This article discusses common misshapen head types, and diagnosis and treatment options.
Changes to a Baby’s Head Shape
In adults and adolescents, the skull appears as one bone. But in reality, it’s made of several bones connected by a type of strong connective tissue called sutures. The sutures are flexible and allow the bones of the skull to shift.
Several changes may happen to a baby’s skull, from birth up until around two years old.
The bendability of the skull is important for childbirth. The birth canal is narrow, and the skull bones shift to allow for easier passage through it. Sometimes the baby’s head becomes uneven as it passes through the birth canal.
A long labor or cesarean section (C-section) can change the shape of the head. The baby’s head may appear more squished or pinched after a long labor, and often, after a C-section, the head remains rounder because it isn’t pushed through the birth canal.
The sutures start to join together around the age of two. During the first two years of life, the brain grows rapidly. The skull needs to remain malleable to allow spaces for the brain to develop.
Sometimes, you may notice flat spots on your baby’s head that appear during the first few months of life. These can develop from spending too much time lying on their back or with their head leaning to one side. Usually, the head will return to a rounded shape as they grow older.
Common Misshapen Head Types in Babies
Two types of conditions may cause misshapen heads:
Positional plagiocephaly is a condition where specific parts of a baby’s head develop a flattened shape. Craniosynostosis is a rare but serious condition where one or more sutures of the skull close too early.
Positional plagiocephaly, often called flat head syndrome, is usually a mild condition that is easily treated. Flat spots may develop on a baby’s skull for a few reasons, including:
Too much time lying on their backFrequently holding their head to one sideTight neck muscles limiting the range of motion in their neckToo much time spent in a car seat, stroller, or carrier
Any part of the skull can develop a flat spot, but it’s more common on the back or side of the head. Sometimes the flat areas can cause the ear or forehead on that side to be pushed forward.
Craniosynostosis results in different shapes depending on which sutures have fused. The brain will grow toward the sutures that haven’t fused, resulting in a misshapen head. Types include:
Scaphocephaly: long, narrow-shaped headAnterior plagiocephaly: Forehead becomes flat on one side, while the other side appears pushed forward and the nose tilts to the non-flat sidePosterior plagiocephaly: One side of the back of the head appears to be bulging, and the opposite ear is lowerTrigonocephaly: narrow and pointed foreheadBrachycephaly: The back of the head is flat and long, while the forehead is short and roundedOxycephaly: All of the sutures are fused together, so the brain and skull are unable to grow
Diagnosis and Treatment for a Misshapen Head Shape
Your healthcare provider will be able to diagnosis a misshapen head through a visual exam and lightly feeling the baby’s head. Often, parents find flat spots before going in for well-child visits.
During each visit, the healthcare provider will monitor the growth of your baby’s head. Usually, flat spots are nothing to worry about and can be easily treated by regularly adjusting the baby’s position.
Common treatments for mild to moderate flat spots include:
Tummy time: When your baby is awake, you want them off their back for as long as possible. Supervised time lying on their stomach reduces the risk for flat spots and strengthens their neck, back, and core muscles. Alternate head position: Lying on their back remains the safest way for babies to sleep. Still, you can help prevent flat spots on the back of their head by alternating their head position each time you place them in their crib. Alternate arms when holding or feeding your baby: This helps move the pressure to different parts of their head. Physical therapy: If your baby has tight neck muscles, your healthcare provider may refer you to physical therapy. A physical therapist works to relieve the tension in muscles and improve the range of motion in your baby’s neck so they no longer favor one head position.
If the flat spots are severe or don’t improve after trying other treatments, your healthcare provider may recommend trying helmet therapy. A helmet helps to shape and mold the baby’s skull. It prevents the head from resting directly on flat surfaces if the baby continues to favor one side of their head.
Helmets are usually only recommended if spots are severe or another treatment hasn’t worked, as there is the risk for skin irritation or rashes when wearing the helmet.
If your healthcare provider suspects craniosynostosis, they will likely order imaging to assess the sutures.
If only one suture has closed or it’s only affecting one side of the head, craniosynostosis may be able to be managed with helmet therapy alone. But many times, craniosynostosis requires surgery to treat.
With positional plagiocephaly, the brain’s development isn’t affected and usually the head shape is an aesthetic concern. But when sutures fuse early, it can interfere with the brain’s development.
After craniosynostosis is diagnosed, your healthcare team will decide if helmet therapy, surgery, or a combination of the two is the best treatment option.
Can you correct a baby’s misshapen head without a helmet?
Yes, a baby’s misshapen head can be corrected without a helmet. It does, however, depend on how severe it is and what the cause is. Usually, babies will grow out of flat spots when given enough tummy time and positional changes.
How long will my baby’s head be misshapen?
Depending on the severity, it may take a few weeks to a few months for the head shape to return to normal. If unevenness hasn’t improved by around 6 months, your healthcare provider may recommend trying helmet therapy.
What is the most common baby misshapen head type?
Positional plagiocephaly is the most common type of misshapen head, particularly the back of the head.
A Word From Verywell
It’s fairly common for babies to develop flat spots on the back of their heads. The number of babies with positional plagiocephaly has increased now that back sleeping is promoted for infant safety. You should continue to have your baby sleep alone, on their back, in their crib for their safety.
When they are awake, adjust their position, hold them, and alternate their head position to help prevent flat spots. Talk with your pediatrician about any questions you have about your baby.
