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

There is usually no reason to worry about changes in a baby’s head shape. It’s normal for babies' heads to be misshapen after birth and in the first few months of life. This is because a newborn’s head is pliable and soft, making it easier for the skull to move through the birth canal.

Fortunately, most babies’ heads will round out during infancy. However, some babies may need help from a healthcare provider. Rarely, more serious birth problems can cause issues with a baby’s head shape. Read more about what to know and when to worry about a baby’s head shape.

Why 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, a baby’s skull is made up of several bones held together by strong tissues. The spaces between the bones are called sutures. A baby is also born with soft spots (fontanels). Soft spots are larger openings where the bones have not yet come together.

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

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

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

• Back sleeping
• Frequently sleeping with the head turned to one side
• Tight neck muscles (which make it more likely they will turn their head in one direction)
• Spending a long time in a car seat, stroller, or rocker

Other Causes for Changes in Head Shape

There are a few conditions that can affect the shape of a baby’s head. 

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 it is not an actual syndrome.

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

Flat spots can form on one side of the head if a 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 a long time. For example, the forehead or ears can also be affected.

Craniosynostosis

Craniosynostosis is a congenital condition that causes the skull bones to come together too early. This condition can affect one or more sutures. 

Sutures that fuse before they are supposed to 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

When to See a Healthcare Provider for Your Baby’s Head Shape

Remember that right after birth (especially vaginal delivery) your baby’s head might be a little misshapen; that’s normal and nothing to worry about. In the week or so after birth, your baby’s head will probably round out.

However, there are some signs that your baby’s misshapen head should be looked at by a healthcare provider:

• Time. It’s been 2 weeks since birth, and their head is still misshapen.
• Swelling. Your baby’s head has a spot that is bulging out or looks swollen.
• Soft spot. Your baby has a sunken soft spot or no soft spot.
• Eyes look different. Your baby’s eyes change shape or position.
• Forehead looks different. Your baby’s forehead changes position.
• Slow or no growth. Your baby’s head is not growing or is growing very slowly.
• Other symptoms. Your baby is unusually sleepy or vomiting. 

Diagnosis

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

If your provider thinks your baby’s head shape is the result of a specific condition, the provider will be sure to check your baby's head regularly. Along with looking at your baby’s head, your provider will lightly feel for flat spots to check if your baby has positional plagiocephaly. This condition is usually diagnosed during the first few months of life and can range from mild to severe.

After a physical exam, if your provider thinks your baby could have craniosynostosis, they may need imaging tests to confirm the diagnosis. A computed tomography (CT) scan is the most accurate way to check if the skull sutures have fused.

An eye exam can check your baby’s optic nerve and diagnose intracranial pressure which can go along with craniosynostosis.

What to Expect During Treatment

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

• Alternating head position. Back sleep is the safest way for your baby to sleep. 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 between the floor, a bouncer chair, a swing, and other spots will help limit the time they spend putting pressure on one part of their head.
• Practicing tummy time. The more time babies can spend off their backs while they’re awake, the less likely they are to develop flat spots. Spending time lying on their stomach (tummy time) while they are supervised can help reduce flat spots as well as strengthen 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 their head. You can also try changing the arm you hold your baby in while feeding. 

Physical Therapy

If your baby has tight muscles, your provider might want them to see a physical therapist. 

Tight muscles can cause your baby to keep their head in the same position and limit the range of motion in their neck. 

A pediatric physical therapist can help babies increase their range of motion and relieve tight muscles.

Helmets

If positional changes alone are not improving the shape of your baby’s head enough, helmet or band therapy might be recommended. 

Cranial remolding helmets can help to mold the skull and treat flat spots. 

However, these helmets are not recommended for mild or moderate cases because they can lead to skin rashes or discomfort.

Surgery

Surgery is rarely used to treat positional plagiocephaly. It is usually only recommended if the baby’s skull structure interferes with their vision, chewing, or the position of their jaw.

Most babies with craniosynostosis will need to have surgery. However, if only one suture has closed and your baby's condition is mild, your provider may recommend trying a helmet first to help shape the baby’s 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 the skull shape.

Summary

Discovering a flat spot on your baby’s head is usually nothing to worry about. A misshapen head is common and often goes away on its own. If not, practicing tummy time, adjusting your baby's head position when putting them down to sleep, and carrying your baby more often can help to prevent and even reverse positional plagiocephaly.

Ask your provider about flat spots on your baby’s head that are worrying you. In the rare case that your baby has a condition that needs treatment, your provider can make sure you find out what the problem is and what the best treatment will be.