When does the shape of a newborn's head require medical attention?

Newborn head shape is a common thing for new parents to wonder about. Sometimes a baby's head is a little pointed; sometimes it's a little flat in a spot or two. This is usually nothing more than the normal effects of being born, according to Christopher Derderian, M.D., pediatric plastic surgeon at Children's Health℠ and Assistant Professor at UT Southwestern.

Babies' skulls are made up of soft plates of bone that are held together by flexible fibers (sutures). This allows babies to pass through the birth canal easier and allows for their brains to grow until adulthood. "At birth, a baby's head may not appear even or perfectly round. That is often related to the position of the baby's head in the womb before being born," says Dr. Derderian. Newborns have poor control of their head that makes them more likely to come to rest on an already flat area on the back of the head.

Does a baby's flat head correct itself?

Some babies – about 10% or 400,000 a year – will develop something called positional plagiocephaly, also known as flat-head syndrome. This is when a flattened area on the back of the head becomes more pronounced. There is virtually no health risk to babies with positional plagiocephaly, and it usually improves on its own once babies can hold up their heads, at around 4 months of age. The skull has just become flattened from the weight of the head resting on one side more than the other.

When does a baby need to wear a head shaping helmet?

Sometimes a baby with positional plagiocephaly has more significant changes in the shape of the head and needs to have a little help to grow into a more normal head shape. A molding helmet is something that a health professional will custom make for the baby. The helmet fits comfortably over his or her head and guides the growth of the skull to round out the flattened areas and improve the shape of the head. This helmet is usually worn between 3-12 months of age with adjustments made to the helmet as the head grows.

When should I worry about a baby's head shape?

Rarely, a misshapen head will be a sign of a more serious problem. According to Dr. Derderian, this occurs when the seams between the skull bones – called sutures – close too early. The sutures are sites of bone growth, similar to the growth plates in the long bones of the arms and legs. When the sutures close before they are supposed to, called craniosynostosis, an abnormal head shape results that does not improve with time. Increased pressure can occasionally develop inside the skull if the brain does not have enough room to grow, which can be dangerous and cause learning delays. Closed skull sutures can very rarely be a sign of more serious health problems, like craniosynostosis.

If you are worried about your baby's head shape, do not hesitate to ask your doctor about this. Again, in most cases, an uneven shape to the skull is not dangerous and self-limited; however, the sooner a patient is diagnosed with craniosynostosis, the better the chances will be that the patient gets timely care and the best prognosis.