Positional cranial deformities refer to atypical head shapes that result from external forces applied to the soft infant skull. Infants are susceptible to developing this condition because their heads are soft and malleable in order to allow for the incredible amount of brain growth that occurs during the first year of life.
Three atypical head shapes are described below. These head shapes can also occur in combination, for example, plagiocephaly with brachycephaly (flatness across the entire back of the head, with one side of the back flatter than the other) or plagiocephaly with scaphocephaly (long and narrow head shape with one side of the back flatter than the other).
Positional cranial deformities can occur before, during or after birth under various conditions:
- Pressure placed on the baby’s skull in the womb by the mother’s pelvis or a twin
- Birth trauma during labor and delivery
- Neck muscle asymmetry
- Premature babies since they have softer skulls than full-term babies
- Sleep positioning after birth
Positional cranial deformities should not be confused with craniosynostosis, which is a more serious medical condition resulting from premature closure of the gaps between the skull bones. The incidence of craniosynostosis is very rare compared to that of positional cranial deformity. Surgical correction is typically required. Craniosynostosis can be ruled out by the pediatrician.
Plagiocephaly
- Asymmetric flattening visible at back of the head, side of head, and/or forehead
- Parallelogram shape from a bird’s-eye view
- Ears may not symmetrically aligned
- One eye may appear smaller
- One cheek may appear fuller
- Asymmetric forehead
- Top of head may slope down on one side
Brachycephaly
- Head disproportionately wide
- Back of head is flat
- Height at the back of the head is increased
- Bumps/bulging above the ears
- Face may appear small relative to head size
Scaphocephaly
- Head is disproportionately long
- Width of head is narrow
- Sides of head may appear flat
- Forehead may appear square-shaped
- Common in premature infants positioned in sidelying in the NICU
- Baby’s head tends to fall over to one side or other when lying down
- May impact ability to develop neck extension against gravity and midline head and neck control
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