Concerns about a baby’s head shape are common. While many variations are benign and resolve naturally, some may require medical attention. Knowing when to consult a healthcare professional ensures appropriate care for a baby’s developing skull.
Understanding Head Shape Variations
A baby’s skull is soft and flexible at birth, with sutures allowing for brain growth and molding during delivery. Positional plagiocephaly, often called “flat head syndrome,” is a common condition where a flat spot develops on one side of the back of the head due to consistent external pressure. This results in an asymmetrical head shape, with the ear, cheek, and forehead on the flattened side appearing pushed forward, creating a parallelogram appearance. Another common variation is brachycephaly, characterized by a symmetrical flattening across the entire back of the head, making the head appear wide and short. This often occurs when babies spend significant time on their backs without sufficient tummy time.
A different, rarer condition is craniosynostosis, which involves the premature fusion of one or more of the skull’s sutures. Unlike positional deformities, craniosynostosis is a birth defect that can restrict brain growth and lead to increased pressure inside the skull if untreated. The specific head shape in craniosynostosis depends on which sutures fuse early; for example, early closure of both coronal sutures can lead to brachycephaly, while premature closure of the lambdoid suture can cause posterior plagiocephaly. This condition causes a more progressive and severe skull and facial asymmetry, sometimes accompanied by ridging along the fused sutures or a lack of a soft spot.
When to Seek Evaluation for Head Shape
Parents should observe their baby’s head shape, as early detection can improve treatment outcomes. Visual cues that warrant medical evaluation include a distinct flat spot on one side or across the back of the head, uneven ears, or an asymmetrical forehead. If a baby consistently turns their head to one side, or if a flat spot persists for several months despite repositioning efforts, consulting a pediatrician is recommended.
A healthcare provider will perform a thorough physical examination, feeling the baby’s head for hard edges along the sutures or unusual soft spots to differentiate between positional issues and craniosynostosis. They may also assess the baby’s neck movement, as a preference for holding the head in one direction can indicate tight neck muscles, a condition known as torticollis, which often contributes to positional flattening. In cases where the diagnosis is unclear from a physical exam, imaging like X-rays or CT scans may be used to visualize the skull sutures and confirm if they have prematurely closed.
The Role of Helmet Therapy
Helmet therapy (cranial orthosis) treats moderate to severe positional plagiocephaly or brachycephaly unresponsive to conservative measures. The helmet works by applying gentle, consistent pressure to the prominent areas of the skull while allowing flattened areas to round out as the baby’s head grows. This redirection of growth is effective because a baby’s skull bones remain pliable during early infancy.
Treatment begins between 4 and 6 months of age, when rapid head growth leads to better reshaping results. Therapy usually lasts three to six months, varying by severity and growth rate. Frequent appointments (every two to four weeks) allow for helmet adjustments as the baby’s head grows. Parents receive instructions on wearing the helmet (usually 23 hours a day) and maintaining hygiene.
Beyond Helmet Therapy
For mild positional head shape variations, or as complementary approaches, non-helmet interventions can be beneficial. “Tummy time” is a widely recommended practice where babies spend supervised time on their stomachs, strengthening neck muscles and reducing pressure on the back of the head. Starting with a few minutes and gradually increasing the duration helps promote balanced skull growth.
Repositioning techniques involve changing the baby’s head position during sleep and waking hours. Examples include alternating crib direction, changing arms during feeding, or placing toys to encourage head turns away from the flattened side. If a baby has torticollis, physical therapy can stretch and strengthen neck muscles, improving range of motion. In rare instances of craniosynostosis, surgical intervention is necessary to separate the fused skull bones, allowing the brain to grow properly and preventing increased intracranial pressure. This surgery, performed by a team of specialists, is distinct from treatments for positional deformities and is carried out within the first year of life.