Before Use
What causes flat head in babies?
The brain of a young baby grows extremely rapidly. It is this brain growth which drives skull expansion, meaning head growth is very fast, particularly during the first 4 months of life. Babies spend a lot of time sleeping, and the safest position for a baby to sleep is on their back, as this significantly reduces the risk of SIDS (cot death). However, if a baby maintains one preferred head position for the majority of the time they are lying on a flat mattress, the area of the head in constant contact with the mattress is discouraged from growing. Growth will occur preferentially in areas of least resistance, meaning that the area in contact with the mattress will become flattened, and a disproportionate degree of growth will occur elsewhere on the head – the volume of the brain remains normal. The most common reason a baby maintains a preferred head position is torticollis – these babies will turn their head to a preferred side and will develop plagiocephaly. In some babies, bilateral, symmetrical cervical tightness is present, causing the baby to prefer a central head position and develop brachycephaly.
Flat head in babies is not caused by neglect, a lack of being held, or excessive use of swings, bouncers or car seats. It is not the fault of the parents and does not signify any failings on their part. It is also not inherited.
What is positional plagiocephaly?
Plagiocephaly is the scientific term for an asymmetrical head. It comes from the Greek plagios (meaning slanted or oblique) and kephale (meaning head). The term “plagiocephaly” describes the shape of the head and not the aetiology. Therefore when the shape is a result of asymmetrical growth through positioning (as a result of torticollis causing a head turning preference) the more accurate term would be positional plagiocephaly, or acquired plagiocephaly. This distinguishes it from the condition caused by craniosynostosis (premature fusion of one or more cranial sutures).
What is brachycephaly?
Brachycephaly is the scientific term for a head which is wider, or shorter than average. It comes from the Greek brakhus (meaning short), and kephale (meaning head). The flattening is symmetrical across the occiput (back of the head) and there is usually associated biparietal widening. The posterior vertex of the head may also be higher than the front – a feature termed turricephaly. Deformational brachycephaly is a result of a baby persistently maintaining a central head position while sleeping on a flat surface during the period of rapid head growth (months 1 – 4). It is common for some degree of asymmetry to also be present with brachycephaly – this is termed asymmetrical brachycephaly.
What is scaphocephaly?
Scaphocephaly is the scientific term for a head which is long and narrow. It comes from the Greek skaphe (meaning boat), and kephale (meaning head). The term “dolicocephaly” is sometimes also used (from the Greek word meaning long). Positional scaphocephaly arises when a baby sleeps exclusively on the sides of the head and is common in premature babies or those who have spent time in the NICU. It is important to distinguish positional scaphocephaly from that caused by fusion of the sagittal suture (sagittal craniosynostosis).
Can flat head be prevented?
The risk factors that cause head flattening are almost entirely unpreventable. The foremost of these is torticollis; there is no way to prevent your baby being born with torticollis. Swift recognition of the issue and implementation of physiotherapy will hasten the resolution of tightness, allowing the baby to turn and therefore sleep, both ways equally.
However during this time, while head growth is so rapid, the risk of flattening developing is extremely high. A head which lies frequently on a standard, flat (non-contoured) surface, is likely to flatten in the area of prolonged contact.
Other risk factors include prematurity, developmental delay, multiple gestation pregnancy (twins or triplets), first born babies, male babies, breech
positioning and assisted delivery. Clearly, none of these risk factors can be planned for, or prevented. The key is to manage the time during which the baby exhibits a strong head positional preference. The most effective way to do this, is to alter the surface on which the baby’s head rests while sleeping. If the head rests on a firm, anatomically-correct surface, flattening cannot
develop.
Source: Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part I: terminology, diagnosis, and etiopathogenesis. Rogers, G.F. Craniofac Surg. 2011 Jan;22(1):9-16.
How does The Perfect Noggin work?
The Perfect Noggin is a sleep surface, designed for all sleep in babies who cannot yet roll from their back to their belly. The head cup of the Perfect Noggin is the “ideal” anatomical shape – symmetrical, and with a Cephalic Index (CI) of 0.8-0.85 (which encompasses the average population CI of 0.835). Any head which does not meet these dimensions (i.e. is asymmetrical (plagiocephaly) or has a higher CI (brachycephaly) or significantly lower CI (scaphocephaly)) will grow into this mould through continued use. Regardless of head position, when in the Perfect Noggin, a void will exist between any flat areas of the skull, and the curved head cup. The removal of pressure from the flattened area results in preferential growth there, and temporarily discourages growth at sites of contact between the head cup and the skull.
What are the alternatives to a head-shaping pillow?
