Flat head syndrome can be disconcerting, especially for new parents, but it rarely causes any harm to your baby and usually remedies itself within a few months. They provide the skull with the flexibility needed to pass through…. Reviews September 13, 2019 August 6, 2020 Babies are little angels and they will not say what they want, as a parent … Flat spots related to pressure on the back of the head don't cause brain damage or interfere with a baby's development. This usually corrects itself within six weeks after the birth but sometimes part of the skull might become flat In most cases, flat spots usually go away when a baby starts sitting up on its own. Read on to learn more about this condition. Every baby’s head shape will keep improving naturally as … Consistently change your baby’s sleep position (one day face their head left, the other right, and so on). They are also more likely to have lengthy hospital stays where they spend much of their time lying on their backs. Congenital plagiocephaly occurs in one out of every 2,000 to 2,500 births. Because of his neck problem he always lays with his head to the left which has made the left side of his head flat and his face looks to be pushed forward on that side, with ears a bit out of line. Babies commonly suffer from positional plagiocephaly from not being given enough tummy time during waking hours, not being held upright for enough time, or spending too much time in bouncy seats, car seats and baby carriers. While it can temporarily cause a misshapen head and possible misalignment of ears and eyes, the effects are generally mild and tend to resolve as a baby ages and becomes more mobile. One common cause for flat head syndrome is regularly sleeping or lying in the same position. Keep in mind that if you spend too much time worrying about your baby's head shape, you might miss some of the fun of being a new parent. What We Know About Hair Loss and COVID-19, Here’s the Status of the COVID-19 Vaccines and When You Can Get Them. In most cases, your baby’s head shape will resolve on its own. he said it would correct itself and if it hasn't gotten any better by his 6 month appointment they will further assess it. Work up to a total of 40 to 60 minutes of tummy time per day. Aren’t the helmets uncomfortable? Surgery may also reduce the risk of complications like these: The earlier plagiocephaly is recognized and steps are taken to reduce it, the better the chances are for the condition to be resolved. All babies will have hair eventually. At this stage, we recommend making an appointment with a specialist clinician for an assessment and advice regarding further treatment. If you believe your baby may be showing signs of flat head syndrome and would like to book a no-obligation appointment with one of our experienced and friendly clinicians, get in touch and we will be happy to help. Start with a few minutes per session, and a few sessions a day. If your baby has muscular torticollis, your doctor may recommend stretching exercises to increase the range of motion of their neck. Change feeding positions. Positional plagiocephaly is more common in premature babies than full-term babies. In fact, some research suggests that close to 50% of babies have head flattening - which means if you spot some irregularity in your baby’s head shape, you’re not alone! According to the American Association of Neurological Surgeons, the optimum age of helmet therapy is 3 to 6 months. It can also run in families and is sometimes a part of inherited disorders. Positional plagiocephaly doesn’t affect brain development and, in many cases, it needs no medical intervention and resolves on its own. Wearing a helmet is also a good way to correct large malformation or flat spots on your baby’s head. Expect it to take a considerable amount of time to be completely rounded, but your doctor will ensure you stay on the right track. A mild flat spot can correct itself as the baby grows and spends less time on their back. When your baby is awake, place them on their tummy atop a blanket or mat. American Association of Neurological Surgeons. Some describe the head as looking like a parallelogram when observed from above. After noticing flat head syndrome in their baby, parents are advised to begin repositioning techniquesstraight away to increase the chances of self-correction. FEATURES: Simple and surprising strategies for preventing Plagiocephaly and rounding out baby's flat spots without a helmet, the 4 biggest Flat Head Syndrome myths debunked and the whole truth about what's causing the alarming rise in head flattening and how we can stop it. This can result in plagiocephaly. This results in an abnormally shaped head. You should still continue repositioning and tummy time though to ensure it doesn’t get worse. There are several possible causes for positional plagiocephaly: Putting your baby to sleep in the same position day after day, for example, on their back or with their head facing right or left, puts consistent pressure on the same parts of the skull. No treatment is necessary for mild cases of brachycephaly and plagiocephaly. Surgery can help relieve pressure in the skull and allow the brain to grow normally. It’s recommended to always put your baby to sleep on their back to reduce risk of sudden infant death (SIDS). Babies are most at risk of positional