While making hospital rounds in the newborn nursery over the years, mothers and fathers alike have routinely had dozens of questions pertaining to their newborn - which I might add is a very welcome gesture. A particular question comes on more frequently in my experience than others and this same question commonly comes up again around the fourth month of life. Yes, you guessed right. It has to do with looks and yes, it’s the shape of the head question.

Descent through the birth canal involves a good deal of navigation by the soon to be born fetus. The skull bones are not rigidly fused together and allow ample overlap to adapt the skull shape more appropriately to the contour of the birth canal and an ending with the uneventful extraction of the newborn. This process often leaves the infant head slightly oblong-shaped and this is often mild and temporary. Most newborns have the overlap restored with an improved round shaped skull becoming apparent by the end of the first week after birth. Newborns born through a planned cesarean section or newborns who were positioned in the womb with their legs leading the descent through the birth canal, a condition called breech seldom have this overlap of the skull bones. The skull bones loosely sliding over each other to facilitate descent during the birthing process is described by the medical term, moulding which is apt since the fetal skull moulds itself to accommodate the birthing process.

After birth, the recommended method of positioning newborns to sleep is, back-to-sleep. This was advocated by all the leading experts and medical authorities from 1992 as a way to reduce the chances of smothering and the dreaded, Sudden Infant Death Syndrome (SIDS). Scientific data collected after the recommendation was issued has strongly corroborated this premise and we now have fewer incidences of SIDS today than we had before the implementation of the back-to-sleep program.

Positioning infants to sleep on their back increases the chances of the skull flattening out over the back, especially on the preferred side chosen by the infant. A slight asymmetry happens as a result and parents become understandably unhappy about the cosmetic appearance of the infant. This is most common around the fourth month of life and begins to get better around the sixth to seventh month of life in normal newborns when they get the ability to sit up by themselves and take the additional pressure and dependent gravity off their skull more often. Routine use of infant car seat indoors long after the car ride is over, infrequent use of “tummy-time” earlier, and failure to alternate dependent side of head the newborn lies to sleep on from day to day are some of the other factors besides back-to-sleep by itself that can affect the chances of an infant developing skull deformities attributable to positioning. We encourage readers of this post to first discuss interventions with their physician and review the information below culled from a post dated November 2011 on www.healthychildren.org on “Preventing and Treating Flat Head Syndrome in Babies”

“The American Academy of Pediatrics (AAP) recommends that infants sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths. As a result, pediatricians have seen an increase in the number of children with positional plagiocephaly, or positional skull deformities (flat heads). In the revised AAP clinical report, “Prevention and Management of Positional Skull Deformities in Infants,” in the December 2011 Pediatrics (published online Nov. 28), positional skull deformities are commonly diagnosed as benign, reversible head-shape irregularities that are caused in utero or may develop during the first few months of life, and do not require surgical correction. It is important for pediatricians to be able to differentiate between infants with positional skull deformities and infants with craniosynostosis, a more serious condition that can lead to neurological damage or severe craniofacial deformity. The vast majority of positional plagiocephaly cases can be corrected with physical therapy and noninvasive measures. Helmet therapy is rarely necessary. If the condition appears to be worsening by 6 months, referrals should be made to pediatric neurosurgeons with expertise in caring for this condition to help determine whether a skull-shaping helmet or other interventions are needed.”