Molding of newborn head

A Head-to-Toe Guide on Your Newborn’s Physical Features

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When you first lay eyes on your baby, chances are you’ll think he’s absolutely perfect, but you can’t help noticing that his body has a few blemishes. So what’s normal? Here, a head-to-toe guide to your newborn’s birthday suit.

Head

If you gave birth vaginally, your baby’s head may be elongated or misshapen. “The odd shape of the head is the result of the baby passing through the birth canal,” explains Richard L. Saphir, M.D., clinical professor of pediatrics at Mt. Sinai School of Medicine in New York City. The two soft spots on your baby’s head, called fontanels, aren’t fused yet in order to make delivery easier. The head should take on a more normal shape within two weeks.

Babies born by Cesarean section are more likely to enter the world with picture-perfect round heads, though not always: The tops of C-section babies’ skulls can appear flat, mimicking the shape of the womb. Flat-tops, which are more common in breech babies, change more gradually, Saphir says, sometimes taking a full year.

  • RELATED: 10 Things to Know About Newborns

You also may notice your baby has a recessed chin; it’s just nature’s temporary way of making it easier for him to breastfeed.

Hair

Some babies are born bald; others arrive with a full head of hair. The texture and color may be equally surprising – fair-haired couple may leave the hospital with a raven-haired infant, while dark-haired parents are often surprised to bring home a blond. Babies who are born late may have especially large amounts of coarse hair.

Either way, don’t be alarmed. A newborn’s hair is a terrible predictor of what it will look like in a few months. “By four to six months, most newborn hair will be gone,” Saphir says. That’s because hormonal changes after birth cause a baby’s hair follicles to enter a period of rest, followed by regrowth.

Some babies are born with a substantial coating of fine hair over most of their bodies. This soft, downy hair, called lanugo, covers all babies in the womb, but most of it usually sheds several weeks before birth. Although most babies are born with some lanugo, preterm babies are likely to have more of it at birth than full-term babies; within a few weeks the hair will naturally shed.

Eyes

You’ll never forget the first time your eyes meet your newborn’s. Yet that tender moment can be quickly supplanted by alarm: Why is my baby cross-eyed? “Almost all newborn babies will have somewhat crossed eyes,” Saphir says. “Just as a newborn doesn’t have the muscle strength and coordination to crawl, newborns don’t have the eye-muscle strength and coordination to synchronize eye movements.”

Most Caucasian babies are born with blue eyes that may go through several color changes in the first few months. They usually darken to their final color between 6 and 12 months. Darker-skinned babies are usually born with brown eyes, which tend to stay brown or turn another dark color, such as a deep green.

Babies delivered vaginally also may have some blood spots in the whites of their eyes (from the pressure of being pushed through the birth canal). These will disappear within a few days.

  • RELATED: Newborn Baby Bootcamp: Taking Care of a Newborn

Skin

Your baby’s skin will be a telltale sign of gestational age: Babies born early have thin, almost translucent skin and may still be covered in vernix – the white, greasy coating that protects the fetus’ skin from amniotic fluid. Babies who arrive past their due dates, on the other hand, may have almost no lanugo and a wrinkly appearance, as if they’ve been lolling in the bath a little too long.

Your newborn will be wrinkly because she’s just spent nine months in fluid – and now she’s exposed to dry air, plus she’s a little dehydrated right after birth. Her circulatory system isn’t quite up to speed yet, so when she sleeps, her hands and feet may look bluish. If you’re worried, pick her up and watch her skin return to a normal color.

It’s common for babies to be born with some form of skin rash, and the most common in newborns is milia—flat, minuscule white dots that resemble pimples and often pop up on the face. These may look like acne, but are merely blocked sweat and oil glands. Milia disappears within two to three weeks, Saphir says. In the meantime, it’s fine to gently wash the area with mild soap and water. True “baby acne” can appear after the first month, but it’s harmless and disappears on its own.

