An abnormal head shape in infants can be caused by two main problems: positional molding or craniosynostosis. Once we know the cause of the abnormal head shape, we can plan for the best treatment.
What is Positional Molding?
Infants may have an abnormal head shape from sleeping in the same position for a long time. This is “positional molding” or “positional plagiocephaly”. This problem is now more common since babies are always placed on their backs to sleep. Positional molding often corrects itself with a change in sleeping position such as turning the infant’s head to the other side or supervised tummy time. Surgery is not needed to correct this problem. These children have normal brain development.
What is Craniosynostosis?
The fibrous tissues between an infant’s skull bones are called “sutures”. As a baby’s brain grows, sutures allow the skull to expand. (Figure 1) Normally, when the child is about 2 years old, the head stops growing. At this time, the sutures close and bone develops at the suture site.
If one or more of these sutures close too early, craniosynostosis is the result. When this happens, brain growth leads to an abnormal shape of the head. The shape of the skull will depend on the type of suture that closes too early.
There are six main sutures that may close early and cause this problem. If the Metopic Suture closes early, the forehead becomes pointed like a triangle. If one of the two Coronal Sutures close early, the forehead is flat on the affected side. If one of the two Lamboidal Sutures closes early, the back of the head is flat on the affected side. If the Sagittal Suture closes early, the head is long and thin.
How Is Craniosynostosis Diagnosed?
Within the first few months of birth, you and your doctor may notice that your child’s head is taking on an unusual shape. Your doctor will feel the child’s suture ridges and soft spots. Your doctor may ask a brain surgeon and a plastic surgeon to help decide the cause of your child’s head shape. The cause will be found by checking the shape of the head and the position of the ears.
If the cause of the problem is craniosynostosis, the doctors decide if it is mild, moderate, or severe. Mild or moderate cases do not affect brain growth or cause pressure on the brain. Surgery in these cases would be to make the head look better. In the rare severe cases, or if many sutures are closed or absent, pressure can build up in the head. Surgery in such cases is required.
Types of Craniosynostosis
Medical Term for Head Shape Fused Suture(s)
|Trigoncephaly||Metopic and/or Coronal Sutures|
|Brachycephaly||Both Coronal Sutures|
|Anterior Plagiocephaly||One Coronal Suture|
|Posterior Plagiocephaly||One Lambdoidal Suture|
Surgery for Craniosynostosis
The type of surgery depends on which sutures are involved. Your surgeons will explain the treatment for your child. The brain surgeon often works with a plastic surgeon to fix this problem. The surgeons shave the least bit of hair needed. Then they make a zigzag cut from ear to ear over the top of the head. The scalp is peeled back so they can see the skull. With the use of plates, wires and stitches the skull is changed to a more normal shape. The head will not reach its final shape for months. Surgery takes 4-6 hours, and when the treatment is done, the scalp is stitched closed.
Many children are now being treated with the use of a small camera (endoscope). This is used to look at the skull through two small cuts on the scalp. The skull is then shaped in much the same way as the treatment we discussed above.
Before surgery, your child will have a work-up. This includes an exam of his body, and blood tests. You will talk to people in anesthesia and admissions. The night before and the morning of the treatment, you will need to wash your child’s hair with Dial® soap.. It is common to receive blood with this treatment, so if you wish to donate blood for your child, do this at least 2 weeks before surgery. Your child should have nothing to eat or drink for 8 hours before surgery.
After surgery, your child will go to the Pediatric Intensive Care unit (PICU) for at least one night where he can be watched more closely. At first, your child will receive a stronger pain medicine. After a few days, he may only need something like Tylenol® or Motrin® for pain.
Your child will have a thick gauze bandage on his head. This dressing will be changed in 1-3 days. It may be removed completely before going home. Also, your child’s face will be swollen, eyes may swell shut, and the face may be bruised.
When your child is eating and drinking without feeling sick, he will be able to go home. This often occurs in 5 days. Your child should be seen in the neurosurgery clinic 7-10 days after surgery. The incision should be kept clean and dry until that visit.
When to Call
Please call if you notice any of these symptoms:
- Fever greater than 101.5° F
- Drainage from the incision
- Redness or swelling at the incision site
If you have any questions please call:
Catie, RN Call (608) 262-2761
Lisa, RN Call (608) 890-6942
After hours, weekends and holidays, call the paging operator (608) 262-0486. Ask for the neurosurgeon on call. Give your name and phone number with the area code. The doctor will call you back.
To schedule an appointment, call (608) 263-6420.
If you live out of the area, call 1-800-323-8942.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/23/2011
Copyright © 12/23/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5436
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