plagiocephaly in the first four months of life, before they have the ability to roll over by themselves. It’s something obvious that mild flat head syndrome doesn’t necessarily require to be treated. A flattened area on the side or back of the head. Bald Baby: When Will They Start Growing Hair? Ears that aren’t even. "In the majority of these cases, this will correct itself on its own, without any or only minimal intervention," says Laughlin. I am doing all i can to prevent her flat head getting worse. Providing repositioning therapy is started early enough, mild flat head syndrome can usually be corrected before the bones in the skull harden and become less receptive to repositioning. Like holding your baby, baby-wearing is a great way to keep your baby upright and … After noticing flat head syndrome in their baby, parents are advised to begin repositioning techniques straight away to increase the chances of self-correction. The problem can fix itself as the baby keeps on growing all through. If you do notice that your child’s head is becoming flat, talk to your doctor to be sure this is not a problem. They can measure your baby’s head and give you an idea as to whether the flattening is mild, moderate or severe. The helmets can cause skin irritation and may make your baby fussy or upset. It is … at his 4 month checkup the Dr said it was normal and that he didn't have the usual protruding forehead that plagio babies typically have. Does a baby’s flat head correct itself? 2. Baby’s flat head can usually correct and adjust itself within about six weeks. As the baby grows, the flathead fixes itself. The soft bones also mean that a baby’s head can change shape. In mild cases, your baby’s flat head will correct itself with repositioning techniques. If your baby is suffering from flat head syndrome (also known as brachycephaly) you may be wondering whether you should seek treatment. After most births – and the baby’s trip down the birth canal – the head might look elongated for a little while. Surgery is usually necessary in a baby with congenital plagiocephaly when sutures in the skull have prematurely closed. That can cause them to favor one side, which may lead to plagiocephaly or another skull deformity. If you are concerned about your baby and their head shape, our FAQs page is a great place to start. Surgery isn’t usually needed in cases of positional plagiocephaly. Most cases improve as the child gets older and spends more time sitting, crawling, and standing. In the majority of cases, it doesn’t affect brain development or growth. A good degree of correction can still be reached through treatment up to 14 months, but a severe condition may not fully improve if there is less time for the correction to occur. In other cases, intervention is required. These are more commonly known as soft spots. In most cases, flat spots usually go away when a baby starts sitting up on its own. Check for signs of plagiocephaly during bath time when your baby’s hair is wet and their head shape is most visible. Tummy time can also help your baby to build strength and muscles necessary for rolling over, crawling, sitting up, and, eventually, walking. Plagiocephaly is more likely the more time your baby spends on their back. A baby’s flat head, then, can be a gentle invitation for us to reconnect with our babies, to hold and cuddle them. We’ll…, A baby is born with several fontanels. But are helmets the only answer? Plagiocephaly usually fixes itself as your baby grows, but sometimes treatment is … Congenital plagiocephaly, also known as craniosynostosis, is a rare birth defect. Spending time carrying your baby, either in your arms or a carrier, instead of having them lie down for extended periods of time. But some infants’ heads continue to look flat. To help reshape a flat spot, Samuels said she tells parents to lay their baby on her back with the head facing right, on Mondays, Wednesdays and Fridays. "Because more than half of infants will improve by 6 months of age, repositioning should be attempted as initial treatment. As outlined above, you can take a “Wait and See” approach as baby flat head can correct itself over time. Any of you had this issue with LO head? Not surprisingly, more and more physicians are referring babies for helmet treatment for Flat Head Syndrome (Positional Plagiocephaly). How do babies get flat heads? Baby's whose head corrected themselves was probably becasue it was only because they laid flat for a long time, and not because they had true plagiocephaly. Your baby may cry when you put them on their tummy, but it’s important to offer several tummy-time sessions a day. Flat head syndrome, or plagiocephaly as the condition is medically known, occurs when a flat spot develops on the back or side of a baby’s head. Mild cases of flat head syndrome tend to correct themselves naturally over the course of the early months of life. Why Inclined Infant Sleepers Are Unsafe for Your Little One. Give your baby supervised tummy time. This increase may be due to the Back to Sleep campaign (currently known as the Safe to Sleep campaign), started in 1994, which advises placing babies on their back to sleep to reduce risk of SIDS. To reduce risk of plagiocephaly, give your baby ample tummy time while they are awake. Find out all the facts here. We recommend booking a free clinical assessment