Does my baby’s head look weird? An Intro to Infant Head Shape

What are clinicians looking for when it comes to my baby’s head shape?

At your first visit to the pediatrician, head shape and development are key parts of the newborn evaluation.  If you are a parent, you may remember your pediatrician pressing on your newborn’s skull during your baby’s well visits.   Most babies are born with the bones of the skull separated or unfused in what we professionally identify as sutures.  This separation of skull bones is very advantageous for newborn development.  It allows the baby’s head to push through the birth canal and also allows room for brain growth after birth (1).  

From day one, clinicians are physically and visually examining the sutures and shape of the infant skull in order to make sure the bones are not joined together (or fused) too early.  Early fusion of these skull bones results in a misshaped head due to the brain’s continued growth. This condition is called craniosynostosis and occurs in about 1 in 2,500 U.S. births (1,2).

Head shape observation from a bird’s eye view is also performed during infant wellness visits to determine skull asymmetries.  Deformational Plagiocephaly is a condition that may be identified when one side of the back of the skull is flat shifting the same side of the front of the skull forward like a parallelogram.  This condition is typically due to external forces acting on the head and may be influenced by head position preference, sleep position, or Congenital Muscular Torticollis (1,3).

How does medical history impact head shape?

The time that infant head shape deformity appears plays a roll in diagnosis.  If a baby presents with a significant head shape deformity at birth, physicians will evaluate for a structural cranial diagnosis like craniosynostosis.  If the head shape changes are observed well after birth, a diagnosis like deformational plagiocephaly is more likely (1,4,5). 

One cause of deformational plagiocephaly is Congenital Muscular Torticollis.  (Refer to this article for more information on CMT.)

Significant maternal and newborn historical events that may indicate CMT include (6):

• A maternal sense of the baby feeling “stuck” during the last 6 weeks of pregnancy

• Cephalic or Breech Birth

• Assisted Delivery with a vacuum or forceps

• Baby’s head posture/preference

• Changes in baby’s head shape

• Family history of Torticollis

• Age-appropriate developmental milestones

Referrals

As we say in the pediatric Physical Therapy world, refer often and early.  The earlier treatment begins, the better the results. Keep an open dialogue with your pediatrician and other healthcare providers about your baby’s head shape including changes. (1,6,7). Looking for more information on helmet therapy? Check out this article.

Looking for help with positioning, positional plagiocephaly prevention, or torticollis treatment?  Worried about a flat head? Contact Boost Babies today!  All home-based services are 1-on-1 with a Doctor of Physical Therapy.

References:

1) Hill, David and Jooanna Parga-Belinkie. Pediatrics Research Roundup, Identifying Misshapen Heads - Episode 10. Pediatrics On Call- American Academy of Pediatrics. September 1, 2020. https://services.aap.org/en/pages/podcast/pediatrics-research-roundup-identifying-misshapen-heads. Accessed Sept 2, 2020.

2) Boulet SL, Rasmussen SA, Honein MA. A population-based study of craniosynostosis in metropolitan Atlanta, 1989-2003. Am J Med Genet Part A. 2008;146A:984–991.

3) Bok Ki Jung; In Sik Yun. Diagnnosis and treatment of positional plagiocephaly. Archives of Craniofacial Surgery , Apr2020, Vol. 21 Issue 2, p80-86, 7p. 

4) Wood RJ. Craniosynostosis and deformational plagiocephaly: when and how to intervene. Minn Med. 2012;95(6):46-49.

5) Looman WS, Flannery AB. Evidence-based care of the child with deformational plagiocephaly, part 1: assessment and diagnosis. J Pediatr Health Care. 2012;26(4):242-250

6) Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA academy of pediatric physical therapy. Pediatr Phys Ther. 2018;30:240-290.

7) Unwin S, Dika C. Deformational Plagiocephaly--A Focus on Prevention. Journal for Nurse Practitioners. 2017;13(2):162-169. doi:10.1016/j.nurpra.2016.10.015

Note:  I am a pediatric physical therapist writing with the purpose of sharing evidence-based information to the pediatric community.  This article, like all of my articles, is NOT medical advice. There are many medical diagnoses associated with a misshaped head that were purposefully excluded due to the basic focus of this article.  Please contact your pediatrician or other healthcare provider with concerns over your baby’s head shape or any other medical concern.