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MONDAY, July 7, 2003 (HealthDayNews) -- The success of the "Back to Sleep" campaign to combat Sudden Infant Death Syndrome seems to have led to an increase in a lesser problem: infants with flattened heads.
The American Academy of Pediatrics launched the campaign encouraging parents to place children on their backs to sleep in 1992. In the ensuing decade, Sudden Infant Death Syndrome (SIDS) rates plummeted more than 40 percent, while infant skull deformities rose. One medical center observed a more than sixfold increase between 1992 and 1994.
There's no question that small babies should be placed to sleep on their backs.
"In no way do we want to recommend changing that," says Dr. Jack Swanson, a pediatrician in Ames, Iowa, and past chairman of the committee on practice and ambulatory medicine for the American Academy of Pediatrics. The question is what can parents do to prevent a flattened head?
The July issue of Pediatrics includes a clinical report with recommendations on the matter.
"The key thing is putting babies on their back in order to reduce SIDS. But in order to reduce the likelihood of having a skull deformity related to persistent head position on the back, you just have to turn the head from the right to left side on alternate nights," says Dr. John Persing, co-author of the report and professor and chief of plastic surgery at Yale University School of Medicine.
For prevention, the report recommends alternating the baby's head position from right to left each night -- while the baby is on his or her back.
"Probably the most important thing is alternating the side they sleep on," Swanson says. "Put the babies down with their head turned to one side one time and the next time to the other side, so that they get about equal amount of time on both sides of the head."
Babies should also get a certain amount of "tummy time" or time spent on their stomachs while they are awake and supervised.
"We've been talking about tummy time for quite some time. We have always encouraged parents to do that as long as it's supervised and the baby is not sleeping," says Dr. Adam Aponte, chairman of the departments of pediatrics and ambulatory care at North General Hospital in New York City. "This also develops other things like arm strength and the ability to move the head a little more."
Parents can also change the position of the crib so the baby has to turn his or her head away from the flattened side to see people or activity. "If the baby wants to look at the room they have to lie on the rounded side and if they lie on the flat side they will look at the wall, which is less interesting," Swanson says.
The infant should also spend as little time as possible in car seats when out of the car or other seating that requires the head to be leaned back.
These measures need only be followed for two or three months, the recommendations state. "It's those first couple of months of life," Aponte says. "Once the baby learns how to roll over, you can't control it."
In severe cases, skull-molding helmets or even surgery may be an option, although this is rarely necessary.
Most of the time, things work themselves out.
"The head grows tremendously in the first year because the brain is growing," Aponte says. "As a result of that growth, we have found that we didn't really have to do much more except recommending tummy time. We have not ever had to recommend a child to a head specialist because the head molding got that severe. We have never recommended any type of equipment and we certainly discourage parents from trying to mold the head themselves."
The "Back to Sleep" campaign has spawned another unanticipated result, Aponte says. Children seem to be bypassing the crawling stage.
"Babies who have been put on their back to sleep don't like to be on their tummy a lot," he notes. "When they're put on their stomach, they get annoyed and frustrated, so much so that we have a lot of children going from sitting to walking and don't crawl."
This is more of a curiosity than a problem and as long as the child is meeting other developmental milestones, such as bearing weight on their legs and sitting by a certain age, there's no need to worry. "These kids turn out to be just fine," Aponte says.
More information
The National Institute of Child Health and Human Development has more on the "Back to Sleep" campaign. The Nemours Foundation has more on flattened heads.