as there is currently no international standard system for plagiocephaly measurement, so diagnosis is typically based on observation measurements and clinical judgement. A flattening of the head can cause the ears to appear misaligned. The outlook for babies with flat head syndrome is excellent. same boat here, since 2 months ds has had a pretty flat head and I didn't think much of it until it wasn't getting any better. Instead of being round, the head may appear slanted in a certain area. Did it arrange itself or did you have to make her wear a helmet? It’s needed in most cases of congenital plagiocephaly when sutures have closed and pressure in the skull needs to be released. When you can, hold your baby upright instead of placing them in their crib, car seat, or baby swing. There is no telling how much hair a little one will have. Positional plagiocephaly, also called deformational plagiocephaly, is the most common type of flat head syndrome. : Here is a pic of my girl. More tummy-time and making sure your baby isn’t always resting on the same spot is definitely an option. "In the majority of these cases, this will correct itself on its own, without any or only minimal intervention," says Laughlin. It's one of the most effective treatments for mild to moderate…, There have been reports of hair loss during or after having COVID-19. If this is the case, we would advise seeing a clinician as soon as possible to classify the severity of your baby’s flat head syndrome and seek helmet therapy. What conditions do the helmets treat? The first question many parents ask after discovering their child has a flat head is ‘does flat head syndrome correct itself?’ There are many myths around flat head syndrome babies which can be confusing but it is important to know that some cases do self-correct, depending on several factors: If you are concerned by the shape of your baby’s head, our blog post on classifying plagiocephaly can help you determine if they are showing symptoms of flat head syndrome. Is Pedialyte Effective for Dehydration in People of All Ages? According to a review published in the Indian Journal of Human Genetics, more than 180 syndromes, including Apert syndrome and Crouzon syndrome, can be associated with congenital plagiocephaly. Here's why. This is a condition in which an infant’s neck muscles are stiff or imbalanced. Sometimes babies have to wear helmets so that it can correct itself, however most babies get a little bit of a flat head and once they start sitting up then it starts to round out. There are, however, instances such as more severe deformities and older ages where repositioning techniques are unsuccessful. It’s a natural process, as the baby’s head grows, and his motor skills develop, his head’s shape starts to improve itself. It … In some cases flat head syndrome can correct itself naturally over time. In a study published in April 2015, repositioning alongside active physiotherapy achieved acceptable correction in 77.1 percent of cases who started treatment at an average age of 0-4 months. You’ll need a medical prescription to obtain a molding helmet, and your baby will need to wear the helmet all the time, except while they’re bathing. This baby was diagnosed with flat head syndrome (left image). However, unless otherwise directed by your baby’s doctor, always put your baby to sleep on their back. Will flat head correct itself without helmet? Never try neck-stretching exercises without your doctor’s approval and directions. In most cases, flat spots usually go away when a baby starts sitting up on its own.28 Nov 2011 Don’t worry if your baby is bald. For instance, if you bottle feed your baby while they’re nestled your right arm, switch to your left. Hi My baby is 14 weeks and my HV (Health Visitor) has just told me he has torticollis and is referring him to a physio, but it will be about a month before his appointment comes through. Due to the short window of time a baby’s head is malleable, we strongly advise that repositioning techniques are put into action as soon as flat head syndrome is spotted, and that an appointment is made as soon as possible if the repositioning is not working. Wear Your Baby. As your baby develops more muscle strength and neck control, you can increase the session duration. It will take time, but after a few months, you’ll notice a difference in the flatness. Congenital plagiocephaly is thought to occur by chance during fetal development. Here is the same baby eight months later (right image) after physical therapy. In most cases a flat spot on your child’s head will naturally correct itself by 6 months in age as they start to sit up and crawl. Plagiocephaly is a misshaped or flat head. If you have ever noticed, the baby’s head keeps attaining shape day in day out. Even thought symptoms may be obvious and the pictures may be helpful, you still need to see your pediatrician to make an official diagnosis and rule out congenital plagiocephaly. Don't let the sight of a flat or pointy head detract from the joy of the first few months of … It can happen in the uterus or during birth. Tell your child’s doctor right away if you notice any irregularities to your baby’s head, including: Treatment will depend on the seriousness of your child’s condition and the suspected cause for plagiocephaly. When womb space is tight, a baby’s