Birthmarks

Fair-skinned babies often have a hemangioma, a cluster of red blood vessels close to the surface of the skin that go by the name “stork bites” or “salmon patches.” They tend to disappear over several months; those that appear on the back of the neck are more likely to persist. “Strawberry hemangiomas” are more raised and last longer, but they, too, are most likely temporary: 30 percent disappear within three months; 60 percent within six months; and 90 percent within nine months.

  • RELATED: What Will My Baby Look Like?

Asian, African and other dark-skinned babies may be born with “Mongolian spots,” deeply pigmented birthmarks usually found on the lower back or buttocks. “Mongolian spots can persist, but they become less noticeable because they get lighter while the rest of the skin becomes darker,” Stratbucker says.

Umbilical cord

Something you never see on TV is the little plastic clamp that will be placed on your baby’s umbilical cord stump, which will shrivel and come off in an average of 10 days (though this can take up to three weeks). In the meantime, you don’t have to compulsively swab the stump with alcohol. “It’s an open wound and you want to keep it clean and dry,” says Bill Stratbucker, M.D., assistant professor of pediatrics at Rush University Medical Center in Chicago, adding that washing the stump with gentle soap and water is sufficient.

Some babies have a noticeably puffy appearance around the umbilical cord, where the abdominal muscles are still weak. These “umbilical hernias” usually resolve on their own in nine months to a year, says Stratbucker, as the surrounding muscles get stronger. (Steer clear of “belly bands” and old wives’ tales that advise taping a silver dollar to your baby’s belly—neither is necessary and can be potentially harmful.)

Feet

Don’t worry if Baby’s feet look pigeon-toed. They’ve rotated inward because he was curled up snugly in the womb for nine months. After about 6 months, they’ll relax into a straighter position. He may also appear to have flat feet, but his arch is there – it’s just hidden by a pad of fat.

The key is to remember that no two babies are alike, which is, after all, what makes each infant so special. “A baby will come out looking different from her sibling or her neighbor in the nursery,” Saphir says. So relax, and savor your baby’s uniqueness.

  • By Kate Jackson Kelly

Newborn head molding

The bones of a newborn baby’s skull are soft and flexible, with gaps between the plates of bone.

The spaces between the bony plates of the skull are called cranial sutures. The front (anterior) and back (posterior) fontanelles are 2 gaps that are particularly large. These are the soft spots you can feel when you touch the top of your baby’s head.

When a baby is born in a head-first position, pressure on the head in the birth canal may mold the head into an oblong shape. These spaces between the bones allow the baby’s head to change shape. Depending on the amount and length of pressure, the skull bones may even overlap.

These spaces also allow the brain to grow inside the skull bones. They will close as the brain reaches its full size.

Fluid may also collect in the baby’s scalp (caput succedaneum), or blood may collect beneath the scalp (cephalohematoma). This may further distort the shape and appearance of the baby’s head. Fluid and blood collection in and around the scalp is common during delivery. It will most often go away in a few days.

If your baby is born breech (buttocks or feet first) or by cesarean delivery (C-section), the head is most often round. Very severe abnormalities in head size are NOT related to molding.

Related topics include:

  • Craniosynostosis
  • Macrocephaly (abnormally large head size)
  • Microcephaly (abnormally small head size)

The bones of a newborn baby’s skull are soft and flexible, with gaps between the plates of bone.

The spaces between the bony plates of the skull are called cranial sutures. The front (anterior) and back (posterior) fontanelles are 2 gaps that are particularly large. These are the soft spots you can feel when you touch the top of your baby’s head.

When a baby is born in a head-first position, pressure on the head in the birth canal may mold the head into an oblong shape. These spaces between the bones allow the baby’s head to change shape. Depending on the amount and length of pressure, the skull bones may even overlap.

These spaces also allow the brain to grow inside the skull bones. They will close as the brain reaches its full size.

Fluid may also collect in the baby’s scalp (caput succedaneum), or blood may collect beneath the scalp (cephalohematoma). This may further distort the shape and appearance of the baby’s head. Fluid and blood collection in and around the scalp is common during delivery. It will most often go away in a few days.

If your baby is born breech (buttocks or feet first) or by cesarean delivery (C-section), the head is most often round. Very severe abnormalities in head size are NOT related to molding.

