Baby’s Head Shape: Should You Be Concerned?

Bringing a baby home from the hospital can be a scary time for a parent as they navigate the first few months as an expanded family. The list of things to worry about as a child develops can seem endless, and baby’s head shape is a common item on that list.  Usually, the head shape issue is due to a benign condition called Positional Plagiocephaly. Your doctor will help to make sure it is not due to a more serious condition called Craniosynostosis.

What is Positional Plagiocephaly?

When babies are born their skulls are soft, which helps them pass through the birth canal. It can take 9-18 months before a baby’s skull is fully formed. During this time some babies develop positional plagiocephaly. This means that there is a flat area on the back or side of the head. Positional plagiocephaly does not affect brain growth or development; it is purely a shape issue.

What causes Positional Plagiocephaly?

A flat area on the back or side of the head is commonly caused by repeated pressure to the same area. This usually happens when a child prefers to lay on his or her head on the same spot, causing the head to be misshapen. Other causes include:

  • Baby’s position in the womb that puts pressure on the head
  • More than one baby in the same pregnancy
  • Spending too much time laying on his or her back
  • Torticollis (a tight muscle on one side of the neck), which can cause the head to tilt one way or make it hard to turn the head

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?

In many children the flattening is corrected as the child becomes more mobile and lies less on the affected area. Other techniques include:

  • When your child is on his or her back, gently turn the head to the side that is not flat. This is the “non-preferred side”. Changing sides takes pressure off the flat spot. Do NOT use anything to keep the head in place; it might block the face and keep the child from breathing
  • Place a toy or Velcro a wrist rattle to your child’s left or right hand to encourage him or her to look toward their non-preferred side and take pressure off the flat side. You can also hold toys at the non-preferred side to encourage looking in that direction.
  • When awake, limit the time your baby spends in swings or baby carriers. If your child is able to sit up, it will take the pressure off the back of the head and builds neck strength.
  • In infants that cannot sit for long periods, increase the amount of supervised tummy time when the child is awake.
  • When you hold your baby make sure there is no pressure on the flattened side of the head.

In some cases these methods will not help the head to round out. In these instances your child’s primary care doctor will discuss with you the pros and cons of using a custom-made helmet or band. These devices work by redirecting head growth and are typically highly effective.

What is Craniosynostosis?

The skull is formed by multiple different bones.  The junctions between the bones are called sutures. Craniosynostosis occurs when one or more of the sutures closes early. Early suture closure can cause the skull to grow in an unusual shape. Sometimes, early suture closure can also restrict overall skull growth which may be harmful to the brain inside which is trying to grow.

Left untreated, craniosynostosis can result in further cranial deformity and potentially an overall restriction in head growth, with secondary increased intracranial pressure. It can also lead to psychosocial issues as the child interacts with peers during development.

What are the signs and symptoms of Craniosynostosis?

The most apparent sign of craniosynostosis is typically an abnormally shaped head.  The soft spot may be open or closed. Less common is a restriction of head growth with the measurements “falling off” the pediatrician’s growth curves. This can lead to build-up of pressure inside the skull. Signs of high pressure may include:

  • Headache
  • Nausea
  • Vomiting
  • Lethargy (very sleepy, difficult to wake)
  • Difficulty moving eyes up
  • Keeping eyes down all of the time (looks like the setting sun on the horizon)
  • Bulging and/or tense soft spot (when patient is upright and does not have respiratory infection)

How common is Craniosynostosis?

The condition occurs in one out of every 2,000 to 2,500 live births.

What causes Craniosynostosis?

In most infants, the cause of craniosynostosis is unknown and the child is otherwise healthy. Sometimes the cause is familial or genetic – a change occurs in one or more genes to result in the condition.

How is Craniosynostosis diagnosed?

Sometimes, craniosynostosis can be diagnosed with an office examination alone. Often imaging will be used to more closely examine the cranial sutures and confirm the diagnosis. Here at Nationwide Children’s we use a special CT scan that provides 3D views of the skull using an ultra-low radiation dose equal to that of only a few regular x-rays.

How is Craniosynostosis treated?

Treating craniosynostosis usually involves surgery to unlock the bones and reshape the skull. Historically, craniosynostosis has been treated using surgical methods that involve an incision from ear to ear and the removal, reshaping, and reattachment of affected bones. Sometimes this is still the best option. However, at Nationwide Children’s, advances in technology are allowing us to conduct more of these procedures in a minimally invasive manner. Left untreated, the head shape will likely worsen but, more importantly, there is a risk for overall head growth restriction with development of increased pressure on the brain.

For more information on Nationwide Children’s Neurosurgery department, click here or for more information on Craniosynostosis, click here or listen to our PediaCast.

Lance Governale, MD
Lance S. Governale, MD, is a pediatric neurosurgeon at Nationwide Children’s and an assistant professor of neurological surgery at The Ohio State University College of Medicine. Dr. Governale has received several distinguished awards from his colleagues for excellence in research, teaching and clinical care, including the Harvard Medical School Richardson Research Fellowship for MD scientists and a nomination for the Harvard Medical School Faculty Prize for Excellence in Teaching.His research interests focus on clinical outcomes and quality improvement, and he is a member of multiple professional societies, including the American Association of Neurological Surgeons and the American Society of Pediatric Neurosurgeons. He is especially interested in craniosynostosis, minimally invasive neurosurgery (including endoscopic treatment of hydrocephalus, craniosynostosis, pituitary disease, and skull base disease), brain / spinal cord tumors, arachnoid cysts and cavernous malformations.

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