Baby's head shape: What's normal?

A baby's head is easily molded, and not necessarily symmetrical. Here's how to prevent flat spots — and detect more serious problems.

Many newborns have slightly lopsided heads. Sometimes a baby's head is molded unevenly while passing through the birth canal. In other cases, head shape changes after birth as a result of spending too much time in one position. Although your baby's head shape will probably even out on its own, you can help prevent flat spots — and detect more serious problems.

How position affects head shape

You'll notice two soft areas at the top of your baby's head where the skull bones haven't yet grown together. These spots, called fontanels, are designed to allow a baby's relatively large head to move through the narrow birth canal. They also accommodate your baby's rapidly growing brain during infancy. But because your baby's skull is malleable, too much time in one position can result in an uneven head shape well past the time when birth-related lopsidedness evens out. This is known as positional molding.

Positional molding is often most noticeable when you're looking at your baby's head from the top down. From that angle, the back of your baby's head may look flatter on one side than on the other. The cheekbone on the flat side may protrude, and the ear on the flat side may look pushed forward.

What you can do about it

Positional molding is most common in babies who spend most of their time on their backs in cribs, car seats or infant seats. Although this is the safest position for sleep, there's plenty you can to do to keep your baby's head from becoming flat or lopsided.

• Change direction. Place your baby on his or her back to sleep, but alternate the direction your baby's head faces. Or place your baby's head near the foot of the crib one day, the head of the crib the next. Use varying positions in the car seat and other infant seats, too. You might also consider using a neck-positioning device — such as a specially designed wedge or U-shaped pad — while your baby sleeps. Never rest your baby's head on a pillow or other type of soft bedding.
• Hold your baby. Holding your baby when he or she is awake will help relieve pressure on your baby's head from swings, carriers and infant seats.
• Try tummy time. With close supervision, place your baby on his or her tummy to play. Make sure the surface is firm. If you must leave the room, bring your baby with you.
• Get creative. Position your baby so that he or she will have to turn away from the flattened side of the head to look at you or to track movement or sound in the room. Move the crib occasionally to give your baby a new vantage point.

Helmets and head shape

Varying a baby's head position is typically enough to prevent or treat flat spots. If the lopsidedness doesn't improve within a few months, your baby's doctor might prescribe a special headband or molded helmet to help shape your baby's head. These devices work by applying gentle but constant pressure in an effort to redirect skull growth.

Headbands and helmets are most effective when treatment begins by ages 3 to 6 months, when the skull is still malleable and the brain is growing rapidly. The headband or helmet is worn continuously during the treatment period — often up to 12 weeks — with time off only to clean the device and the skin underneath. Adjustments to the headband or helmet may be needed every one to two weeks. Correction may be possible for older babies, too, but the headband or helmet may need to be worn more than 12 weeks.

More serious causes

Rarely, two or more of the bony plates in a baby's head fuse prematurely. This rigidity pushes other parts of the head out of shape as the brain expands. This condition, known as craniosynostosis, is typically treated during infancy. To give the brain enough space to grow and develop, the fused bones must be surgically separated.

Keep it in perspective

If you spend too much time worrying about your baby's head shape, you may miss some of the fun of being a new parent. In a few short months, better head and neck control will help your baby keep pressure more evenly distributed on the skull. Until then, change your baby's position often — and check with your baby's doctor if you're concerned about your baby's head shape.