Why Your Baby Doesn't Need a Head-Shaping Pillow

    Manufacturers claim these devices alleviate flat-head syndrome in infants. But they are unnecessary—and even dangerous.

    Baby sleeping on back in crib holding feet Photo: Getty Images

    Topping the list of rules for new parents is that you should always put babies to sleep on their back, on a firm, flat surface, free of soft bedding, pillows, or padding.

    That advice saves lives: Since the American Academy of Pediatrics launched its campaign promoting back sleeping for infants in 1994, the rate of sudden infant death syndrome in the U.S. has been cut by 50 percent. 

    But this safety recommendation can have an effect that some parents find disconcerting: When babies spend a lot of time on their backs, they can develop a flat spot on the back of their head, a problem called flat-head syndrome, technically known as plagiocephaly.

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    To address that concern, many companies now sell “head-shaping pillows” that are meant to prevent or alleviate it.

    But these devices—essentially a small pillow with an indent or a hole in the center (shown below)—are unnecessary and even dangerous, says Ben Hoffman, MD, chairman of the AAP Council on Injury, Violence, and Poison Prevention. “Infant head-shaping pillows run counter to what we recommend at the AAP, which is that babies should sleep on their backs without any soft bedding. These products pose the same suffocation risk to your sleeping baby as does any other soft bedding, such as padded crib bumpers and blankets,” he says.

    Is Flat-Head Syndrome a Problem?

    It’s true that the more time babies spend in one position on their backs, the more likely they are to develop a flat spot. That’s because the bones of a newborn’s skull are not yet fused together, says Elias B. Rizk, MD, chief of pediatric neurosurgery at Penn State College of Medicine in Hershey, Pa., so they are more malleable than the skulls of older children or adults. 

    But Rizk says most plagiocephaly is benign and temporary, and doesn’t lead to any long-term developmental problems, contrary to what some parents may fear. As babies get older, “they’re mobilizing more and sleeping less, so they have less pressure on their backside, and [flat-head syndrome] tends to improve with time,” he says.

    In addition, slight head deformities that do persist tend to become less noticeable as children get bigger, Rizk says. The skin around their skull bones thickens, their hair grows in, and they get taller, which makes their head appear proportionally smaller. All these changes cause any flat spots to appear much less pronounced.

    Generic head shaping baby pillow
    Pediatricians do not recommend infant head-shaping pillows, which increase the risk of suffocation.

    Illustration: Brown Bird Design Illustration: Brown Bird Design

    Still Concerned? Try These Strategies.

    If you’re concerned, talk with your pediatrician, who may suggest one or more of these strategies.

    • Give your baby plenty of supervised tummy time so that she is not always lying flat on her back even when she’s awake.
    • Lay your baby down in different spots in the crib from week to week so she’s not always facing in the same direction and pressing on the same spot on the back of her head.
    • If you have a mobile hanging in the crib, move it around periodically so that your baby is enticed to turn in a new direction to see it.
    • Regularly switch where you stand when changing your baby’s diaper so that he won’t have to turn to only one side in order to look at you.
    • Alternate how you hold your baby during feedings so that her head is not always pressed flat in the same position.
    • Limit the amount of time your baby spends in car seats, bouncers, swings, and other carriers, which can constrain head movement and put pressure on the same spots on the head as lying flat.
    • Ask your pediatrician about gentle neck stretches for your baby. Often plagiocephaly is linked to neck stiffness, a condition called torticollis. The more your baby looks in one direction, the more the neck muscles contract on that side. So stretching out your infant’s neck muscles can encourage greater head movement, providing the opportunity for growth and expansion in the flat areas of the head.

    What About Head-Shaping Helmets?

    If a mild to severe flat spot remains even after trying these steps for four to eight weeks, some doctors may prescribe a head-shaping helmet for your baby to wear before the skull bones fully fuse. Typically prescribed when a baby is around 6 months old, the helmet allows growth in the flat area of the head while inhibiting it in other spots.

    Going this route is a task for families, Risk says. “The child has to visit with an orthotic specialist maybe once per week to adjust for the rapid head growth during that time period,” Rizk says, and babies “have to wear the helmet 23 hours per day for several months sometimes.”

    It can be a big expense, too. Rizk says that the helmets can cost several thousand dollars and that many insurers don’t cover them. 

    While some manufacturers sell helmets online or in stores directly to consumers, Rizk discourages buying one of those. “Every skull is different, and the timing of the child’s head growth can vary, so we would not encourage getting a helmet unless it’s prescribed, custom-made, and closely followed in the office,” he says.

    Another caveat: It’s unclear whether even the best custom-made helmets are any better than simply doing nothing. “If you look five years out at children who used helmets vs. no helmets, in mild to moderate cases there’s not much of a difference between these two groups,” Rizk says. 

    And if you think your grandma had the answer when she advised regularly rubbing the baby’s head to round out the skull, think again. Though it certainly won’t harm a baby to be gently caressed, Rizk says, “I don’t see any science behind rubbing on the outside of the head. It is not really going to affect the way the skull will shape or grow.”

    Rachel Rabkin Peachman

    I'm a science journalist turned investigative reporter on CR's Special Projects team. My job is to shed light on issues affecting people's health, safety, and well-being. I've dug deep into problems such as dangerous doctors, deadly children's products, and contamination in our food supply. Got a tip? Follow me on Twitter (@RachelPeachman).