Bringing a newborn home from the hospital may be a frightening experience for parents as they navigate the first few months as a larger family. The number of things to be concerned about as a child grows can seem infinite, and a baby’s head shape is often on that list. Many babies have somewhat misshapen heads. Is it, however, a cause for concern? To decide this, it’s important to understand what causes unevenness in babies’ skulls and when it is necessary to seek medical intervention for the issue.
What causes a baby’s head to appear uneven?
While going through the birth canal, a newborn’s head may be molded irregularly. Fontanels are soft spots on babies’ heads that form when they are born. The skull bones in the soft places have not yet fused, which allows the comparatively large head of a baby to pass through the small birth canal. During infancy, these soft spots also accommodate a baby’s rapidly growing brain. A newborn’s head that is irregularly formed immediately after birth usually rounds out with time.
In some situations, the shape of a baby’s head (*1) changes after the delivery. Since it can take 9 to 18 months for a baby’s skull to become fully formed, soft spots are left susceptible to environmental factors. These soft softs can become flattened out due to pressure on the baby’s head from lying in the same position repeatedly. Spending too much time resting flat in one position may result in an uneven head shape long after birth-related asymmetry has evened out. This is known as positional plagiocephaly, or positional molding. This can also happen inside of the womb if the baby’s positioning puts pressure on the head or if there is more than one baby in the same pregnancy.
Positional molding is most noticeable while observing your baby’s head from above. From this angle, the back of your baby’s head may appear flatter on one side than the other. The ear on the flat side may also appear to be pushed forward. In the flat areas, there is typically little hair to be found.
Safe sleeping guidelines for babies promotes them lying on their backs for extended periods of time, which can cause positional plagiocephaly. Since car seats, strollers, and other carriers often position babies in this position as well, it is likely that all of these factors play into positional molding.
Another cause of abnormal head shape in babies is known as craniosynostosis (*2). When a baby has craniosynostosis, two or more bones fuse before the baby’s brain development is finished, often even before delivery. The shape of the skull, brain, and face might become twisted depending on which sutures seal early and where they are positioned. Some syndromes associated with craniosynostosis include Apert syndrome, Crouzon Syndrome, Pfeiffer Syndrome, and Saethre-Chotzen Syndrome.
How does one diagnose head shape abnormalities?
Pediatricians will consult with parents to piece together a developmental and family history to assist understand what’s causing a baby’s uneven head shape. They will also perform thorough inspections, looking at the baby’s head and face from various angles, checking for elevated or flattened areas, and noting any asymmetry. When the baby’s hair is moist, this may be easier. These findings and data will aid in distinguishing positional plagiocephaly (produced by simple pressure in one location) from craniosynostosis (caused by bony fusion).
The traditional parallelogram shape is one indication that a baby’s irregular head shape was created solely by positioning. When compared to the opposite side, one side of the head may appear to be pushed forward with the back of the head flattened, the ear shifted slightly forward, and the forehead pushed slightly forward as well. Your doctor may gently insert a finger into each ear and observe the location of their fingers relative to each other from above the baby’s head. The two fingers will not line up opposite each other in the case of positional plagiocephaly. Plagiocephaly is more common on the right side and more common in male babies.
How does one treat abnormal head shape in babies?
How abnormal head shape is treated depends on the origin of the asymmetry. If your baby is diagnosed with positional plagiocephaly, your doctor may recommend some changes in the way you position your baby. For example, while you can still place your baby on their back, make sure you alternate the direction of your baby’s head. When your baby is awake, your doctor may recommend that you hold them up to relieve pressure on your baby’s head from swings, carriers, and infant seats. Another great way to combat positional plagiocephaly is to try tummy time. Your doctor may even recommend physical therapy to help alter your baby’s preferred head position and to strengthen the neck and head muscles.
If tummy time, regular position changes, or physical therapy do not improve head unevenness by 6 months, your baby’s doctor may recommend a molding helmet. A molding helmet is a custom-fitted helmet that relieves pressure on your baby’s flattened side of the head. Molding helmets are most helpful in addressing head unevenness between the ages of 4 and 12 months. The skull bones are still pliable during this time, and the brain is quickly expanding. Treatment with a molding helmet is unlikely to be beneficial after the age of one, when the skull bones fuse together and head growth slows.
Craniosynostosis frequently requires surgery to repair the deformity and, in some situations, to prevent pressure inside the skull while the baby’s brain develops. Extra tummy time and molding helmets can help cure positional skull defects, but they are ineffective in addressing craniosynostosis (although they are sometimes used after surgery). For babies 6 months or younger, when the bones are still soft and flexible, your doctor may recommend endoscopic surgery to treat this. For babies over 6 months, when the skull bones are too thick for the other procedure, open surgery may be needed to remedy this head deformity.
Sources:
(*1) Mayo Clinic- https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/healthy-baby/art-20045964#:~:text=Spending%20too%20much%20time%20lying,your%20baby’s%20head%20from%20above.
(*2) Duke Health- https://www.dukehealth.org/pediatric-treatments/pediatric-plastic-and-reconstructive-surgery/abnormal-head-shape-and-skull-deformity
