Why does the shape of the head change?
The bones of a newborn’s skull are connected by movable sutures and fontanelles - this is necessary for passage through the birth canal and for rapid brain growth. The soft skull is easily deformed where there is constant pressure on it. If a child lies on his back almost all the time, turning his head in the same direction, the back of the head flattens on this side. The forehead and ear on the same side move forward. Often the reason that a child prefers one side is muscular torticollis or simply the habit of looking at the window or at his mother.
- Soft bones and open sutures of the baby's skull
- Constant pressure on one area of the back of the head
- Muscular torticollis, limitation of head rotation
- Not enough tummy time while awake
- Close position of the fetus with twins or oligohydramnios
- Prematurity and prolonged lying in one position
What does it look like
Parents usually notice that the back of the head has become flat on one side. If you look at the head from above, you can see that the ear on the flattened side is moved forward, and the forehead on the same side protrudes slightly. Sometimes there is a noticeable difference in the position of the eyes and cheeks. Hair on a flat area may be rubbed off. The child develops normally, eats and sleeps well. In addition to the occipital form, there is brachycephaly - a uniformly flattened occiput with constant lying strictly on the back.
- Flat area of the back of the head on one side
- Ear displacement forward on the same side
- Prominent forehead on the same side
- Facial asymmetry in severe form
- Dry hair on a flat area
- Parallelogram-shaped head seen from above
How is it different from craniosynostosis?
The main thing that the doctor must rule out is craniosynostosis, premature fusion of one of the sutures of the skull. With it, the deformity is usually noticeable from birth, increases, a dense ridge is felt along the suture line, and the growth of head circumference may deviate from the norm. With positional plagiocephaly, the head grows normally, the sutures are mobile, and the deformation is related to position and decreases when changing positions. Craniosynostosis requires observation by a neurosurgeon and often surgery, so if in doubt, the child is referred for consultation and, if necessary, tomography.
- Positional shape: head in the form of a parallelogram, ear shifted forward
- Craniosynostosis: dense ridge along the suture, deformation increases
- Assessment of head circumference dynamics
- Examination by a pediatric neurosurgeon in case of suspicion
- Computed tomography of the skull only when indicated
What should parents do?
A child should sleep on his back - this has been proven to reduce the risk of sudden infant death syndrome, and this rule cannot be abandoned. But you can change the position of the head: alternate the sides to which the baby is turned, turn him in the crib with his head in different directions, change sides when feeding and carry him in different arms. The most important thing is supervised tummy time while awake: starting with a few minutes and building up to an hour total per day. Less time in the car seat, bouncer and swing when not traveling.
- Sleep only on your back, but alternately turning your head
- Laying on the stomach while awake
- Change sides when feeding and wearing
- Turn the baby in the crib with his head in different directions
- Limit time in car seat and bouncer
- Not using positioners and pillows for sleeping is dangerous
Treatment: gymnastics and helmet
If there is torticollis, working with the neck plays a key role: the doctor selects exercises to stretch and strengthen the muscles, and sometimes prescribes massage and physical therapy. Most mild and moderate deformities significantly level out by 6–12 months due to the growth of the skull and the child’s activity. In case of severe asymmetry, if there is no improvement by 4–6 months, a cranial orthosis is discussed - an individual helmet that is worn almost around the clock for several months. The decision is made by a specialist; you cannot select a helmet yourself. Over time, hair hides residual asymmetry.
- Neck mobility exercises for torticollis
- Massage and physiotherapy as prescribed by a doctor
- Positional therapy as the basis of treatment
- Cranial orthosis for severe deformity
- Observation by a pediatrician with head measurement
- Surgical treatment only for craniosynostosis