Babies’ head shape: What to know and when to worry

As a new parent, it’s natural to feel that your baby is the most perfect infant ever born. But even with the intensity of our “love goggles,” parents will sometimes notice their baby’s head shape is uneven or has flat spots. In fact, one in three babies will have some kind of uneven shaping of the head. Don’t panic — most cases of an irregularly shaped skull will resolve on their own in the first six months of life.

Why are babies’ heads soft?

Babies’ skulls are soft, with bones that move and two soft spots, called fontanels, where the skull bones haven’t yet grown together. There are good reasons babies’ heads are malleable — it allows the head to move through the birth canal and makes room for a baby’s growing brain during the first few months of life.

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A misshapen head can be a result of a prolonged birth, cramped quarters in the mother’s womb for twins or triplets, or birth complications.

Flat spots or unevenness can also result from newborn babies resting their heads in the same position — called positional plagiocephaly. The condition is not dangerous, but the earlier it’s caught, the more easily it can be treated. A much less common but more serious cause of uneven head shape is craniosynostosis, in which the plates of a baby’s skull fuse too soon. Craniosynostosis is treatable, but requires surgery.

Causes of positional plagiocephaly

Prematurity. Long periods of lying on their backs, combined with the fact that preemies’ bones are softer than those of older babies, can cause a baby’s head to become misshapen — often with a symmetrically flat back of the head combined with a wideness from side to side.

Preferred head position. Some babies prefer sleeping with their heads turned in the same direction most of the time. Consistent pressure on that part of the head can mold the skull unevenly.

Tortocollis. Babies with this condition of tight or imbalanced neck muscles often also have a skull deformity.

Positional plagiocephaly usually becomes apparent between 2 and 4 months of age. If caught early, it can often be reversed by some simple interventions at home. That’s one reason it’s so important for babies to be seen regularly for wellness exams in the first year of life.

Preventing flat spots

To prevent flat areas on the head or to help babies who show some signs of positional plagiocephaly, I recommend that parents:

• Avoid prolonged periods of time in the car seat, baby swing or bouncy seat. Sometimes very “content” babies spend more time in places where their heads rest on a surface. Be aware of this and be sure to vary their positions.
  
  
• Have regular “tummy time.” Have your baby lie on their stomachs for a few minutes at a time and work up to an hour a day in shorter chunks. Babies don’t usually like tummy time at first, but stick with it!
  
  
• Alternate your baby’s head position when holding, feeding and putting to sleep. You can alternate putting baby to sleep on opposite ends of the crib in case they prefer looking in one direction, or put interesting things to look at outside both sides of the crib to encourage babies to turn their heads.
  
  
• Always put your baby to sleep on a firm, flat surface.

Your pediatrician will look at your baby’s head shape at every wellness checkup. If interventions don’t resolve the issue, your doctor may refer your baby for an evaluation and/or physical therapy. In a few cases, babies may benefit from helmet therapy that gently corrects a baby’s head shape over time. The therapy is not painful or uncomfortable for your baby, though you will need to have baby refitted and the helmet adjusted frequently while their head grows.

Remember how quickly your baby changes and grows, see your doctor for regular wellness checkups and help babies vary their positions. If you have questions about your baby’s head shape, talk to your pediatrician.

Lisa Bosshard, MD Pediatrician West Bend Pediatrics

Children’s Wisconsin has more than 20 primary care offices conveniently located throughout the Milwaukee area and southeast Wisconsin. Find a pediatrician near you.