Related topics include:

  • Craniosynostosis
  • Macrocephaly (abnormally large head size)
  • Microcephaly (abnormally small head size)

Bringing a baby home from the hospital can be a scary time for a parent as they navigate the first few months as an expanded family. The list of things to worry about as a child develops can seem endless, and baby’s head shape is a common item on that list. Usually, the head shape issue is due to a benign condition called Positional Plagiocephaly. Your doctor will help to make sure it is not due to a more serious condition called Craniosynostosis.

What Is Positional Plagiocephaly?

When babies are born their skulls are soft, which helps them pass through the birth canal. It can take 9-18 months before a baby’s skull is fully formed. During this time some babies develop positional plagiocephaly. This means that there is a flat area on the back or side of the head. Positional plagiocephaly does not affect brain growth or development; it is purely a shape issue.

What Causes Positional Plagiocephaly?

A flat area on the back or side of the head is commonly caused by repeated pressure to the same area. This usually happens when a child prefers to lay on his or her head on the same spot, causing the head to be misshapen. Other causes include:

  • Baby’s position in the womb that puts pressure on the head
  • More than one baby in the same pregnancy
  • Spending too much time laying on his or her back
  • Torticollis (a tight muscle on one side of the neck), which can cause the head to tilt one way or make it hard to turn the head

Please note: As part of the recommended ABC’s of safe sleep, babies should always sleep Alone, on their Backs, in a Crib to reduce the risk of Sudden Infant Death Syndrome (SIDS).

How Is Positional Plagiocephaly treated?

In many children the flattening is corrected as the child becomes more mobile and lies less on the affected area. Other techniques include:

  • When your child is on his or her back, gently turn the head to the side that is not flat. This is the “non-preferred side”. Changing sides takes pressure off the flat spot. Do NOT use anything to keep the head in place; it might block the face and keep the child from breathing
  • Place a toy or Velcro a wrist rattle to your child’s left or right hand to encourage him or her to look toward their non-preferred side and take pressure off the flat side. You can also hold toys at the non-preferred side to encourage looking in that direction.
  • When awake, limit the time your baby spends in swings or baby carriers. If your child is able to sit up, it will take the pressure off the back of the head and builds neck strength.
  • In infants that cannot sit for long periods, increase the amount of supervised tummy time when the child is awake.
  • When you hold your baby make sure there is no pressure on the flattened side of the head.

In some cases these methods will not help the head to round out. In these instances your child’s primary care doctor will discuss with you the pros and cons of using a custom-made helmet or band. These devices work by redirecting head growth and are typically highly effective.

What Is Craniosynostosis?

The skull is formed by multiple different bones. The junctions between the bones are called sutures. Craniosynostosis occurs when one or more of the sutures closes early. Early suture closure can cause the skull to grow in an unusual shape. Sometimes, early suture closure can also restrict overall skull growth which may be harmful to the brain inside which is trying to grow.

Left untreated, craniosynostosis can result in further cranial deformity and potentially an overall restriction in head growth, with secondary increased intracranial pressure. It can also lead to psychosocial issues as the child interacts with peers during development.

What Are the Signs and Symptoms of Craniosynostosis?

The most apparent sign of craniosynostosis is typically an abnormally shaped head. The soft spot may be open or closed. Less common is a restriction of head growth with the measurements “falling off” the pediatrician’s growth curves. This can lead to build-up of pressure inside the skull. Signs of high pressure may include:

  • Headache
  • Nausea
  • Vomiting
  • Lethargy (very sleepy, difficult to wake)
  • Difficulty moving eyes up
  • Keeping eyes down all of the time (looks like the setting sun on the horizon)
  • Bulging and/or tense soft spot (when patient is upright and does not have respiratory infection)

How Common is Craniosynostosis?

The condition occurs in one out of every 2,000 to 2,500 live births.

What Causes Craniosynostosis?

In most infants, the cause of craniosynostosis is unknown and the child is otherwise healthy. Sometimes the cause is familial or genetic – a change occurs in one or more genes to result in the condition.

