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Baby's head shape: What's normal?
Helmets and head shape
Varying a baby's head position is typically enough to prevent or treat flat spots. If the lopsidedness doesn't improve by age 4 months, your baby's doctor might prescribe a special molded helmet to help shape your baby's head. These devices work by applying gentle but constant pressure in an effort to redirect skull growth.
Molded helmets are most effective when treatment begins by ages 4 to 6 months, when the skull is still malleable and the brain is growing rapidly. To be effective, the helmet must be worn 23 hours a day during the treatment period — often a number of months. The helmet is adjusted regularly — sometimes weekly — as the baby's head grows and changes shape. Treatment with a molded helmet isn't likely to be effective after age 1, when the skull bones are fused together.
Keep in mind that positional molding is generally considered a cosmetic issue. Flat spots related to pressure on the back of the head don't cause brain damage or interfere with a baby's growth and development.
Beyond positional molding
Sometimes an underlying muscular issue — such as torticollis — causes a baby to hold his or her head tilted to one side. In this case, physical therapy can help stretch the affected muscles and allow the baby to more freely change head positions.
Rarely, two or more of the bony plates in a baby's head fuse prematurely. This rigidity pushes other parts of the head out of shape as the brain expands. This condition, known as craniosynostosis, is typically treated during infancy. To give the brain enough space to grow and develop, the fused bones must be surgically separated.
Keep it in perspective
If you spend too much time worrying about your baby's head shape, you might miss some of the fun of being a new parent. In a few short months, better head and neck control will help your baby keep pressure more evenly distributed on the skull. Until then, change your baby's position as often as it's practical to do so. If you're concerned about your baby's head shape, check with your baby's doctor.
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- Pogliani L, et al. Positional plagiocephaly: What the pediatrician needs to know. A review. Child's Nervous System. In press. Accessed Oct. 6, 2011.
- Lipira AB, et al. Helmet versus active repositioning for plagiocephaly: A three-dimensional analysis. Pediatrics. 2010;126:e936.
- Dec W, et al. Current concepts in deformational plagiocephaly. The Journal of Craniofacial Surgery. 2011;22:6.
- Amer A, et al. Plagiocephaly. In: McInerny TK, et al. American Academy of Pediatrics Textbook of Pediatric Care. Elk Grove Village, Ill.: American Academy of Pediatrics; 2009:2433.
- Laughlin J, et al. Prevention and management of positional skull deformities in infants. Pediatrics. 2011;128:1236.
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