Dolichocephaly describes a head shape that appears longer from front to back and narrower from side to side. While often a benign variation, it can sometimes indicate underlying medical conditions. Understanding when this elongated head shape warrants professional medical evaluation is important for parents.
Understanding Dolichocephaly
Dolichocephaly results in a head that is noticeably long and narrow, with its front-to-back measurement greater than its side-to-side width. This head shape can arise from a variety of factors, many of which are not concerning.
A common cause is positional dolichocephaly, often seen in infants who spend extended periods lying on their backs. The “Back to Sleep” campaign, while successful in reducing Sudden Infant Death Syndrome (SIDS), has led to an increase in positional head shape variations, including dolichocephaly and plagiocephaly. Consistent pressure on the back of the head encourages lateral narrowing and front-to-back elongation.
Dolichocephaly is also frequently observed in premature infants. Their skulls are softer and more pliable, and prolonged side-lying positions used in neonatal intensive care units (NICUs) can contribute to this elongated shape. In these cases, the dolichocephaly is typically a result of external molding forces and often improves as the infant grows and becomes more mobile.
Signs That Warrant Medical Attention
While many cases of dolichocephaly resolve without intervention, certain signs indicate a need for medical attention. A primary concern is craniosynostosis, a condition where one or more of the skull’s fibrous sutures fuse prematurely. When the sagittal suture, which runs along the top of the head, fuses too early, it restricts sideways growth and forces the head to grow longer and narrower.
Signs suggesting craniosynostosis include a palpable ridge or hard spot along a suture line. The head shape may appear disproportionate, with an exaggerated forehead (frontal bossing) or a pointed back of the head. Unlike positional flattening, craniosynostosis is a birth defect that does not correct itself and can worsen over time.
Abnormal head growth, such as a head circumference that fails to increase or falls off the growth curve, is another sign that warrants evaluation. In severe cases of craniosynostosis, particularly if multiple sutures are involved, premature fusion can restrict brain growth and lead to increased intracranial pressure (ICP). Symptoms of increased ICP in infants may include extreme irritability, a high-pitched cry, poor feeding, increased sleepiness, bulging soft spots (fontanelles), or vomiting.
Developmental delays or other neurological symptoms, even if subtle, in conjunction with an unusual head shape, should prompt medical consultation. An association between head shape anomalies and developmental delays has been observed. Consulting a pediatrician is important if there is any doubt or if the head shape seems to be worsening despite repositioning efforts.
What to Expect at the Doctor’s Office
When a parent consults a doctor about their child’s head shape, the process begins with a thorough physical examination. The pediatrician will assess the head shape, measure head circumference, and palpate the skull sutures and fontanelles to check for any ridges or early closure. They will also discuss the child’s medical history, developmental milestones, and typical sleeping positions.
If concerns arise, the pediatrician may refer the child to a specialist, such as a craniofacial specialist, neurosurgeon, or plastic surgeon, who has expertise in head shape anomalies. To confirm a diagnosis, imaging studies are often performed. A computed tomography (CT) scan is considered the preferred method to visualize the skull bones and sutures. X-rays can also be used, though they offer less detail than a CT scan.
Management approaches depend on the underlying cause. For positional dolichocephaly, recommendations include repositioning techniques, such as increasing “tummy time” when the infant is awake, and encouraging head rotation during sleep. If repositioning is not effective and the deformity is severe, helmet therapy (cranial orthosis) may be prescribed to gently reshape the skull. For craniosynostosis, surgical intervention is necessary to separate the fused sutures, allowing the brain to grow normally and correcting the head shape.