How Is Craniosynostosis Diagnosed?

Sometimes, craniosynostosis can be diagnosed with an office examination alone. Often imaging will be used to more closely examine the cranial sutures and confirm the diagnosis. Here at Nationwide Children’s we use a special CT scan that provides 3D views of the skull using an ultra-low radiation dose equal to that of only a few regular x-rays.

How Is Craniosynostosis Treated?

Treating craniosynostosis usually involves surgery to unlock the bones and reshape the skull. Historically, craniosynostosis has been treated using surgical methods that involve an incision from ear to ear and the removal, reshaping, and reattachment of affected bones. Sometimes this is still the best option. However, at Nationwide Children’s, advances in technology are allowing us to conduct more of these procedures in a minimally invasive manner. Left untreated, the head shape will likely worsen but, more importantly, there is a risk for overall head growth restriction with development of increased pressure on the brain.

Face Presentation and Birth Injury

Normally, children are born head-first with the chin tucked towards the chest (vertex presentation). In a face presentation, the chin is not tucked and the neck is hyperextended. This can inhibit the engagement of the head and complicate the labor process. In some cases, a baby in face presentation can be delivered vaginally, but in other cases vaginal delivery is difficult and dangerous. Face presentation increases the risk of facial edema, skull molding, breathing problems (due to tracheal and laryngeal trauma), prolonged labor, fetal distress, spinal cord injuries, permanent brain damage, and neonatal death. Usually, medical staff conduct a vaginal examination to determine the position of the baby. If they suspect an abnormal presentation, they can confirm with an ultrasound and take action to properly handle the delivery of a baby in the face presentation. This includes additional monitoring and in some cases requires a C-Section. Because ventilation issues are more common in babies with face presentation, staff should be ready to intubate immediately after delivery (1).

Image by healthand.com

Jump to:

  • Video: face presentation demonstration
  • Risk factors and causes
  • Diagnosing face presentation
  • Face presentation and delivery
  • Complications and side effects
  • Standards of care, medical malpractice, and face presentation
  • Trusted birth injury attorneys
  • Sources

Risk factors and causes of face presentation

Conditions that may increase the likelihood of a face presentation include the following (1, 2, 3, 4):

  • Prematurity
  • Very low birth weight
  • Fetal macrosomia (large baby)
  • Cephalopelvic disproportion, or CPD (a mismatch in size between the mother’s pelvis and the baby’s head)
  • Anencephaly (a birth defect in which the baby is missing part of the brain and skull)
  • Severe hydrocephalus with enlargement of the head
  • Anterior neck mass
  • Multiple nuchal cords (umbilical cord wrapped around baby’s neck more than once)
  • Maternal pelvis abnormalities
  • Maternal obesity
  • Multiparity (the mother has previously given birth)
  • Polyhydramnios (too much amniotic fluid)
  • Previous cesarean delivery
  • Black race

Diagnosing face presentation

Face presentation is diagnosed late in the first or second stage of labor by vaginal examination. The distinctive facial features of the chin, mouth, nose, and cheekbones can be felt. Face presentation is sometimes confused with breech presentation (because both are characterized by soft tissues with an orifice), which is why it is imperative that a very skilled physician be present during any potentially risky delivery or malpresentation. Diagnosis can be confirmed by an ultrasound, which reveals a deflexed/hyperextended neck (1).

Face presentation and delivery

There are three types of face presentation:

  • Mentum anterior (MA). In this position, the chin is facing the front of the mother, and will be the presenting part of the face. Babies in mentum anterior position are usually delivered vaginally, although in some cases a C-section may be necessary.
  • Mentum posterior (MP). In this position, the chin is facing the mother’s back. The baby’s head, neck, and shoulders enter the pelvis at the same time, and the pelvis is usually not large enough to accommodate this (however, the baby may spontaneously rotate into mentum anterior position) . Typically, a C-section is indicated, but there are certain circumstances under which vaginal delivery may be attempted (e.g. the mother is multiparous, the infant in face presentation is relatively small compared to her other children, fetal monitoring is reassuring, and the baby is progressing in labor). Regardless, the medical team should be prepared to perform a prompt C-section if there are any complications.
  • Mentum transverse (MT). In this position, the baby’s chin is facing the side of the birth canal. Doctors may recommend a trial of labor under certain circumstances, but they should promptly proceed to a C-section if there are issues. If labor is progressing and the fetal heart monitor is reassuring when face presentation is present, physician intervention may not be necessary since many MP and MT positions convert to MA. Oxytocin (Pitocin) augmentation may be used in a face presentation with a normal fetus and abnormally slow progress, as long as fetal heart rate patterns remain reassuring (although there are certain risks associated with this drug, including uterine tachysystole). Of course, in any face presentation, if progress in dilation and descent ceases despite adequate contractions, delivery must occur by C-section.

There is an increased risk of trauma to the baby when the face presents first, and the physician should not internally manipulate (try to rotate) the baby. In addition, the physician must not use vacuum extractors or manual extraction (grasping the baby with hands) to pull the baby from the uterine cavity. Furthermore, midforceps (forcep extraction when the baby’s station is above +2 cm, but the head is engaged) should never be used. Outlet forceps should only be used by experienced physicians who understand the circumstances under which this is appropriate (1).

Abnormalities of the fetal heart rate occur more frequently with face presentation. In one study, 59% of infants in face presentation had variable heart decelerations, and 24% had late decelerations. Of the babies who were born live, 37% had 1-minute Apgar scores lower than 7, and 13% had 5-minute Apgar scores lower than 7. The majority of the low 5-minute Apgar scores were babies that had been in mentum posterior position (5).

For these reasons, it is crucial that babies are continuously monitored during labor, ideally with an external heart monitoring device. An internal device may cause facial or eye injuries if improperly placed. If internal monitoring is needed, the electrode should be cautiously placed over a bony structure such as the forehead, jaw or cheekbone to minimize the risk of trauma (1).

It is always critical that doctors obtain a mother’s informed consent, which means discussing delivery options (vaginal, C-section, enhanced with oxytocin, etc.) with her and explaining the potential risks and benefits of each. Failure to do so constitutes negligence.

Complications and side effects of face presentation

Complications associated with face presentation include the following:

  • Prolonged labor
  • Facial trauma
  • Facial edema (fluid build up in the face, often caused by trauma)
  • Skull molding (abnormal head shape that results from pressure on the baby’s head during childbirth)
  • Respiratory distress/difficulty in ventilation due to airway trauma and edema
  • Spinal cord injury
  • Abnormal fetal heart rate patterns
  • Low Apgar score

A baby may be at increased risk of complications if forceps or oxytocin are used during labor. Forceps can cause traumatic injury to the head, and oxytocin can deprive a baby of oxygen due to uterine tachysystole/hyperstimulation (strong, frequent contractions). Hyperstimulation increases pressure on the blood vessels in the womb, which can deprive the baby of oxygen-rich blood.

Trauma to the head and decreased oxygenation can cause permanent brain damage, such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP), as well as fetal deaths.

Standards of care, medical malpractice, and face presentation

Informed consent must be given during all medical procedures. This means that when a mother has a baby with face presentation, she must be given the option of a C-section versus a vaginal birth. One of the reasons a mother may opt for a C-section is to avoid the extensive facial bruising/trauma that is common in babies with face presentation. In addition to thoroughly explaining the risks and benefits of each type of delivery method, the physician must explain and obtain consent from the mother if forceps or oxytocin are used.

Because there are many complications associated with face presentation, it is essential that the baby be closely monitored and that delivery is handled by a physician with experience in this area. Furthermore, the physician must quickly proceed to a C-section delivery if there are any signs of fetal distress, labor is not progressing, or the baby fails to convert (rotate) to MA position. In addition, once a face presentation is diagnosed, the physician must check for pelvic adequacy. When the pelvis is inadequate (contracted/small), a C-section is recommended (1).