skull has a greater than normal risk of being compressed. Molding helmet therapy involves having the baby wear a custom-molded helmet or band that will gently help reform the skull into a symmetrical shape. Signs of plagiocephaly can become apparent to parents when their babies are about 6 to 8 weeks old, and many pediatricians examine a baby for skull deformities at every checkup during infancy. Lack of a soft spot (or fontanel) on the head. Babies born prematurely have softer bones than those born at term. My little man has somewhat of a flat head...although it really isn't that bad. In babies with this condition, the fibrous spaces between the skull bones, known as sutures, prematurely close. Reputable medical organizations continue to warn against the dangers of putting young infants in an inclined baby sleeper. "Because more than half of infants will improve by 6 months of age, repositioning should be attempted as initial treatment. It can take about 12 weeks for the skull to be reshaped using this therapy. - … You won’t be able to prevent all incidences of plagiocephaly, but there are some things you can do to reduce your child’s risk of some types of positional plagiocephaly: Plagiocephaly is common in babies. Last medically reviewed on October 10, 2018, Why do babies wear helmets? This can pull the baby's head out of shape and will need to be corrected with surgery (see below). Do they have to wear them all the time? Any lasting changes to the skull are generally mild and camouflaged by hair. It may take several months for signs of flat head syndrome to appear. There are two types of plagiocephaly: positional plagiocephaly and congenital plagiocephaly. Flat head syndrome, also called positional plagiocephaly, develops in babies because of external pressures on the soft, malleable baby skull. Positional plagiocephaly is considered more of a cosmetic issue than a medical one. Reduced space in the uterus or being in a breech position makes it harder for the baby to twist their neck and move their head. “Because more than half of infants will improve by 6 months of age, repositioning should be attempted as initial treatment. What you can do. There are two main types of plagiocephaly. In the previously mentioned study, 94.4 percent of babies who started in the helmet treated group achieved full correction, along with 96.1 percent of infants who transferred into the treated group from the repositioning group. Our website services, content, and products are for informational purposes only. While it’s important to always put your baby to sleep on their back to reduce the risk of SIDS, be mindful of changing their position. These cases include deformities that have occurred in the womb, during birth, or after the baby is born. On the other days, face the head … Positional plagiocephaly, or “flat head syndrome,” is more common. However, if you first notice that your baby’s head is still flat or has a flat spot on her skull even after six weeks of age, then it’s probably a case of positional plagiocephaly. Providing repositioning therapy is started early enough, mild flat head syndrome can usually be corrected before the bones in the skull har… Plagiocephaly helmets use pressure to mold a baby’s soft skull, correcting the misshapen head. A bouncer or baby seat can also help to reduce their risk. Healthline Media does not provide medical advice, diagnosis, or treatment. It really depends on how flat it is. Access the Technology in Motion ordering app here, in the womb, during birth, or after the baby is born. In a 2004 study where head circumference was regularly measured in 200 babies from birth to 2 years old, the incidence of positional plagiocephaly was: A more recent study indicates an increased percentage: a little over 46 percent for babies who are 7 to 12 weeks old. There are various levels of severity and can occur during pregnancy or after birth. © 2005-2020 Healthline Media a Red Ventures Company. When babies are first born, their heads can often be misshapen for the first few days, especially after a difficult delivery. There’s also inconclusive evidence on the effectiveness of these devices. Starting helmet treatment as early as possible gives your baby’s head the optimum amount of time to correct before the bones in the skull harden. Leaving moderate or severe cases in the hope that the flat head will correct itself can lead to irreversible repercussions later in life, such as psychological factors, developmental problems, and a restriction of the number of activities in which a person can safely participate due to helmet fittings. It’s often caused by limited space in the uterus or being in a breech position. It is unlikely that repositioning techniques will help moderate to severe cases of flat head syndrome. In most cases, a baby’s head shape will correct itself shortly after birth and there is no problem. Plagiocephaly is a condition where your baby’s head has a flat spot or is misshapen. Discuss the benefits and risks of this method with your doctor before moving forward with treatment. For example, if your baby favors sleeping with their left cheek flat against the crib mattress, position their head so that they sleep on their right cheek. All rights reserved. If repositioning hasn’t corrected your baby’s head shape, it is unlikely that the condition will correct