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Home › Articles › Babies › Heads Up!

Heads Up!

Infant Sleep Positions and Positional Molding

By Mindy Hudon, M.S.,CCC-SLP

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I'll never forget the day my husband was holding one of our 4-month-old twins and said, "His head is crooked!" I frantically ran over, looked down at the top of my beautiful baby's head and noticed that his ears were displaced and the right side of his head was flat! I immediately ran over to his twin brother for comparison and realized that his head seemed crooked, too!

We immediately took our twins to their pediatrician, who said that they both had positional molding. Positional molding is a skull deformity caused by the weight of the brain on an infant's soft skull, creating flat spots on the head. It occurs when infants lie on their backs in one position for too long.

SIDS and Positional Molding
"Positional molding occurs very early, usually the first several weeks," says Mimi Nurre Miller, R.N., pediatric neurosurgical nurse clinician at the Children's Hospital Medical Center of Cincinnati. "An infant's skull is soft and pliable to be able to pass through the birth canal." Miller adds that premature infants are at greater risk for positional molding because their heads do not have the same rigidity as older infants.

In 1993, the American Academy of Pediatrics recommended that infants should be put on their backs while they're sleeping to help prevent sudden infant death syndrome (SIDS). Many babies have been saved from SIDS because parents have followed this recommendation. However, the incidence of positional molding has increased. "Since 1993 to 1994, the diagnoses of positional molding has gone from a handful a year to a handful a week!" says Miller.

Our pediatrician recommended that we start rotating our twins' sleep positions from side to back every time we put our babies down. She suggested using a wedged-shaped foam pillow to help position them on their sides. "When positional molding is identified early, at less than 3 months of age, repositioning can stop the process and reverse the appearance of flattening," says Miller. "Changing your baby's sleep position each time you put your baby down for a nap is the most important step you can take in preventing deformity."


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