Understanding the Cognitive Consequences of Flat Head and the Practical Science of Building a Better Brain
Excerpted from “The Confident Parent: A Pediatrician’s Guide to Caring for Your Little One – Without Losing Your Joy, Your Mind, or Yourself” by Jane Scott, MD, with Stephanie Land. © 2016 by Dr. Jane Scott. TarcherPerigee, an imprint of Penguin Random House LLC.
In the two decades since the adoption of Back to Sleep [a campaign launched in 1992, instructing parents to put their children to sleep on their backs to prevent the risk of SIDS], child restraint seats, and attachment parenting, this country has seen a 600 percent increase in the rates of flat head syndrome. (The incidence has risen sharply in scattered areas around the world that have adopted the busy Western lifestyle and can afford the comforts of modern life; a Canadian study found that almost 50 percent of infants aged seven to twelve weeks are affected.) Up to half of these children also suffer from torticollis, a tightening of the neck muscle that limits infants’ ability to turn their neck or move their head from side to side. Torticollis usually requires treatment with physical therapy, and severe cases of flat head syndrome sometimes require correction with a helmet. Yet contrary to many people’s belief, these conditions aren’t always a mere cosmetic problem whose effects go away after treatment. Infants with flat head syndrome are at risk for increased long term developmental delays.
In addition, it’s being documented that babies with flat head can develop problems with their vision and hearing
I have been at the forefront of the effort to eliminate this largely preventable problem, increasing the time I take with new parents to teach them how to avoid it, and I even developed the Tortle—a beanie that promotes turning a baby’s head from side to side when she’s resting on a firm surface. But the Tortle fixes only the physical symptom of the real problem, which is that our babies, whether at home or in childcare, are not being given enough freedom and time to move. In fact, my conclusion is that the developmental delays being seen in the research data have less to do with the children’s head shape than with their being restrained and their general lack of movement and exercise. The New England Journal of Medicine released statistics that showed children’s tendency toward obesity might be set by the time they are five years old; researchers hoping to turn the tide of public health may want to start looking at how a chronic lack of free movement affects children even before they can walk.
Yet even as the medical community’s awareness of this dilemma grows, parents are getting worse about limiting their children’s movement, not better. As we’ve discussed, part of the problem is that the market is saturated with products meant to instill fear. For example, I was recently informed about a harness being developed meant to secure a baby in its crib so that it could never roll over. But once babies are capable of rolling over, we’re supposed to let them. That’s how babies develop. Unfortunately, while we’ve absorbed the lessons of the Back to Sleep movement, we’ve ignored “tummy to play” and thus have taken our mandate to protect our children to such an absurd degree that, in the interest of safety, we’re causing a whole new danger.
A few years ago, a colleague sent an eight-month-old boy and his parents, young professionals in their thirties, to my clinic for evaluation because he was starting to suspect the boy was cognitively disabled. He couldn’t sit up. He couldn’t even hold his head up. And yet when I met him I didn’t believe he was cognitively disabled. His eyes were alert and followed me. He had normal muscle tone and although weak, his body wasn’t floppy. None of this was typical of an infant with a neurological problem. What he did have was a weirdly shaped head, and some developmental delay. After spending some time with the child I told the parents that I really didn’t think there was anything wrong with him other than he needed to move more and build some strength. Both parents began to cry with relief. I arranged for the baby to start therapy for motor development, and we got him fitted for a helmet to fix the shape of his head. As soon as his father knew for sure there was nothing wrong with his child, he took all of my advice and began working with the boy to make him active and build up his strength. The mother, however, took a lot longer to come around. Whenever she brought him in, I could see how uncomfortable it made her to watch me maneuver her child on the examining table. Her face would tighten every time I rolled him over or pulled him up.
As it turns out, before she brought her baby to me, she never put him down. If he wasn’t sleeping, he was in her arms. He got no stimulation and no play. “He’s just a baby!” she told me weakly when I tried to explain that he needed time on the floor, “He could get hurt.”
I showed her how I could pull her little boy into a sitting position by his arms. “See, he’s not crying. He doesn’t mind.” But she just shook her head. “I don’t feel comfortable doing that.”
Fortunately, the mother eventually came around, and her child started to move about on his own within a couple of months. I monitored the family until I moved to another state when the child was about five years old. By that time he was running around like any other little boy and even showing signs of mental precocity.
Building a Better Brain
It was only because this child started treatment for his inactivity well before he was a year old that he grew out of his induced lethargy and suffered no permanent side effects. Babies’ cognitive and motor development is directly related to their environment in infancy, especially before their first birthday. For example, when a baby’s head is severely flattened between the back and the ear on one side, the eye and the ear on that same side often move forward. When that happens, the baby starts to shift his eyes, looking first with one eye then the other; he may be unable to look at an object with both eyes together at the same time. If this continues without correction, after a year babies lose the ability to develop normal binocular vision, or the ability to use both eyes together in a coordinated fashion. A lack of normal binocular vision affects depth perception and can make it hard for the eyes to track, which can make reading difficult. Often when these children reach school age they have problems learning to read along a line, which can lead to academic struggles and even dyslexia.
The human brain sees its fastest rate of growth immediately after birth, with the head circumference increasing by ½ to 1 inch per month, until about three months of age, with the cerebellum, which controls motor function, more than doubling in volume. Flat head syndrome usually starts to show between four and eight weeks of life, so pediatricians don’t become aware of the problem until they see the infant at her two-month well-baby checkup. At that point they will usually try to help by recommending repositioning the baby’s head from side to side. The problem is that by then the infant often doesn’t want to turn the other way because it’s less comfortable. As brain growth slows down, the skull bones become firmer, and by six months old the skull is fairly firm and almost fully formed. At this point just repositioning is no longer a good treatment option, and babies with severe flat head are sometimes fitted for a helmet. Some get fitted even later. Unfortunately, it takes several months for the skull to reshape itself, and the longer the baby waits to get into the helmet, the longer it takes to fix the problem. And if you wait too long, some problems, such as binocular vision, cannot simply be corrected by reshaping the baby’s head with a helmet.
There’s a reason new mothers around the world routinely use traditional methods to ensure a round skull and build their babies’ strength, stamina, and flexibility as soon as possible. Kenyan mothers massage their babies’ heads daily to keep them beautifully round. It’s common for a grandmother to inspect the baby’s head to make sure it is perfect. Jamaican mothers use bath time to stretch and massage their babies’ limbs. Mothers in the Mithila region of India and Nepal have been known to hold their babies from their ankles and swing them gently upside down or toss them several inches into the air to instill fearlessness, which they believe promotes good health. I’m not at all advocating that we should go this far, but we have become so consumed with keeping our infants still—because in our minds, stillness equals safety—that even after introducing tummy time to counter the effects of Back to Sleep, we still have a generation of flat-headed babies.
Recently, fitness professionals and child advocates have developed and implemented programs geared toward helping school-aged children incorporate exercise into their lives. But these habits need to be developed from infancy so children have the building blocks in place to develop more strength and skills to enjoy an active life. In fact, a combination of sensory development with plenty of supervised free play is perhaps the most valuable thing you can do to encourage exceptionally strong cognitive and motor skills in your child both during infancy and later life.
We can’t change the way we put our babies to bed—all the data show that putting a baby to sleep on his back on a firm mattress in a crib cleared of all bedding except a fitted mattress sheet is the most effective way to prevent SIDS—and it would be unreasonable to instruct parents to restrain their activities and travel so that children no longer spend time in carriers and car seats. We have to find a solution that balances our need for a grown-up life and our babies’ biological needs for mobility and the freedom to experience new sensations and the great big world.