy) when awake or to carry them upright in a sling. Tummy time not only reduces the risk for a flat head, but also helps to strengthen the muscles needed for crawling and sitting. Because the risk of SIDS is greater when babies are on their tummies, parents need to watch their babies carefully during tummy time sessions. If parents need to leave their baby alone, even for a minute or two, they should place them on their back until they return.

Preterm babies (babies born early) are more likely to get flat spots on their heads because their heads are even softer than heads of full-term babies. In addition, preterm babies often spend more time on their backs without being moved or held. To prevent flat heads, parents of preterm babies should be encouraged to hold them skin-to-skin against their chest, similar to how a mother kangaroo carries her joey in her pouch.  For more on kangaroo care check out these articles on babygooroo.