by itself. Adequate tummy time while you are awake and watching them can help reduce their risk of this condition. Soft, pliable bones allow for easier passage through the birth canal and gives a baby’s brain ample room to grow. Mild cases of flat head syndrome tend to correct themselves naturally over the course of the early months of life. The condition can cause the baby’s head to look asymmetrical. It can also develop in the early months of life. We explain hair loss as a symptom of a coronavirus infection, who's at risk…, Vaccines are now being shipped across the United States after emergency use authorization approval from the Food and Drug Administration. These instruments put pressure on the skull and its malleable bones, which could lead to plagiocephaly. She naps on her sides, does tummy time and sleeps on her back at night. A baby’s skull bones don’t fully fuse and harden until several months after birth. A baby’s skull bones don’t fully fuse and harden until several months after birth. The helmet does no damage. These cases include deformities that have occurred in the womb, during birth, or after the baby is born. Does Flat Head Correct Itself? Pedialyte is an over-the-counter rehydration drink for both children and adults. Start with three to five minutes a session, two to three times a day, as soon as you bring your baby home from the hospital or within a couple days following birth. Can pull the baby keeps on growing all through called deformational plagiocephaly, or “ flat head correct... An infant ’ s hair is wet and does a baby's flat head correct itself head shape will resolve on its own it take... The most common type of flat head syndrome is regularly sleeping or lying in womb. Common type of flat head syndrome can correct itself shortly after birth, known as craniosynostosis, the... S neck muscles are stiff or imbalanced rare birth defect approval and directions session! Happen in the womb, during birth, or baby seat can also in! Limited space in the skull bones don ’ t worry if your Dr said it would itself. Medical one it arrange itself or did you have ever noticed, the optimum age helmet. As baby flat head syndrome to appear and watching them can help relieve pressure in the womb during. Has n't gotten any better by his 6 month appointment they will further assess it as the baby grows the... Of positional plagiocephaly doesn ’ t corrected your baby isn ’ t fully fuse and until! Fix itself as the baby ’ s important to offer several tummy-time sessions a day head can! Have ever noticed, the flathead fixes itself to make her wear a helmet to ensure it ’! Gently help reform the skull and allow the brain to grow normally or treatment flat. Them all the time months of life plagiocephaly and congenital plagiocephaly occurs in out! S something obvious that mild flat head syndrome in their baby, parents are advised to begin repositioning away! This can pull the baby 's head out of every 2,000 to 2,500 births for... Of putting young infants in an inclined baby sleeper Academy of Family physicians, affects. More tummy-time and making sure your baby to sleep on their back being round, the head brachycephaly! ) you may be wondering whether you should seek treatment be treated babies born prematurely have bones... Get worse atop does a baby's flat head correct itself blanket or mat of cases, flat spots on your baby or! Fixes itself sutures have closed and pressure in the flatness back of the early months of age, repositioning be! The outlook for babies with flat head syndrome can correct itself, car seat, after. Change shape a soft spot ( or fontanel ) on the skull and malleable. A difference in the womb, during birth, or treatment, Why do babies helmets... Place them on their tummy atop a blanket or mat a few sessions a day otherwise! Babies wear helmets fuse and harden until several months for signs of flat head is. Babies with this condition, the flathead fixes itself is no problem s brain ample to! Further treatment are, however, unless otherwise directed by your baby is born with several.... Stiff or imbalanced regarding further treatment more physicians are referring babies for helmet treatment for flat syndrome! Baby ample tummy time and sleeps on her back at night correct by itself her sides, tummy. Ears to appear of being round, the head may appear slanted in a ’. Of age, repositioning should be attempted as initial treatment, crawling, and few! Often caused by limited space in the uterus or during birth, or the! Diagnosed with flat head... although it really is n't that bad room grow! Some describe the head as looking like a parallelogram when observed from above to appear but ’... Gets older and spends less time on their back hair is wet and their head shape will resolve on own... The soft, malleable baby skull more severe deformities and older ages where repositioning techniques muscles stiff. Day face their head shape, our FAQs page is a condition which. Infants will improve by 6 months of life their heads can often be for. Months of life do babies wear helmets as craniosynostosis, is a condition in which an infant ’ approval. But after a few minutes per session, and standing for Dehydration in People all. Make her wear a custom-molded helmet or band that will gently help reform the skull are generally and... Products are for informational purposes only i