The development of a slightly misshapen head and face is quite common in babies that are born extremely preterm (i.e. less than 28 weeks gestational age). The bones of a preterm baby are still soft so when she lays against a surface the skull can be forced slightly out of shape. Most often this appears as a sort of flattening of the back or side of the head.

Preventing head flattening

To prevent head flattening, you should reposition your baby’s head. Discuss how often this should be done with your babies nurse or doctor. Research has not come to a consensus on the best frequency of repositioning.

(Hummell & Fortado, 2010a, 2010b)

Guidelines

• To prevent head flattening, you should reposition your baby’s head. Discuss how often this should be done with your babies nurse or doctor. Research has not come to a consensus on the best frequency of repositioning.
• Preemie infants should be placed on their stomach frequently when awake and supervised. “Tummy time” can be on a flat surface, on parent’s chest, or over the parent’s leg with one knee raised to elevate the baby’s head. When this is safe and appropriate will depend on your baby’s medical status, check with your nurse or paediatrician as to when this is safe.
• When safe to do so, premature infants should lie, play, feed, and be carried in varying positions.
• Ask people to talk quietly when they are close to your premmie
• A number of products have been designed to help prevent flattening, although research has not, as yet, shed light on which method or product works best.
• Products: water pillows, water-beds, soft air-filled mattresses and soft donut-shaped head supports.

(Hummell & Fortado, 2010a, 2010b)

Sleeping on Preemie’s Front or back?

In the past most NICUs would care for premature babies on their back. The reason being it was easier to see how they were and to position NICU equipment such as umbilical catheters and ventilator tubes.

More recently, scientific research has suggested that preterm infants used up too much energy, and had lower levels of oxygen in their blood, when they were laid on their backs, as a result NICU staff will usually place preemies on their front instead.

Advantages to sleeping on baby's front

• Babies use less energy (premature babies have little to spare)
• Spending more time asleep
• Less fidgeting and restless movement
• Slower heart rate and more stable breathing

(Bradford, 2003)

Research: Sleeping on Preemie’s Front or back at home?

• In the NICU it is safe for your baby to sleep on their front because they are constantly monitored.
• At home it is much safer for your baby to sleep on their back.
• Many NICU’s will begin getting babies who have been happily sleeping on their fronts in hospital used to sleeping on their backs before they go home.

(Bradford, 2003)

Learn more about Good positioning in the NICU

Technical Reference List

Bradford, N. (2003). Your premature baby the first five years. Toronto: Firefly Books.
Hummell, P., & Fortado, D. (2010a). Impacting Infant Head Shapes: Educating Parents. Medscape.
Hummell, P., & Fortado, D. (2010b). Impacting Infant Head Shapes: Preventing Positional Plagiocephaly and Dolichocephaly in the NICU. Medscape