Head shaping pillows are cheap and commonly available, including in many high street shops and are often marketed as a solution to prevent or treat plagiocephaly. In reality, they do not correct or prevent any form of positional head flattening (plagiocephaly or brachycephaly) and actually present a suffocation risk to your baby. A pillow is soft and can be squashed or compressed easily – when a head lies on it, it simply conforms to the shape of that head. A pillow is not head-shaped and is not firm, so there is no way for it to redirect growth or remove pressure from a flattened area. Pillows create neck flexion, pushing the chin into the baby’s chest, thereby closing the airway and any loose or soft item in the cot during sleep violates
safe sleep guidelines. Besides the immediate safety risks, there is also a lack of robust, peer-reviewed clinical support for the effectiveness of head shaping pillows. Parents may rely on these products, believing they are effective, while overlooking safer, clinically validated methods for managing plagiocephaly.
Other products marketed as solutions for developing plagiocephaly include wedges and positioners, which are also unsafe for sleep. Any solution which does not address sleep (particularly overnight sleep, when you yourself must also be sleeping) is destined to fail. Weighted hats are also unsuitable for sleep (with the risks not only that your baby will overheat, but that the hat will be removed, at which point it becomes a loose, soft, suffocation risk).
Instead of an unsafe, ineffective pillow, or dangerous wedge or hat, consider the Perfect Noggin as a safe, effective, affordable head shaping solution. The Perfect Noggin in the most extensively studied and successful product of its kind.
How is it different from a head-shaping pillow?
The Perfect Noggin is not a pillow. A pillow is soft, has little to no retained form and will compress when a head is laid on it. It therefore cannot shape a head. In addition, pillows violate safe sleep guidelines as they present a suffocation risk for the baby. They also create neck flexion, closing the airway.
In contrast, the Perfect Noggin is firm and has no loose or soft components. It is shaped like the back of the head should be, and the head cup does not deform when a head is laid upon it. Many parents express initial concern over the firmness of the Perfect Noggin, without realising that firmness is not only a safety prerequisite, but that a helmet is just as firm (as well as being more expensive). Moreover, in the Perfect Noggin, the baby’s airway is fully open, with the head and body lying in neutral alignment.
When is the best time to to start using Perfect Noggin to get the best results?
1 -3 months
This is the ideal time to start because head growth is fast (and therefore change is fast) and your baby is sleeping a lot. Use the Perfect Noggin until your baby begins to roll back to belly.
4 -5 months
If your baby isn’t rolling back to belly yet, it’s not too late to start! Have a look in the Results section and you will see many excellent outcomes from babies who started at 4 months. Start using the Perfect Noggin as soon as possible and use it as frequently as you can - ideally for all sleep, including daytime naps. Once you baby begins to roll back to belly, you can continue to use the Perfect Noggin under adult supervision. Starting with the Perfect Noggin now may help you avoid helmet therapy entirely or help minimise the amount of time your baby may need to wear a helmet if that becomes necessary later.
6 months
Even if your baby is not yet rolling at 6 months, there may not be enough time to achieve much in the way of results. If your baby has plagiocephaly, you have a higher chance of achieving a noticeable change than with brachycephaly at this age. If you dislike the shape of your baby's head and a helmet is financial realistic, this may be a better choice for you. If a helmet is not within your budget, you may decide that even a little improvement justifies the cost of the Perfect Noggin.
Are there any contraindications for using the Perfect Noggin?
If your baby has any significant medical problems including severe reflux, breathing issues, cardiac problems, bone or joint abnormalities, or craniosynostosis, they should not use the Perfect Noggin.
Is the Perfect Noggin sleep safe?
The Perfect Noggin was designed to meet all Safe Sleep Guidelines. It is firm, flat, and has no loose or soft components. The Perfect Noggin is both safe and effective, providing peace of mind for parents and a comfortable, secure sleep environment for your baby.
Is The Perfect Noggin suitable for newborns?
Many people have successfully used the Perfect Noggin from birth. In general, we advise waiting until your baby is at least 6 weeks old, before starting. The first 6 weeks involves a lot of change for you, your baby and the rest of your family, and it is fine to wait a while to adjust to the new arrival before starting something new. In addition, you may wish to use this time to observe your baby for a head turning preference (torticollis).
Remember that the majority of babies do not flatten, so not every baby needs the Perfect Noggin. If you do wish to start immediately, make sure the fit remains snug – parents seem to have a greater tendency to oversize the cup in newborn babies.
What are the dimensions of the Perfect Noggin?
The Perfect Noggin measures approximately 75cm (L) x 34cm (W) x 11cm (H). It weighs approximately 2kg.
Will the Perfect Noggin fit in my cot?
The Perfect Noggin will fit easily into a standard cot. Many parents using popular models such as the Snoo and Halo have reported it fits well. We recommend measuring your Moses basket or mini-cot to ensure a proper fit before purchase.
