Repositioning techniques

Health visitors and GPs in the UK are not uniformly experienced with, or knowledgeable about, positional plagiocephaly and will often tell parents that the head shape will round out on its own as the child grows and as it spends less time on its back, or that future hair growth will cover it. They often, therefore, advise non-intervention. While mild cases often improve spontaneously over time, in severe cases, most parents prefer to undertake some kind of active treatment. 
 
Repositioning techniques are best used when a baby is under six months old. After six months, it is much harder to control the side that the baby sleeps on, so repositioning cannot be as effective. Repositioning is simply the concept of ensuring that the baby does not rest on the flat spot. By removing the external pressure, the flat area will “round out” as the head grows. 
 
Repositioning is a very effective method of treating plagiocephaly. It is estimated to take longer than using a helmet, but if started early enough, in the first weeks of life, may take only a few weeks or months. Certainly, repositioning techniques should be practised as standard by parents to AVOID plagiocephaly in the first place. 
 
Before trying repositioning, it is important that the baby be checked for torticollis. If the baby has torticollis, physiotherapy should be pursued to stretch the neck muscles and ultimately resolve the condition; just ask your GP for a referral to a paediatric physiotherapist, or check your private medical insurance, as this will often cover physiotherapy in infants. 
 
Employing the following repositioning tips will help to encourage a baby’s head to grow more symmetrically:


Sleeping

• Babies should always be placed on their backs to sleep, to avoid cot death.
• From birth, position the head two nights to the right, two nights to the left, then two nights to the centre.
• Try changing the baby’s position by alternating the end of the cot that his head is placed each night.
• Change the position of the light in the room so that it is on the side that the baby tends to turn away from.  Even young babies will turn towards the light source.
• If the baby sucks a thumb, try covering the one that he prefers, to encourage turning to the other side.
• Reposition the baby’s head away from the flattened side after he has gone to sleep. It is best to do this when the baby is in a deep sleep as he will be less likely to move it back again.
• Sleepcurve mattresses have been recommended by many parents.

Play Time

• Back to Sleep, Tummy Time to Play. When awake and supervised, place the baby on his tummy to play. If the baby is not used to being on his tummy, he will probably not like it at first. Gradually increase the length of time spent on the front and he should soon learn to enjoy it very quickly.  Get down to his eye level and play peek-a-boo, or choose stimulating toys that will keep his attention when he is on his tummy As well as taking pressure off the flattened area, babies who spend time on their tummies exercise their neck, back and shoulder muscles and their hips ready for crawling.
• If he is old enough, use a prop-up cushion or breastfeeding cushion to sit your baby upright.
  

Feeding

• Alternate the side that you hold your baby when feeding.
• When feeding, encourage your baby to turn his head away from the flattened area.

Travel

• Reduce the amount of time that your baby spends with the back of his head on a firm flat surface, for example, when in car seats, baby walkers, buggies, etc.
• When in a car seat, use a rolled towel or soft foam pad to move the baby’s head away from the flattened side, or use a neck support to completely keep the head from touching the car seat.
• Use slings and front carriers or hold the baby in your arms.

Other

• Many people have recommended Bumbo seats for when the baby is old enough for them.
• Use a sling or baby carrier during the day, rather than leaving your baby on his back or in a bouncy chair
• If you do use a bouncy chair or a swing, use a neck support to keep the head away from the seat.
• Goi Goi Baby Pillows have been recommended for use when the baby is awake and supervised, for example, at nappy changes.

See the Repo products page for specific products that can help you with repositioning.