Skull Deformities in Infants

It's the rare newborn who arrives with a perfectly-formed head. Any new parent can attest to that! Soft and fuzzy, yes. Round and symmetrical-hardly ever, especially in infants born vaginally. The head is pliable by design. The flexible structure enables movement through the narrow birth canal.

Most misshapen heads round out within the first few weeks after birth but some do not. The occurrence of plagiocephaly (or flattened-head syndrome) is on the rise affecting an estimated one in 60 babies compared to one in 300 births in 1974. The increase may be an unintended consequence of the hugely-successful "back to sleep" campaign launched by the American Academy of Pediatrics (APA) in 1992.

Putting babies to sleep on their backs is still recommended and credited for reducing the number of deaths from SIDS (sudden infant death syndrome). However, when babies do not have ample time on their tummies and are not encouraged to turn their heads, pressure from the crib mattress on the same spot of the head can flatten the area. Experts recommend switching the baby's head-to-toe direction in the crib or turning the crib around every few days since babies instinctively turn away from walls.

Plenty of supervised tummy time starting in the first few days of life is also recommended. When baby gets off her back it provides a break for the occipital area (back of the head) and strengthens neck and leg muscle, both of which are important prep work for crawling.

Plagiocephaly is not life-threatening but untreated children can suffer from vision problems, migraines, chronic ear infections, jaw misalignment, muscular joint problems in their necks and other neurological issues. Aside from that there can be emotional and social consequences for children whose heads don't look "normal".

Non-surgical Devices are Effective

Sometimes repositioning and using mobiles and toys to coax a baby to turn her head are enough to resolve the problem.

In more severe cases, the FDA has approved a medical device known as a cranial orthosis. In layman's terms, that's a specially-designed helmet. The hard plastic exterior and foam interior gently guide the head's growth and allow the flat part of the skull to expand and round. (Depending on the manufacturer the device can also be called a cranial band or cap).

The devices are light weight (about 6 ounces) and worn up to 23-hours a day for an average period of 4 months. Costs vary—usually between $1,500 and $3,000—and aren't always fully-covered by insurance.

Babies who wear these devices are closely monitored by a physician. Physical therapy may also be prescribed.

If you are concerned about the shape of your infant's head, seek medical advice to rule out other conditions such as torticollis or craniosynostosis that require other forms of intervention.

Babies with torticollis seem to have a constantly cocked head and look only toward one side at all times. This is caused by tight neck muscles. Physical therapy is usually effective but for infants whose range of motion is limited there are also non-surgical devices. The TOT collar (Tubular Orthosis for Torticollis) is a simple mechanism constructed from soft plastic tubing that fits around baby's neck. Hard-plastic pieces that fit in between the soft tubing on the tilted side of the neck are uncomfortable and encourage baby to straighten her head. The collar can be worn on infants as young as 4 months old but only when the baby is alert, awake, and supervised.

Preemies and multiples are more susceptible to both plagiocephaly and torticollis. Intra-uterine constraint (for example, cramped quarters before birth due to multiples in the womb) can affect head shape and the less-developed skulls of preemies are softer than the heads of full-term babies.

Far less common, craniosynostosis occurs once in every 2,000 births. This condition results from the premature fusion of sutures between sections of bone in a newborn's skull. When this occurs, normal growth can be inhibited resulting in a misshaped head. The condition is also characterized by protruding or misaligned eyes and more serious problems like increased pressure on the brain or an obstructed airway. Pressure on the developing brain can lead to inhibited intellectual growth, seizures, and other problems affecting cognitive development. Surgery is necessary to correct these issues.

If you are concerned about the appearance of your infant's skull, consult your pediatrician as soon as possible. Early intervention will result in the best outcome for your baby.


Pediatric Plastic Surgery Unit at the Univ. of Missouri Children's Hospital

The Mangaement of Deformational Plagiocephaly: Repositioning vs. Orthotic Therapy (Research Paper published Feb. 2004)
By John M. Graham, JR, MD, SCD; Mayela Gomez, BS; Andy Halbert, BS and Dawn L. Earl CPNP, MSN on behalf of the medical Genetics Institute, Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Burns and Allen Research Institute, Cedars-Sinai Medical Center and the Department of Pediatrics, University of California, Los Angeles

Healthy Children (Journal of the American Academy of Pediatricians)  

Jorge Posada Foundation