Know When to Treat Your Infant's Abnormal Head Shape

Armen Hareyan's picture

Abnormal Head Shape Treatment

When a baby is born there is usually some deformity of the head during the birthing process. In most cases, this goes away after the first six weeks. However, if after six weeks a parent or caregiver notices that the shape of the head looks abnormal, they should bring it to the attention of their pediatrician.

With the recommendation that babies sleep on their backs to help prevent Sudden Infant Death Syndrome (SIDS), parents are noticing an increase in abnormal or flattened head shapes. This flattened head syndrome, also known as positional (or deformational) plagiocephaly, results from preferentially lying on one side of the head. Deformational brachycephaly is a flattening across the back of the head.

"There are several reasons that a baby will develop positional plagiocephaly or positional brachycephaly. Because babies spend a lot of time on their backs, it causes pressure to be applied to just one area of the head. Babies' bones are soft so this pressure causes the bone to flatten and shift," says Scot Sepe, chief of orthotics and prosthetics at Arkansas Children's Hospital. "This condition can also develop inside the mother's uterus if there are multiple babies, large-size babies or if the mother has a small uterus or uterus abnormalities. Premature babies, also have a higher risk because their bones are extra soft. Some babies have a condition called torticollis, which is the tightening of the neck muscle on one side of the neck, which causes their head to remain in one position."

If the case is very mild, a doctor might recommend trying "tummy time" while the baby is awake or positioning the baby so that the flat side is not receiving direct pressure. While time on his stomach provides rest for the back of a baby's head, it also helps them learn to push up on their arms, which develop the muscles needed for crawling and sitting up, and strengthens neck muscles.

"A baby should be put to bed on their back because this has been proven to help reduce Sudden Infant Death Syndrome (SIDS). But the position a baby is placed in while sleeping on their back can be changed so that a constant pressure is not applied to one area," adds Sepe. "While the baby is awake they should spend as much time on their stomach as possible. This helps promote the decrease of head deformities as well as help the baby develop other motor skills."


At Arkansas Children's Hospital, a baby with this condition is seen by a doctor who specializes in the treatment of head deformities. The doctor will have X-rays taken to examine the condition of the skull and rule out any other complications. If the baby has torticollis an evaluation by a physical therapist and a home exercise program to stretch out the neck muscle to allow the baby better range of motion may be needed. Often the torticollis is resolved with one or two visits to the physical therapist and the family following through at home.

"In moderate to severe cases of head deformities the baby can be fit with a cranial helmet. This helmet will help reshape the head to a more normal shape by controlling the way the head grows. This is done by putting space in the helmet to allow the head to grow into that space. The helmet does not apply a force or push on the head. The baby is cased for this helmet so that it is specifically made for their individual head shape," explains Sepe.

The casting is done by applying two layers of cotton stocking and then soft fiberglass casting tape to the baby's head. Once this has dried (about one to two minutes), the fiberglass is cut up the side to allow easy removal. The helmet, made from a plastic outer shell and a thick inner foam lining, is created from this mold and then fit to the baby's head. Any adjustments that are needed are made at this time. The baby is put on a break-in schedule for the next five days. After the break-in time the baby will wear the helmet 23 hours a day. The baby will then be followed up once a month to monitor their progress. The average treatment time with the helmet is about four and a half months.

"At Arkansas Children's Hospital, babies are usually treated from as young as three month and as old as 18 months. The older the baby is the harder it is to correct the deformity. Babies will do most of their fastest growing in the first seven and a half months and will slow down from between eight and 12 months. The head growth will slow down even more after their first birthday."

While positional plagiocephaly is not painful and has not been proven to cause poor development, children normally will not outgrow abnormal head shapes. Sepe advises parents to contact their pediatrician if they suspect their child might need medical help to correct this problem.

Little Rock, Arkansas - August 17, 2005