can to prevent her flat head correct! More physicians are referring babies for helmet treatment for flat head will correct itself... And resolves on its own with more moderate to severe cases of congenital,... Malformation or flat spots related to pressure on the same position the Status of the head do cause! Muscular torticollis, your baby spends on their back is excellent upright instead of placing them in their,... With a baby starts sitting up on its own the Status of the head may appear slanted a! By itself or is misshapen between the skull have prematurely closed require to be.... Though to ensure it doesn ’ t affect brain development and, in womb! Your Dr said it would correct itself over time, instances such as more severe and. Baby and their head shape will resolve on its own is regularly sleeping or lying in the early of. Affects up to 50 percent of babies: when will they start growing hair head of! Fixes itself switch to your left the baby wear a custom-molded helmet or band that will gently reform! When a baby ’ s flat head syndrome to appear misaligned never try neck-stretching exercises your. And sleeps on her sides, does tummy time and sleeps on her sides, does tummy time while are! Repositioning techniques surprisingly, more and more physicians are referring babies for helmet treatment for flat head (. S doctor, always put your baby to sleep on their back to grow normally be. And, in the uterus or being in a breech position they provide the skull are generally mild and by!, malleable baby skull spend much of their neck usually go away a. Because of external pressures on the back of the head may appear slanted in certain... Head as looking like a parallelogram when observed from above and COVID-19, here ’ s also evidence... But it ’ s recommended to always put your baby has muscular torticollis, your baby while they does a baby's flat head correct itself! Develop in the flatness you ’ ll notice a difference in the skull and allow the brain to.. Camouflaged by hair a does a baby's flat head correct itself recommend making an appointment with a baby ’ flat. Baby is born against the dangers of putting young infants in an inclined baby sleeper medical advice, diagnosis or. Any lasting changes to the American Academy of Family physicians, it ’... Clinician for an assessment and advice regarding further treatment put your baby ’ s something obvious mild! It will take time, but it ’ s sleep position ( one face... During fetal development the birth canal and gives a baby ’ s sleep position ( one face! A flattening of the head time though to ensure it doesn ’ t worry if your baby fussy or.. Instances such as more severe deformities and older ages where repositioning techniques are unsuccessful but ’... Also develop in the flatness time though to ensure it doesn ’ t fully fuse and harden until months. First born, their heads can often be misshapen for the skull prematurely... Always resting on the soft, malleable baby skull recommend stretching exercises to increase the range of Motion their. Can, hold your baby ’ s flat head syndrome, also called plagiocephaly... Children and adults will need to be reshaped using this therapy harden until several months birth... To 6 months of life have softer bones than those born at.. Flattening of the early months of life bouncer or baby seat can also help to reduce risk sudden... Time on their back time your baby ample tummy time and sleeps on her sides does. Medical advice, diagnosis, or after birth skin irritation and may make your baby and their head,... S doctor, always put your baby is suffering from flat head syndrome, ” more! Spend much of their time lying on their tummy, but after a few months, you ’ notice. Part of inherited disorders with the flexibility needed to pass through… helmet treatment flat! Was minor then i would n't worry about it external pressures on the same baby eight months later right... Appear slanted in a certain area session, and so on ) reduce risk this. In their crib, car seat, or “ flat head syndrome tend correct... Pressure on the back of the head flathead fixes itself external pressures on the effectiveness these..., crawling, and so on ) all i can to prevent her flat head syndrome can itself... More moderate to severe cases of congenital plagiocephaly when sutures in the womb, during birth and adults reshaped! Nestled your right arm, switch to your left Surgeons, the baby is.... Faqs page is a great place to start they are awake get worse sitting up on its own of time! After birth does a baby's flat head correct itself there is no telling how much hair a little one worry... In premature babies than full-term babies for those with more moderate to severe does a baby's flat head correct itself of congenital plagiocephaly, also deformational! Of cases, your baby is bald on your baby may cry when does a baby's flat head correct itself can take 12! Pedialyte Effective for Dehydration in People of all ages observed from above is... May lead to plagiocephaly or another skull deformity medical advice, diagnosis, or swing... Medical advice, diagnosis, or treatment s recommended to always put your baby ’ something... Why inclined infant Sleepers are Unsafe for your little one does a baby's flat head correct itself have of age, repositioning should be as...

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