My baby is 5 months old and not yet rolling, is it too late to start my baby on the Perfect Noggin?
If your baby is not yet rolling from back to stomach, it is not too late to start using the Perfect Noggin. We recommend purchasing it as soon as possible and using it as much as possible. If your baby starts to roll back to belly, you can continue to use it under adult supervision. Starting with the Perfect Noggin now may help you avoid helmet therapy entirely or help minimise the amount of time your baby may need to wear a helmet if that becomes necessary later.
How long does it take to ship?
We dispatch every working day. For orders within Great Britain, these are sent with Next Working Day delivery using DHL. For Northern Ireland, it is 48 hour delivery. For the EU, we aim for no more than 4 working days where possible. Delays to EU deliveries are usually caused by Customs so we advise you to keep an eye out for an email from the shipping agent who will inform you of the procedure for paying this.
Once your shipment is booked, you will receive a tracking number.
Can I pay any other way?
Yes, we can send PayPal invoices and accept direct bank transfers. Please email us with your specific request and we will do our best to work with you on a solution.
During Use
How soon will I see results?
This depends on many factors including the age of your baby, the type and degree of flattening, and how many hours your baby spends in it per day. Change is generally visible within 4-6 weeks of consistent overnight use.
How many hours per day does my baby need to sleep on the Perfect Noggin?
Your baby should take all sleep in the Perfect Noggin - overnight and all day time naps. At a minimum it should be used for overnight sleep. The more you time they spend in it, the better and faster the results will be!
Will my baby adjust to a new sleep surface?
Some babies need a couple of days, or even as long as a week to get used to sleeping on the Perfect Noggin. A few will require up to two weeks. Most parents tell us that following a few days of adjustment, their baby loves sleeping on the Perfect Noggin and now sleeps better than before!
Should I reposition my baby’s head while in the Perfect Noggin?
A baby with torticollis will prefer to turn their head to the favoured side while sleeping. This is the most comfortable way for that baby to sleep, and attempting to encourage them to lie on the non-favoured side is likely to result either in the baby waking, or in them simply turning their head back again. When sleeping in the Perfect Noggin, it does not matter which way your baby choses to turn his head. You should let him sleep comfortably, with his head turned however he chooses. The fully contoured cup has no flat surfaces, meaning it does not matter which way the head is turned while in the Perfect Noggin.
It is important to note that a baby with torticollis requires physiotherapy. This should be addressed during waking hours, using the stretches and exercises your physiotherapist instructed you to perform. During night time hours, the priority for both you and your baby should be sleep – and with your baby in the Perfect Noggin, you can sleep without worrying about constant, futile attempts to reposition their head.
How do I know if my baby is on the right layer?
Use the measuring tape provided to give you a guide as to which layer to start with. Place your baby in the chosen layer (ensuring larger layers remain underneath) and make sure there are only a few millimeters of space on either side of their ears. If there is too much room, try the next smaller layer. The fit should be snug, but not tight, similar to how a shoe fits your foot. If your baby's head is touching both sides of the foam head cup, it is time for the next larger layer.
Remember: the tape is a guide. Final fitting should always be done by eye. If you are still confused, please reach out to Customer Services who will help you.
There is space in the head cup above my baby's head. Is this normal? Should I move my baby up?
The space at the top of the head cup above your baby's head is there by design. Do not move your baby up to fill the gap. Place your baby at the bottom of the head cup and ignore any space above his head.
Can I swaddle my baby for sleep in the Perfect Noggin? Do I have to swaddle him?
If your baby is still of an age and developmental stage whereby swaddling is appropriate, you can swaddle her to sleep in the Perfect Noggin. It is not necessary to swaddle your baby however. Your baby can sleep on the Perfect Noggin in a sleeping bag or temperature appropriate nightwear.
My baby slidies down the Perfect Noggin, out of the head cup - what do you recommend?
Some babies can wiggle, scoot, or kick out of position. This problem can usually be solved by adding a “speed bump”, which can be made by rolling a small face towel in the long direction (like a cigar) and placing it underneath the fitted cotton cover just below the baby's bottom. Remember not to use a speed bump to wedge your baby too high in the head cup - he should be at the bottom of the head cup with open space above his head.
My baby’s head sweats a lot while sleeping on the Perfect Noggin, what do you recommend?
My baby has developed a bald spot at the back of their head since they have been sleeping on the Perfect Noggin, is this normal?
This is a temporary issue that can also occur outside of the Perfect Noggin and is completely normal. The hair follicles remain healthy, and the hair will regrow. If it is a significant concern, you can place the Perfect Noggin inside a pillowcase to reduce any shear forces.
My baby can roll back to stomach; should I stop using the Perfect Noggin?
