Misshapen baby’s head

Q: I’m worried because my baby’s head isn’t perfectly shaped. Is this something that will correct itself over time?

While most parents leave the delivery room feeling their babies are perfect and precious as can be, it’s not uncommon for newborns to enter the world with misshapen heads. Taylor and Zach each weighed more than 8 pounds at birth, and their large heads really had to compress during delivery. It was frightening, because both looked deformed those first few hours after birth.

Oddly shaped newborn heads are usually the result of a tight squeeze in the birth canal (officially known as “intrapartum molding”). Sometimes a small maternal pelvis or breech position in utero is to blame.

Some “asymmetrical heads” result from forceps or vacuum-assisted deliveries. Others can be traced to a tight fit in the womb (“uterine constraint”), most often caused when a mother is carrying multiples.

For most infants born with seemingly misshapen heads, the problem resolves in just two to four weeks, according to Edward Joganic, M.D., co-director of the Southwest Craniofacial Center in Phoenix and section chief of Plastic Surgery at Phoenix Children’s Hospital.

When an infant’s head is asymmetrical at birth and fails to resolve within the first few months, pediatricians may suspect a condition called “craniosyntosis” in which the sutures, or “soft spots,” of the child’s brain fuse prematurely. In extreme cases, a child’s brain may be affected, and surgical correction may be necessary.

Much more common, according to Joganic, is a condition called “deformational plagiocephaly.” This can occur for several reasons, including extremely tight neck muscles that cause the infant to favor tilting or turning the head in a particular direction (“muscular torticollis”). Premature birth increases the risk of this condition because cranial bones strengthen and harden during the final weeks of pregnancy. In some cases, these infants need physical therapy and parents are taught specialized exercises to perform on their child at home.

Most cases of deformational plagiocephaly occur when infants spend too much time in any one position. It’s not uncommon for a baby who spends most of his or her time in a supine position (lying on the back) to develop a flat spot at the back of the head, says Joganic. Too much time spent with one side of the head facing down can cause a flat spot as well.

These “positioning” problems are often seen by the time an infant reaches two months of age, observes Joganic. Unless parents take preventive action, the problem will gradually worsen during the course of several months.

If simple interventions recommended by the pediatrician (such as exercises, changes in head position, etc.) don’t work, you may be referred to a craniofacial specialist or pediatric neurosurgeon for further evaluation.

A specialist may determine that your child needs an orthotic device  a molding helmet  to gently reshape his or her head. “The best response for helmets occurs in the age range of four to 12 months,” according to the American Academy of Pediatrics. Only rarely is surgery required to correct asymmetry.

Pediatricians have recommended since 1992 that infants sleep on their backs or sides in order to reduce the risk of sudden infant death syndrome (SIDS). There has been an “unbelievable floodgate of babies’ heads deforming” since the AAP adopted this policy, according to Jeanne Pomatto, clinical orthotist and CEO of Cranial Technologies, which makes a product called the DOC Band, a type of helmet that treats positional and other types of plagiocephaly.

Pomatto supports the AAP policy but fears parents misunderstand the recommendations and assume that babies should always be kept on their backs, even when they’re awake.

An infant whose head always rests one particular way against a car seat or baby swing is at greater risk for developing a flat spot, says Pomatto. She recommends that parents pay close attention to babies’ heads, making sure they don’t favor one side over another during sleep or play time. Parents should gently move their baby’s head as needed to help prevent flattening in a particular area.

When infants are awake, they need plenty of what Pomatto calls “tummy time.” Give your baby plenty of opportunities to lift his or her head and it from side to side. Babies should not spend long periods of time in infant seats or lying on their backs gazing at toys overhead.