Changes to a Baby’s Head Shape: When to Worry

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A newborn’s head is pliable and soft to allow the baby’s skull to move through the birth canal. It’s normal for babies’ heads to become misshapen after birth and in the first few months of life.

Fortunately, most heads will round out during infancy. However, some babies may need additional help from a healthcare provider. Read more about what to know and when to worry about a baby’s head shape.

Pediatric nurse measures baby's head

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A Baby’s Head Shape Changes

Birth is the first thing that will affect your baby’s head shape. Their head shape may change based on:

  • How long you're in labor
  • The amount of pressure the baby experiences while passing through the birth canal
  • Whether you have a vaginal birth or cesarean section (C-section)

Before the age of 2, the skull is composed of several bones held together by strong tissues. The seams, or spaces between the bones, are called sutures. A baby is born with soft spots, or fontanels, as well. Soft spots are larger openings where the bones have not yet come together.

The two most prominent soft spots are on the top of the head and in the back of the head. These extra spaces help the skull bones shift during childbirth, allowing the head to move through the birth canal. They also provide room for the brain to grow.   

The brain and head grow rapidly during the first two years of your baby’s life. At about 2 years old, your baby's skull bones slowly start to fuse together as the sutures become bone.

C-Section vs. Vaginal Birth

Your baby is more likely to have a rounded head if you deliver by C-section. If you deliver vaginally, you have a greater chance of giving birth to a baby whose head is slightly misshapen from having passed through the narrow birth canal. This is common.

In the next few months after delivery, you may notice changes in your baby’s head shape. This is completely normal and usually is nothing to worry about.

A baby’s head can have temporary flat spots from:

  • Back sleeping
  • Frequently sleeping with the head turned to one side
  • Tight neck muscles making it more likely for them to turn the head in one direction
  • Spending long periods of time in a car seat, stroller, or rocker

Conditions That Impact Head Shapes

A few conditions that may affect the shape of your baby’s head include:

Positional Plagiocephaly

Positional plagiocephaly is a condition in which a flat spot develops on a baby’s head. It is a very common condition and is sometimes called flat head syndrome, although this is not an actual syndrome.

While it may be alarming to notice a flat spot on your baby’s head, the flat spot won’t affect your baby’s brain development. Most of the time, the flat spot will return to normal after a few months.

Back Sleeping

Research shows sleeping on their backs remains the safest position for babies during the first year of life. Still, this can cause a flat spot on the back of the head, especially if babies spend a large portion of the day on their backs.

Flat spots may form on one side of the head if the baby's head is frequently turned to one side.

Sometimes other parts of the head or face can become misshapen from lying in a certain way for long periods of time. For instance, the forehead or ears may be affected.

Craniosynostosis

Craniosynostosis is a congenital condition that causes the skull bones to fuse together too early. This can affect one or more sutures. Sutures that fuse before their time can affect brain development and lead to complications like:

  • Misshapen head or face
  • Intracranial pressure
  • Respiratory problems
  • Neurological problems
  • Nausea and vomiting
  • A bulging of the soft spots

Diagnosis

Your healthcare provider will routinely check the shape of your baby’s head during well-child appointments. Your doctor may look for changes in your baby's head shape when observing it from above.

Along with a visual assessment, your doctor may make a positional plagiocephaly diagnosis by lightly feeling for flat spots. The condition is usually diagnosed during the first few months of life and can range from mild to severe.

After the physical exam, if your healthcare provider suspects craniosynostosis, your baby may need imaging tests to confirm the diagnosis. A computed tomography (CT) scan is the most accurate way to assess if the sutures have fused together.

An eye exam may be performed to assess the optic nerve, as well. This is used to diagnose intracranial pressure in patients with craniosynostosis.

What to Expect During Treatment

Most babies will naturally grow out of any flat spots they develop during the first few months of their life. For mild forms of positional plagiocephaly, you can encourage a normal head shape by:

  • Alternating head position: Back sleep is still the safest way for your baby to sleep. Still, you can help prevent a flat spot on the back of your baby’s head by alternating the position of their head each time you put them down to sleep.
  • Moving baby frequently: Frequently moving your baby among the floor, bouncer chair, swing, and other spots reduces the time babies spend putting pressure on one part of their head.
  • Practicing tummy time:  The more time babies can spend off their backs while awake, the less likely they are to develop flat spots. Spending time lying on their stomach, called tummy time, while supervised is a good idea. Tummy time helps to reduce flat spots and strengthens your baby’s neck, arms, and core muscles.
  • Carrying your infant: Holding your baby and using a sling or other soft carrier helps keep pressure off your baby’s head. Additionally, try alternating the arm you hold your baby in while feeding. 

Your doctor may refer your baby to physical therapy if they have tight muscles. Tight muscles can cause your baby to keep their head in the same position and to limit the range of motion in their neck. A pediatric physical therapist can help babies increase their range of motion and relieve tight muscles.

If positional changes alone aren’t improving the shape of your baby’s head enough, helmet or band therapy may be recommended. Helmets can help to mold the skull and treat flat spots. But they aren’t recommended for mild or moderate cases because they may lead to skin rashes or discomfort.

Surgery is rarely recommended for positional plagiocephaly. It is typically only recommended if the skull structure interferes with vision, chewing, or the position of the jaw.

For most cases of craniosynostosis, surgery is recommended. However, if only one suture has closed and your baby's condition is mild, your healthcare provider may recommend a helmet first to help shape the head.

If more than one suture is fused, surgery is recommended to allow for healthy brain development. Sometimes after surgery, a helmet is still needed to help maintain a healthy skull shape.

Frequently Asked Questions

What can cause abnormal head shapes in babies?

Positional plagiocephaly and craniosynostosis are conditions that can cause abnormal baby head shapes. Positional flat spots can develop on the back or side of the head depending on the head’s position.

Craniosynostosis may cause a long, narrow head, a pinched forehead, flattened top of the head, and other asymmetrical features.

What does it mean to shape a baby’s head?

Usually, you won’t need to do anything to shape your baby’s head. If flat spots don’t improve with positional changes, however, your healthcare provider may recommend a band or helmet to gently mold your baby’s head.

When should I worry about my baby’s head developing plagiocephaly?

If the flat spot hasn’t improved after a couple of months, talk to your healthcare provider about tips to change your baby's position while sleeping or resting and to see if a helmet is needed.

If your baby has a strong preference for holding their head in one direction, it could be a sign of tight muscles. Your healthcare provider can assess if your baby has constricted muscles and if physical therapy can help.

A Word From Verywell

Discovering a flat spot on your baby’s head is usually nothing to be concerned about. They are common, and most are easily corrected with simple positional changes. Practicing tummy time, adjusting your baby's head position while lying down, and carrying your baby more often can help to prevent and reverse positional plagiocephaly.

Ask your healthcare provider about flat spots that concern you. Doctors can help monitor and diagnose the condition. In rare cases, the skull may fuse together too soon and require treatment to allow for healthy brain development.

Follow up with routine wellness appointments to monitor your baby’s development, and don’t hesitate to ask your healthcare provider about any concerns you have regarding your baby's head shape.

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