Abnormal head shapes can develop in babies for a variety of reasons. Early evaluation is important in an infant with an abnormal head shape in order to determine the cause and plan a course of treatment.
There are several types of head shape abnormalities. Each type has its own symptoms:
- Positional plagiocephaly. The bones that make up a baby’s skull are thin and flexible. Constant pressure in one area of the skull can change the skull's shape. This condition is called positional plagiocephaly (skull molding) and is one of the most common forms of abnormal head shapes. Babies with plagiocephaly often have noticeable flatness on the back or sides of their head, and there is typically little hair in those areas. This can be due to recommended safe sleeping guidelines, which promote babies lying on their backs for extended periods of time. Car seats, strollers and other carriers often position babies in this way, too. It is also possible for a tight neck muscle to cause torticollis (a persistent twist of the neck to one side). When this happens, one area of your child's
- Craniosynostosis. The skull is made up of many bones that fit together like a puzzle, and the place where the bones eventually grow together is called a suture. If one of these sutures fuses too early, growth cannot continue in that area. This condition is called craniosynostosis. This leads to an abnormally shaped skull. If this condition is not treated, it causes pressure inside the head along with head deformity, developmental delay and, in some cases, seizures. Craniosynostosis can be classified as non-syndromic and syndromic. Non-syndromic craniosynostosis is the most common form and is most often characterized by an isolated single suture synostosis.
- Syndromic craniosynostosis. Patients with this condition have craniosynostosis and associated anomalies involving the face and extremities, which can also affect the shape and placement of the eyes and development of the upper and lower jaw. Some of the associated syndromes are:
- Apert syndrome. Children with Apert syndrome typically have craniosynostosis, midface hypoplasia (underdevelopment), increased intracranial pressure, exophthalmos/proptosis (bulging eyes) and syndactyly (webbed fingers or toes).
- Crouzon syndrome. Children with Crouzon syndrome may have craniosynostosis, midface hypoplasia and mild exophthalmos.
- Pfeiffer syndrome. Children with Pfeiffer syndrome may also have crowded teeth along with thumbs and toes that appear broadened and an abnormally shaped forehead or nose.
- Saethre-Chotzen syndrome. In addition to affecting the position of the eyes, Saethre-Chotzen syndrome may also affect the position of the nose. Children with this condition may also have low hairlines and short or fused fingers.
Diagnosis of Head Shape Abnormalities
A craniofacial surgeon will obtain your child’s medical history and complete a detailed physical examination to diagnose a head shape abnormality. Doctors may also use medical imaging such as traditional X-rays or computed tomography (CT) to make a diagnosis.
Treatment for head shape abnormalities varies depending on the specific anomaly and its cause:
- Positional plagiocephaly. A starting point in treating plagiocephaly is placing your baby onto his or her side or stomach during waking hours to relieve pressure on the side or back of the head. Infants with torticollis require physical therapy to stretch and straighten the neck. In such cases, head flattening typically improves through successful treatment of the torticollis. In more severe cases, your child's doctor may prescribe a special helmet that helps distribute pressure around your baby’s head. This distribution of pressure helps prevent further flattening and promotes growth to a more rounded head shape. Early treatment of plagiocephaly leads to the best results.
- Craniosynostosis. If a CT scan confirms a diagnosis of craniosynostosis, surgery to separate the skull bones is recommended. This procedure relieves pressure in the skull, allowing the brain to expand and the bones to grow in a more normal shape. Reconstructive surgery is generally done before age 1. The pediatric neurosurgeons, craniofacial surgeons and dedicated pediatric anesthesiologists with the Cleft & Craniofacial Anomalies Program at Riley at IU Health are highly skilled in performing this delicate surgery. They see more patients with craniosynostosis than any other hospital in the Midwest.
- Syndromic craniosynostosis. Multiple suture craniosynostosis requires surgical treatment. Several surgeries are necessary to correct the condition as your child grows and develops. Early treatment leads to the best outcomes.
Key Points to Remember
Key Points to Remember
- Plagiocephaly can develop when babies spend nearly all their time on their backs. A starting point in treating this condition is placing your baby onto his or her side or stomach during waking hours to relieve pressure on the side or back of the head.
- When the bones of the skull fuse too early, the condition is called craniosynostosis, and surgical separation is required.
- In addition to the sutures of the skull fusing too early, syndromic craniosynostosis can also involve abnormal growth of the head and face. The shape and placement of the eyes and development of the upper and lower jaw may also be affected.
- Early treatment of head shape abnormalities leads to the best outcomes.
Support Services & Resources
Support Services & Resources
Visit these websites for more information on head shape abnormalities:
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This nonprofit organization addresses the medical, financial, psychosocial, emotional and educational concerns related to head shape abnormalities, including craniosynostosis, Apert syndrome, Crouzon syndrome, Pfeiffer syndrome and Saethre-Chotzen syndrome.
This nonprofit organization provides education and support for families of children living with craniosynostosis.
This U.S. government site explains the causes, symptoms, diagnosis and treatment of craniosynostosis.
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