Posterior-type deformational plagiocephaly is caused by constant gravitational forces applied to the occiput when the infant remains for prolonged periods in the same supine position-the sleep position promoted by the American Academy of Pediatrics (AAP) Back to Sleep campaign ( Figure 2). Craniofacial Anomalies. Available at: /healthinfo/pediatric/craniofacial/cranio.htm.)ĭeformational plagiocephaly. (Reprinted with permission from: University of Utah Health Sciences Center. Three of the more common types are shown here. There are numerous types of craniosynostosis, each of which involves a different suture or combination of sutures and results in a distinctive head shape. In craniosynostosis, one or more of the sutures close prematurely, causing problems with normal brain and skull growth and resulting in an abnormal, asymmetric appearance. Reassure parents that a cephalohematoma poses no long-term risk.īecause molding secondary to the birthing process typically resolves in hours to weeks, persistent or progressive shape deformities beyond that time should raise suspicion for deformational plagiocephaly or craniosynostosis.įigure 1 – A normal newborn’s skull consists of several plates of bone that are joined by fibrous sutures that facilitate vaginal delivery and expansion of the growing brain. When discovered by a concerned parent (usually when the child is 1 to 2 months old), such a lump often prompts a visit to the pediatrician. In addition, the calcification of a healing cephalohematoma can produce a distinct lump on the skull, usually on one of the parietal convexities. Difficult deliveries that require the use of forceps or vacuum extraction can result in severe molding. During parturition, the strong forces applied to the skull as it is squeezed through the birth canal cause the bones that make it up to override one another this process can "mold" the head into various shapes. In utero, molding can result from uterine crowding, such as occurs when multiple fetuses share the same womb. Early fusion of one or more of the sutures (craniosynostosis ).Gravitational forces applied to the skull during early infancy (deformational or positional plagiocephaly).External pressure, either applied to the skull during the birthing process or resulting from uterine constraint in cases of multiple births (molding).The major forces that misshape the head include: The posterior fontanelle is more difficult to appreciate on physical examination and often closes in the first few months of life. The anterior fontanelle, easily palpated at the top of the head, typically closes by 18 to 24 months of age. The bones are able to move because they are adjoined by fibrous sutures (junctures between 2 bones) and fontanelles (junctures between more than 2 bones) that remain unossified throughout the first years of life to facilitate vaginal delivery and allow expansion of the growing brain. Odd head shapes develop because the bones of the newborn skull are moveable and malleable. Here we offer a practical, objective approach to determining which patients with odd head shapes require further evaluation and treatment.ĬAUSES OF HEAD SHAPE ABNORMALITIES IN INFANTS How would you respond to this parent's concern? "Does my baby's flat head mean he has to wear a helmet?" That question, recently posed by a concerned parent, is typical of the inquiries pediatricians hear regularly about head shape abnormalities. The need for surgery to correct craniosynostosis depends on the severity and extent of associated deformities. To prevent this disorder, advise parents to provide their child with at least 5 minutes of "tummy time" daily. Deformational plagiocephaly is usually treated with repositioning therapy or, in more severe or recalcitrant cases, helmet therapy. Skull radiographs can rule out craniosynostosis in infants with pronounced shape abnormalities. Those that persist beyond this time or become apparent later require a thorough workup that includes a medical and family history, various skull measurements, checking for torticollis, and careful palpation of the head and neck. Head shape abnormalities caused by molding usually disappear within the first few weeks of life. Craniosynostosis is by far the rarest of these 3 etiologies. ABSTRACT: Head shape abnormalities in infants may be the result of pressure on the malleable bones in the newborn skull during a vaginal delivery (molding), of constant gravitational forces on the occiput when an infant is kept in the same supine position for prolonged periods (positional deformational plagiocephaly), or of premature fusing of one or more of the cranial sutures (craniosynostosis).
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