Bringing a newborn home from the hospital is a momentous occasion for parents, but it often comes with a flurry of concerns. Especially in the first few months, the shape of your baby’s head often becomes something to worry about. Typically, head shape issues stem from a benign condition known as Positional Plagiocephaly. Your care team will help to make sure it is not due to a more serious condition called Craniosynostosis.
What Is Positional Plagiocephaly?
Babies are born with soft skulls that take 9-18 months to fully form and some infants develop Positional Plagiocephaly, which is a flat area on the back or side of the head. This condition does not impact brain development and is purely a cosmetic concern.
The flat area often results from repeated pressure on the same spot, typically when a baby consistently favors one side while lying down. Other factors include the baby’s position in the womb, more than one baby during pregnancy, extended periods lying on the back, or Torticollis (a tight muscle on one side of the neck).
Please note: As part of the recommended ABC’s of safe sleep, babies should always sleep Alone, on their Backs, in a Crib to reduce the risk of Sudden Infant Death Syndrome (SIDS).
How Is Positional Plagiocephaly Treated?
Gentle Repositioning: When your baby is on their back, gently turn their head to the non-flat side, known as the “non-preferred side.” This simple action can help alleviate pressure on the flat spot. Avoid using anything to restrain the head, as it may obstruct the face and impede breathing.
Interactive Toys: Introduce toys, or Velcro a wrist rattle to their hand, that encourage them to look toward their non-preferred side and take pressure off the flat side.
Supervised Tummy Time: For infants that cannot sit for long periods of time, increase the amount of supervised tummy time when you baby is awake.
Limit Time in Swings and Carriers: When your baby is awake, restrict the time spent in swings or carriers. If they can sit up, this position helps alleviate pressure on the back of the head and contributes to neck strength development.
Mindful Holding: When holding your baby, avoid putting pressure on the flattened side of the head.
Customized Intervention: In cases where these methods prove insufficient, your child’s care team may discuss the possibility of using a custom-made helmet or band. These devices are designed to redirect head growth and are typically an effective solution.
What Is Craniosynostosis?
Craniosynostosis refers to a condition where the skull, composed of various bones, experiences premature closure of its sutures- the junctions between these bones. Early suture closure can lead to an abnormal skull shape, potentially hinder skull growth and pose risks to the developing brain. If left untreated, craniosynostosis may progress and result in further deformities, a potential restriction in overall head growth and psychological issues as a child interacts with peers.
Craniosynostosis occurs in one out of every 2,000 to 2,500 live births. While the cause is often unknown, it can be attributed to familial or genetic factors in some cases.
Signs and Symptoms of Craniosynostosis
The primary and most noticeable sign of craniosynostosis is an irregularly shaped head. Notably, the soft spot may be open or closed. Less commonly observed is a deviation from typical head growth, where measurements fall outside the expected range on the pediatrician’s growth curves. This can lead to a build-up of pressure inside the skull. Signs of high pressure may include:
Diagnosing Craniosynostosis involves a thorough office examination and often, imaging is used for a closer examination of cranial structures and confirmation of the diagnosis. At Nationwide Children’s Hospital, a specialized CT scan is utilized that provides 3D views of the skull with an ultra-low radiation dose equal to only a few regular x-rays.
Treatment typically involves surgical intervention to unlock the bones and reshape the skull. Historically, surgical approaches involved an incision extending from ear to ear and the removal, reshaping and reattachment of affected bones. While this method may remain the optimal choice in certain cases, advancements in technology at Nationwide Children’s now enable us to perform a growing number of these procedures using minimally invasive techniques. Timely intervention is crucial, as untreated Craniosynostosis not only increases concerns about head shape but, more significantly, poses a risk of impeding overall head growth and increased pressure on the developing brain.
Gregory D. Pearson, MD is a member of the Cleft Palate and Craniofacial team, helps staff the Vascular Malformations Clinic at Nationwide Children’s Hospital and is an Assistant Professor of Clinical Plastic Surgery at The Ohio State University College of Medicine.
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