This question is one of the most frequently asked during consultations, but unfortunately, without actual photos to share, I've been slow to complete this article. Surprisingly, my third child unexpectedly appeared, and now I'm sharing about my child's head shape development.
First, let's define what an 'ideal' head shape means. Unlike previous eras where a flatter back of the head was preferred (perhaps indicating a baby who would be more obedient?), modern parents mostly hope their baby's head maintains its round shape from birth, looking better when 'bald' in the future (roughly, boys might care more?)
Below is a reference for the 'ideal' head shape, which babies typically have at birth. Viewed from the top and sides. By comparing carefully, any abnormal head shapes can also be spotted here.
Safe Sleeping Concepts
To shape the ideal head, first understand safe sleeping concepts.
From a medical perspective, when discussing newborn sleep, the most important thing is ensuring the baby's safety. Previously, for newborns, side sleeping was preferred for stability. However, the occurrence of 'Sudden Infant Death Syndrome' (SIDS) changed recommendations for newborn sleep. SIDS refers to unexplained deaths in newborns under one year, especially from birth to four months. Since the American Academy of Pediatrics (AAP) began recommending 'back sleeping' for all babies in 1992, deaths from SIDS have significantly decreased.
However, sleep-related death rates from other causes (such as suffocation, strangulation, and blockage) have risen. (For example, babies with Pierre Robin syndrome or cleft palate are not recommended for back sleeping; this will be discussed later.)
Additionally, regarding head shape abnormalities, since the AAP recommended back sleeping, due to the back of the head becoming flat, cases suspected of 'positional plagiocephaly early closure' undergoing surgery have increased (possibly due to early imaging diagnosis not being advanced.)
Below, I'll introduce safe sleeping concepts, then explain how to shape the ideal head through safe sleeping.
Safe Sleeping Environment (Data Source: American Academy of Pediatrics)
For the baby, first have a safe sleeping space, which is a separate sleeping area near the parents' bed. Babies should sleep in the parents' room until 6 months, ideally up to one year. Mainly, if issues arise, parents can more easily notice.
Babies need to be placed in a separate sleeping space, like a crib, and use a firm sleeping surface. Sheets need to be certified safe, usually not too 'soft' to prevent the baby's mouth and nose from sinking in. Cover with a size-appropriate sheet.
Do not use pillows, blankets, stuffed toys, sheepskin, etc., that do not allow air passage in the baby's sleeping area.
Ensure nothing obstructs the baby's head.
Dress the baby in sleepwear, like a onesie, do not use blankets.
Soft objects, toys, and loose bedding must be far from the baby's sleeping area.
Other safe sleeping recommendations:
- Always place the baby on a firm mattress to sleep, do not use car seats or other seated devices.
- Do not breastfeed on a sofa or while sitting on a sofa, in case you fall asleep. After breastfeeding, try to put the baby back in the crib or bassinet.
- Remove soft objects or loose bedding from the crib; cribs should not use crib bumpers. Currently, there is no evidence that crib bumpers prevent injury, but they pose risks of suffocation, strangulation, or entrapment.
- Consider using a pacifier during naps and sleep.
- Do not let the baby feel too hot during sleep; measure room temperature to ensure it's comfortable for adults. Add or remove clothing based on your feel.
- Recommend daily supervised tummy time for awake babies to help develop head, shoulder, and muscle strength. It can also reduce the chance of the baby's head becoming flat.
(Data Source: Kaiser Permanente Postpartum Care Guidelines, American Academy of Pediatrics AAP, and Centers for Disease Control CDC)
How to Shape the 'Ideal' Head?
Below are several key points based on expert recommendations and personal experiences:
- Use a firmer mattress for the baby: Babies' skulls are soft, and most babies are born with round heads. Basically, as long as the mattress isn't very soft, the baby's head naturally becomes 'side-shaped' (because the back of the head is round). How firm? Not too soft? Generally, mattresses for 1-6 month olds are regulated, usually firmer. If no mattress, on a wooden bed, the appropriate firmness is about the thickness of two towels (if using towels, need a fixed, flat sheet on top). This firmness allows the head to be side-shaped without mouth and nose blockage issues.
- Do not recommend using pillows: Babies basically do not need pillows within three months, and skulls within three months are very soft and easily deformed. Pillows' drawback is fixing the head in the same position, almost always prone. Although babies seem comfortable, due to no head movement, it's easy to cause flat back of the head. Prone has drawbacks; if just fed, prone risks choking.
- Change sleeping position every 3-4 hours after feeding: Because the baby's head tends to 'side-shape', so each time after feeding and putting back in the crib, try to switch head sides. For example, right side this time, left side next. This way, the head shape will be even. Breastfeeding is the same; alternate sides, don't let the baby always face the same side.
- Crib, change mobile position when using: Some mobiles hang on the crib rail; older babies will turn their head towards the sound, possibly causing head asymmetry over time. Also, cribs usually lean against the wall; babies usually turn towards the sound, so they might habitually face the same side leading to head asymmetry.
- Before feeding every 3-4 hours, let the baby 'tummy' a bit: Many new parents, when starting with babies, often immediately give milk when crying, thinking they'll sleep after drinking. Result is babies sleep after little drinking, but wake crying in 1-2 hours. This vicious cycle tires everyone. In fact, babies also need 'exercise'. For babies, the best 'exercise' is practicing 'crying' and 'tummy time' (these usually happen together). Tummy time has many benefits for babies, including exercising neck strength, and can prevent soft skulls from molding to the bed. Taking my third child, born underweight, as an example: after practicing 'tummy time' for a couple days, his head could turn! Originally too heavy to lift. But giving babies 'tummy time' needs someone watching closely! Never leave the baby alone, to avoid risks of suffocation if the head can't turn back.
- Slight 'side sleeping' is possible: Use rolled cloth under the baby's chest, abdomen, and back to let the baby slightly side sleep. Keep the head in a side position. But note, the head area must be 'open' carefully, watch that the baby doesn't accidentally change from 'side sleep' to 'tummy sleep'. Usually a few weeks before birth, if neck strength isn't strong enough, still start from 'back sleeping' to train the baby's neck strength.