Worried about that soft lump on your newborn infant's head? Noticing that your 3 month old baby's head seems disproportionately large? Concerned about the flat spot in the back of your 5 month old's skull or the bulging forehead in your 12 month old?
Here's an overview of the conditions that affect head shape in infants. Some of these conditions are completely benign but others can have disastrous consequences if they are ignored.
Keep in mind that you should be attending regular well-baby checks with your pediatrician. At these appointments, your doctor will chart your infant's head circumference, length and weight. It is important to know if your child is within the normal growth curves for his or her age, but it is also important for your doctor to see how quickly or slowly these parameters are changing in your infant.
When to worry about a large but normally-shaped head in an infant:
Babies have heads that are naturally large in proportion to the rest of their body. Your physician may start to worry if he or she notices that the head circumference growth curve is too steep, in other words your baby's head is growing too quickly, or the head circumference is so large that it's well off the growth charts.
Remember that an infant with a head circumference that is consistently a bit off the growth chart may simply be part of a family with large heads. Take note of head or hat size in the parents, siblings and grandparents and you may find a comforting answer to your baby's large head.
When to worry about a soft lump or hard bump in a newborn infant:
Many infants who are delivered vaginally will have some superficial blood vessels break in their scalp. The blood gathers into a soft, raised bruise called a hematoma. The hematoma may disappear quickly or may first turn into a firm bump on the infant's head and then become smaller and smaller till gone.
A hematoma that results from vaginal delivery is a normal and safe condition for your newborn. The only complication may be a mild hyperbilirubinemia from the break down of the old blood. Your pediatrician may need to monitor your newborn's bilirubin levels.
When to worry about a misshapen head in an infant:
The most common cause of a misshapen head in a newborn infant is vaginal birth. The birthing process squeezes the skull, called "molding". Molding is completely natural and will reverse quickly.
The most common cause of a misshapen head in an older infant is called plagiocephaly. This is simply a flat spot on the back or side of the head. If the flat spot on the back of your baby's head isn't centered, then it also has the potential to push the ear and forehead forward on that same side.
Plagiocephaly is increasingly common with the excellent implementation of the "Back To Sleep" program that is intended to reduce the incidence of SIDS (sudden infant death syndrome). Plagiocephaly can be avoided by making an effort to put your baby on their belly to play.
Plagiocephaly persisting past 6 months to 9 months of age may need to be treated with a specially designed head band. Some few doctors may still prefer the head helmet for reshaping your infants head. There is limited evidence showing benefit from either the headband or helmet used for plagiocephaly, thus it is best to prevent this condition in the first place.
Less common forms of misshapen heads in infants arise from a condition called craniosynostosis. The term craniosynostosis refers to the premature closure of the cranial suture lines. The bones of the skull are disconnected from each other at birth. The spaces where the skull bones meet form lines called cranial sutures. Having open cranial sutures allows the bony skull to expand and comfortably contain the growing brain.
If one of the cranial sutures closes early then the brain expands out into the rest of the skull that still has open cranial sutures. The skull will assume different shapes depending on which cranial suture(s) has closed. The types of cranial sutures include:
-metopic suture- down the forehead
-coronal sutures- temple to temple
-sagittal suture- midline down the back half of the skull
-lamboid sutures- back part of the skull
Sometimes the cranial sutures close because the brain has stopped growing. This form of craniosynostosis is actually the most common form and is in the grouping called Secondary Craniosynostosis. In this case, it is possible for the head to be nicely shaped but abnormally small, called microcephaly.
Craniosynostosis can be treated surgically in most cases. It is important to recognize the condition as early as possible. Don't wait to see your pediatrician if you notice anything unusual about the shape of your infant's head.