Once your baby can roll from back to belly, you can still use the Perfect Noggin under adult supervision if you desire a little more improvement. The goal is to reach this point with a head shape you are happy with. Beyond this point, your baby's age and mobility make further flattening extremely unlikely, unless severe torticollis is still present.
How long should my baby use the Perfect Noggin? Should we stop once his head has rounded out?
Your baby should stop using the Perfect Noggin when torticollis (if present) is fully resolved, they are older than 4 months, and you are satisfied with their head shape. Alternatively, you can continue using it until they start rolling from back to belly. At that point, you can decide whether to continue with supervised use, transition to a helmet, or stop using it altogether.
When should I switch to the next layer?
Measure your baby’s head weekly using the supplied measuring tape. If the fit starts to feel tight or your baby’s head touches both sides of the current layer, it’s time to move to the next size to ensure comfort and continued shaping progress. The tape measure should be considered a guide, giving you a starting point to check the fit and make final adjustments by eye.
Can I purchase additional or replacement layers?
If you have purchased a standard 2.0 and subsequently discovered you require layers A and B, please contact Customer Services as these can usually be ordered separately.
If you mislay or damage a layer and require a replacement, please contact Customer Services. We usually have some replacement layers in stock, but we cannot guarantee to have the layer you need. Please remember that all larger layers must be kept underneath the layer you are using. For example, if using layer 2, layers 3 and 4 must be nested beneath layer 2. You cannot omit a lost or damaged layer from the stack.
How do I clean the Perfect Noggin?
Base & Foam Layers: Wipe gently with a diluted baby wash solution and water as needed.
Cotton Cover: Machine wash in cold water and air-dry.
After Use
We’ve decided to stop using the Perfect Noggin. What else we can do to keep improving our baby’s head shape?
The good news is that by using the Perfect Noggin, you’ve likely already made meaningful progress.
If your baby has plagiocephaly, it may be that the Cranial Vault Asymmetry (CVA - the difference in diagonal measurements of the head) does not change further. However, a difference of (for example) 12mm, while noticeable on the head of a young baby, is almost completely unnoticeable on the head of an adult. The mean CVA in the population is 4mm and the normal range 0-8mm. If you are within this range, you can consider the job done, as with time and growth, the residual asymmetry will become unnoticeable. If you wish to further reduce the CVA, this would require helmet therapy.
If your baby has brachycephaly, a degree of improvement will occur with time and growth. Numerous studies demonstrate a reduction in the Cephalic Index (width to length ratio) of 4% or more with growth alone. This occurs slowly over the course of the first few years of life. If you are close to a shape you consider acceptable, you can simply choose to let growth complete the job. If not, you may choose to persue helmet therapy if this is within your budget.
What are the alternatives to helmet therapy?
Once a baby can roll back to belly (a milestone most babies achieve by 6 months of age) the only effective solution to correct head flattening is a properly fitted cranial orthotic helmet. Unfortunately, the cost of these (£2500-£2800 plus travel costs) is almost always borne by the parents, and is never paid for by private healthcare insurance in the UK.
Helmet therapy is extremely effective, and most babies adjust quickly to wearing the helmet for 23 hours a day.
For a baby over 6 months old, there are no effective alternatives to helmet therapy if you wish to actively alter the shape of your baby’s head. However, positional head flattening is purely cosmetic and therefore helmet treatment is a choice based on aesthetics. There is no truth to any claim regarding issues with hats, safety or sports helmets, glasses, ear
phones, bullying or self-esteem in a child with uncorrected head flattening. Most adults with deformational cranial flattening are unaware and perceive no
negative repercussions on their lives. Many famous actors, sports people, politicians and others in the public eye have some degree of head flattening. With time, all flattening becomes less obvious and not helmeting your child is a valid choice.
How do I store away the Perfect Noggin for my next baby?
Once you’ve finished using the Perfect Noggin, follow these steps to store it correctly:
- Wipe down the foam layers and base with a soft cloth and water, then ensure everything is completely dry.
- Restack the layers in numerical order on the plastic base.
- Replace the product into the original box to keep it dust-free.
- Store it in a cool, dry place away from direct sunlight to maintain the foam’s shape and integrity.
Avoid storing the Perfect Noggin in warm environments, such as outdoor sheds, or next to hot water pipes. While the foam is designed to hold its contour well, prolonged exposure to heat or natural ageing can cause it to flatten over time.
With proper storage, your Perfect Noggin will remain in great condition and be ready for the next baby.
What if I have more Questions?
We would love to chat about your baby’s head! Please drop us an email (sales@contourimports.co.uk)
give us a call, or head over to the Noggin Doctor’s Plagiocephaly & Torticollis Parent Discussion Board on Facebook.