Head Shape
When babies come out ready to join the world, their heads can be a bit wonky looking, and that is okay (see section on fontanelles). Over the next 6 to 18 months, a kiddo’s head shape will change dramatically. Because the skull for babies is made up of all these moving plates, the way that babies are positioned over time has a lot to do with their head shape during infancy. Pretty much all babies have some sort of flat spot on their head at 1-2 months of age because, as pediatricians, we tell y’all to put baby on their back for a safe sleeping position, and because babies sleep a lot and spend a lot of time on their back, that pressure will cause movement of the skull plates away from the pressure, causing a flat spot. Now not to worry, this will often self-correct as kiddos spend more time in upright positions, but sometimes it does not self-correct. This can be due to common causes like always holding or feeding a baby on one side. Or baby prefers to look at their parents when sleeping, and we don’t change where baby’s head is in relation to their feet every couple of days or so. No need to get those fancy head pillows, oftentimes just making parents aware that variety in where the head is in space throughout the day is the spice of life when it comes to a nice eventual head shape for baby.
It is also good to remember that you don’t want a perfectly round head or your kiddo can look like Charlie Brown and no one wants that. Some definition and differences are OK. As pediatricians, we are OK with pretty much any head shape as long as the ears and eyes are lined up by the time the fontanelles (soft spots between the skull bones) disappear.
Sometimes a baby is born with tightness in their neck muscles, also called torticollis, that makes them always have their head and neck in a certain position, leading to very prominent head shape abnormalities called positional plagiocephaly. To remedy this will often require physical therapy for baby and training for parents on how to promote more equal movement of the head and neck allowing for less chance of awkward head shapes. In the more extreme cases, your pediatrician may request an evaluation with a specialist in craniofacial (head and face) medicine to provide for more accurate measurement and monitoring, or even for fitting for a helmet that will provide the right pressure over the right parts of the head to make the head shape more even over time. We usually need to make the decision to go for the helmet by 6 months of age.