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A baby’s skull is made up of bones (plates) with fibrous cranial sutures between them.
During birth, the plates slide over each other to ease passage of the head through the birth canal. Normally, an infant’s skull is moldable in the womb and for the first year, up to about 18 months.
Everyone’s skull is a bit asymmetrical. Usually a baby’s head naturally becomes more symmetrical and better proportioned within about 6 weeks after birth and will continue to improve.
Sometimes there may be a noticeable flattened area on an infant’s head, or a flat spot. You may notice that the forehead protrudes on one side, or that one eye or ear is not symmetrical with the other.
A flat spot can occur in the womb if there is restricted space, such as with twins. Premature babies may have a deformity because their skull bone is thinner than a full term baby.
A flat spot can be caused by some muscle disorders or other medical problems such as craniosynostosis (when the cranial bones and sutures fuse together too early) or torticollis (a shortening of one of the neck muscles). A physician must make this diagnosis.
In most cases a flat spot will round out on its own about 6 months of age when the infant starts to crawl and sit up. Infants with continued head shape problems may need further evaluation.
Did you know that there is a name for a flat spot on a baby’s head?
“Plagiocephaly” is the term that is commonly used to refer to any head shape abnormality; it literally means “oblique head” ( from Greek: plagio = oblique, and cephale = head).
Actually, the three main head shape abnormalities are plagiocephaly, brachycephaly and scaphocephaly. Any of these head shapes can be the result of premature fusion of the cranial sutures (see craniosynostosis) which is why a physician must determine the probable cause of the abnormality.
Plagiocephaly (pla-gi-o-sef-alee) is when the skull slants on either the right or left side. It is called a parallelogram deformity because this is the shape you see if you look down at the top of the infant’s head (see above). From this angle it looks as though half of the head has been pushed forward, often accompanied by misalignment of the ears, facial asymmetry and bulging forhead.
Brachycephaly (brake-E-sef-alee, from Greek brachys = short) refers to the condition where the head is disproportionately wide. It can result from the premature fusion of the coronal sutures (see craniosynostosis) or from external pressure due to prolonged lying on the back (a positional deformity) so the head flattens uniformly causing a wider and shorter head.
Scaphocephaly (skaf-O-sef-alee, from Greek skaphe = light boat or skiff) refers to a condition where the skull is long and narrow. It can result from the premature fusion of the sagittal suture (see craniosynostosis) or from external deformation, and is especially common in premature babies.
What should I do if my baby’s head has a flat spot?
It is very important for the baby’s doctor to determine why the head shape is abnormal so consult your physician if you notice a flat spot or uneven features. As babies grow their skull becomes less soft and pliable, so the younger your baby is, the easier it will be to intervene.
The most common form of plagiocephaly is ”positional plagiocephaly.”
Positional plagiocephaly typically develops after birth when babies spend time in a position that puts pressure on one part of the skull, developing a flat spot. Babies are vulnerable because their skull is soft and pliable when they’re born. They develop plagiocephaly because of prolonged periods of time on their back, or in an infant carrier, car seat, swing, or stroller.
Since the “Back To Sleep” campaign to fight Sudden Infant Death (SIDS) was started in 1992, the incidence of SIDS has decreased, however the incidence of head shape problems have increased by up to 600% (American Academy of Pediatrics).
For positional plagiocephaly the physician may recommend a repositioning therapy such as “Tummy Time“ and wait to see if it corrects the problem. If the baby’s head shape gets worse despite repositioning therapy, or after the baby has begun to roll and reposition themselves, consult your physician.
Most head shape problems are not life threatening and are completely correctable if caught and treated by 18 months of age. Cases that can’t be corrected with tummy time, repositioning and physical therapy may need a headband, also referred to as helmet therapy, remolding orthosis, or cranial helmet.
Tip: If you notice a flat spot your baby’s head early on, you might want to take photographs of the top of the head from above every month or so. Then you can see whether the flat spot is improving over time. These images may also be helpful for your baby’s doctors.
Why is head shape important?
Did you know that historically, cradleboards and other external pressure devices have been used to intentionally mold children’s skulls into desireable shapes? The head shape signified high social status, ethnicity, or both. (Infant Head Molding: A Cultural Practice, Archives of Family Medicine ).
An oddly shaped head does not cause problems unless the abnormality is excessive. Some physicians do not treat this condition because they perceive the problem as “cosmetic.” However, reaserchers are studying medical and social effects that plagiocephaly can have on other structures on the skull and on a child’s development. Some examples:
- Visual field defects (Visual Field Defects in Deformational Posterior Plagiocephaly, American Association for Pediatric Ophthalmology and Strabismus, J AAPOS 2005;9:274-278)
- Excessive asymmetry of the jaw or temporomandibular joint (Mandibular dysmorphology in unicoronal synostosis and plagiocephaly without synostosis, American Cleft Palate-Craniofacial Association, 1995)
- Neurodevelopment issues (Neurodevelopment in children with single-suture craniosynostosis and plagiocephaly without synostosis, University of Oklahoma)
- Developmental difficulties during school-age years (Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly, American Academy of Pediatrics).
A head shape deformity, when not caused by craniosynostosis, may be a symptom of another problem, such as torticollis, or inadequate levels of Vitamin D causing bone softening. For these reasons, consult your physician for a diagnosis.