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Baby's head shape

misshapen; plagiocephaly; head; flat; spot; shape; deformed; deformity; skull; position; growth; uneven; face; asymmetrical;

It is common for a newborn baby to have an mis-shapened head.

Sometimes in the first 6 to 8 weeks after birth, a baby will develop a flattened spot (plagiocephaly) on the back or side of her head rather than having a rounded shape. This does not affect growth of the baby's brain, but it can cause uneven growth of the baby's face as well as her head.

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It is common for a newborn baby to have an mis-shapened head.

  • This can be caused by the position of the baby before birth, or by 'moulding' of the head during birth. Moulding happens when pressure in the birth canal moves the skull bones a little so that the head moves through the birth canal more easily.
  • A baby's head will become a more normal shape within about 6 weeks. By 6 weeks, a baby should also be able to turn his head from side to side.

Sometimes in the first 6 to 8 weeks after birth, a baby will develop a flattened spot on the back or side of her head rather than having a rounded shape. This is called plagiocephaly (play-gi-o-cef-a-ly).

Plagiocephaly does not affect growth of the baby's brain, but it can cause uneven growth of the baby's face as well as her head.

Causes of plagiocephaly

  • The bones of a newborn baby's head are thin and flexible, so the skull can change shape if there is pressure on part of it for a long time.
  • Flattening of the back or side of the head happens when the baby lies with his head in the same position for a long time (for example, lying on his back with his head always facing up or always turned to the same side). Pressure from the weight of the baby's head will cause the flattening.
  • Sometimes one of the muscles in the neck is tight, so that the baby's head is turned to the same side most of the time. See 'Congenital torticollis'.

What does it look like?

Normally the back of the head is rounded, the ear position is level and the face looks the same shape on each side.

  • With a misshapen head, there will be a flat spot on one side of the back of the head, one ear will be further forward than the other, and one side of the face will be further forward.
    Example of misshapen head (plagiocephaly)
  • Having a flat spot makes it harder for a baby to turn her head, because she has to lift it slightly as she turns it. You may notice that she keeps her head turned to the same side most of the time.
  • A small flat spot on the back of the head is common, and this is not plagiocephaly unless the rest of the head is also becoming misshapen. However, this needs to be watched, as any flattening makes it a bit harder for a baby to turn her head by herself.

Preventing a misshapen head

A baby's head position needs to be varied during times she is asleep and awake, particularly in the first 6 weeks.

During sleep:

  • Babies should always sleep on their back. This makes them much less likely to die from SIDS.
  • Place your baby's head to the right side for some sleeps, and to the left for other sleeps.

Cot position:

  • Place your baby at the other end of the cot for some sleeps, or move the cot around in his room. Babies like looking at windows or bright objects like murals, and by moving the cot you will encourage him to turn his head different ways to look at them.

Play time:

  • Put your baby on her tummy and on her side for some of the time while she is awake.
  • Start small amounts of tummy time from birth. In the early weeks your baby may seem a little unhappy on her tummy, but as she gets used to it and her muscles get stronger she will enjoy this time and it is good for muscle development.
  • When she is on her back, move toys that she likes to look at from side to side.

Holding your baby:

Holding your baby erect, either while having a cuddle or having your baby in a sling will also take pressure off the back of the head.

Treatment

  • If, after your baby is about 6 weeks old, you are concerned about the shape of his head, or you notice that your baby only turns his head to one side, talk to your doctor or child health nurse.
  • Plagiocephaly is the most common cause of a misshapen head, but there are other, rare causes which can cause problems with head growth.
    • Sometimes a baby will hold his head turned to one side all the time because of a tight muscle in his neck (see the topic 'Congenital torticollis'). This can be confused with plagiocephaly.
    • If the baby's head is quite obviously quite misshapen, it is important to see a specialist (such as a plastic surgeon) early.
  • Most children with plagiocephaly do not need to have any treatment. Their heads will become more rounded as they move more and begin to sit up.
  • However, it is still worth placing the baby's head in different positions (as described above) and moving the baby or her toys around so that she wants to move her head to look at interesting things.
  • Very gentle stretching of neck muscles may be useful, because the muscles may tighten if the baby's head is always in the same position. Get advice from a doctor, physiotherapist or child health nurse before starting this.
  • Sometimes a baby does need treatment for the shape of his head. The baby will need to be assessed by a plastic surgeon who will be able to advise you about whether a helmet might be needed. For more information about this have a look at the Fact Sheet about Plagiocephaly from the Royal Children's Hospital (link below).

References

SIDS and Kids 'Baby's head shape - information statement - 2009'
http://www.sidsandkids.org/wp-content/uploads/BabysHeadShape.pdf

The Royal Children's Hospital (Melbourne) 'Plagiocephaly (misshapen head)' http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=7666

The Royal Children's Hospital, Australian Physiotherapy Association, Physiotherapy Research Foundation and SIDS and Kids pamphlet 'How to protect the head shape of your baby' 2005.

Shweikeh F, et al
Positional Plagiocephaly: An Analysis of the Literature on the Effectiveness of Current Guidelines
Neurosurg Focus. 2013;35(4):e1

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

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