When a Baby's Head Is Misshapen: Positional Skull Deformities

When a baby spends a lot of time in one position, it can cause the shape of their head to change.

This is called a positional skull deformity.

• For about 20% of babies a positional skull deformity occurs when they are in the womb or in the birth canal.

• For other babies it happens between 4 to 12 weeks of life.

  • This happens at this age because babies can’t sit up or move on their own yet.

• By 6 months of age, many babies are more mobile, allowing them to turn their heads and move more often on their own.

A baby’s skull has soft, bony plates that can still move so:

• The baby’s head can pass through the birth canal.

• The baby’s brain has room to grow.

There are many things that can cause a positional skull deformity such as:

• Your baby’s preferred head position.

  • Some babies like to sleep on a specific side of their head.

• Not enough tummy time for your baby.

  • When awake and being watched, have your baby on their belly, so they can practice lifting and turning their head.

• If your baby was born premature.

  • Premature babies have softer skull bones than full-term babies and spend a lot of time sleeping on their back if hospitalized.

• If you had more than one baby.

  • With twins, triplets, or more, babies can be cramped or in unusual positions that cramp their heads in the womb.

• Skull bone movement, as your baby made their way down the birth canal.

  • If your labor was difficult or your baby needed vacuum extraction or forceps, this can cause a misshaping of the head as well.

• Torticollis, a condition where your baby’s neck muscles are tighter on one side.  

  • Around 85% of babies that have torticollis have a misshapen head because of the position their neck is in.

  • Physical therapy can help with this.

The change in a baby’s head shape is usually related to the position in which they spend most of their time.

A good time to check your baby’s head is after bath time when their hair is wet.

• A normal head shape will have an evenly round head and forehead along with evenly placed ears.

Your child’s healthcare provider can determine whether your baby’s head shape is caused by a positional skull deformity or an uncommon, but more serious condition called craniosynostosis.

Common positional skull deformities that do not require surgery are:

• Deformational Brachycephaly is where the head is evenly flat and wide in the back.

• The bone above the ears may look like it is sticking out, and this often happens when babies spend a lot of time on their back, so they need more tummy time.

Deformational plagiocephaly is where the head is flat in the back on one side.

• The ear and forehead may look more prominent on the same side of the head that is flat.

• Usually this means the baby likes to sleep on that side.

• Your child may have this if they have torticollis.

Nicucephaly is a common condition in preemies who spend a month or more in the NICU (neonatal intensive care unit) and their heads look long and narrow.

These deformities do not affect your baby’s brain or development.

The majority of these deformities do not require surgery, and the bothersome part is the way your baby’s head looks.

When found early, simple changes for your baby’s position can help and these include:

• Avoid too much time in a car seat, bouncy seat, baby swing, or carriers.

  • These positions put pressure on the back of your baby’s head.

Increase tummy time when your baby is awake and being watched.

• This allows your baby to practice lifting their head, moving their neck, back, shoulders, arms and hips.

• You can start with short periods of times to help your baby learn how to tolerate it.

• The goal is to have your baby spend short sessions on their tummy each day that add up to one hour.

When holding or feeding your baby, alternate the arms you use.

Alternate the end of crib you place your baby in for sleep.

Your baby’s healthcare provider may recommend treatment if your baby’s head is moderate to severely flattened.

Examples of treatment options:

• Physical therapy involves an evaluation of your baby’s head shape and their skills like head and neck control, along with checking for torticollis.

  • You will be taught different stretching exercises and how to position your child at home.

  • The therapist will decide how often your child needs to be seen by them.

Helmet therapy may be needed if your child is 5 or 6 months of age and their head shape is still moderately to severely flattened.

• These are fitted by specialists to mold and re-shape your baby’s head.

Surgery is only considered if your child has craniosynostosis, your child’s head shape has not responded to other therapies and after a pediatric neurosurgeon or plastic surgeon feels it is necessary.

You have any concerns or questions about your child’s head shape.  

You have any concerns or questions about your child’s development.

You have any other concerns or questions.