Since respiratory problems can occur in babies with face presentation, equipment and staff to perform intubation of the baby (placement of a breathing tube) should be readily available at the time of delivery.

Failure to follow any of these standards of care is negligence. If this negligence results in injury to the baby, it is medical malpractice.

Trusted birth injury attorneys

If your baby has HIE, cerebral palsy, periventricular leukomalacia (PVL), developmental delays, a seizure disorder, or any other birth injury, we may be able to help. Unlike other firms, the attorneys at ABC Law Centers (Reiter & Walsh, P.C.) focus solely on birth injury cases and have been helping children throughout the nation since 1997. During your free legal consultation, our attorneys will discuss your case with you, determine if negligence caused your loved one’s injuries, identify the negligent party, and discuss your legal options with you. Moreover, you pay nothing throughout the entire legal process unless we win or favorably settle your case.

“Reiter and Walsh goes above and beyond the norm in getting their clients the best possible results. Each client is treated with respect and compassion, and they are truly sensitive to what it means to help a family whose child has been injured.”

-Client review from 11/23/2015

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Sources

The above information is intended to be an educational resource. It is not meant to be, and should not be interpreted as, medical advice.

As anyone who has gingerly handled a new baby will know, infants are born with soft skulls. their heads need to be a bit squishy in order to make it through the relatively narrow birth canal. But the details of “fetal head molding,” as doctors call the shape changes that occurs to babies’ heads during labor, are not well understood. It isn’t easy, after all, to peek inside a mother as she is giving birth.

But as Mindy Weisberger reports for Live Science, researchers in France have done just that. For a new study published in PLOS One, medical experts used 3-D M.R.I. to capture remarkably detailed images of babies’ skulls and brains during advanced stages of labor. Their findings suggest that infants’ little noggins undergo considerable stress during birth—more so than experts had previously thought.

Twenty-seven pregnant women consented to recieving M.R.I. scans before they gave birth, and of those, seven agreed to be scanned during the second stage of labor—the period between when the cervix has dilated to 10 centimeters and the baby is born. The imaging was performed no more than ten minutes before “expulsory effort,” or when the baby descends into the birth canal and mother can begin to push. After the images were taken, the mothers were swiftly rushed to the delivery room; “Patient transportation time from the M.R.I. suite to the delivery room in the same building, bed to bed, was less than three minutes,” the study authors note.

Upon comparing the pre-labor and mid-labor images, the researchers were able to see that all seven babies experienced fetal head molding. This means that different parts of the skull overlapped, to varying degrees, during the birthing process. Infants’ skulls are thus comprised of several bony sections, held together by fibrous materials called sutures, that eventually fuse as the baby grows outside the womb. (Researchers know that skull shifting during birth has been happening in humans and their ancestors for millions of years; it’s an adaptation to the evolution of larger brains and the switch to upright walking, which altered the shape of the pelvis.)

Three-dimensional finite element reconstruction of the cranial bones before labor and during the second stage of labor (Ami et al., 2019)

Still, the researchers were surprised by just how much babies’ heads were squishing as they moved through the birth canal. “When we showed the fetal head changing shape, we discovered that we had underestimated a lot of the brain compression during birth,” first study author Olivier Ami, an obstetrician and gynecologist at University of Clermont Auvergne in France, tells Erika Edwards of NBC News.

The skulls of five of the babies under observation quickly returned to their pre-birth state, but changes persisted in two of the babies—possibly due to differences in the elasticity of the skull bones and the supporting fibrous material, among other factors. Two of the three babies with the largest degree of head molding still needed to be delivered via C-section, indicating that mothers may not always be able to give birth vaginally, “even when significant fetal molding occurs,” the study authors note.

Interestingly, the third baby among those with the highest degrees of head warping initially scored low on the Apgar test, which is given to babies soon after birth and assesses skin color, pulse, reflexes, muscle tone and breathing rate. By the time the baby was 10 minutes old, however, its score had risen to a perfect 10. The researchers do not yet know how or if ease of delivery—the infant was born vagianally and the delivery was “uncomplicated”—and fetal head molding factors into this “risky clinical presentation,” the study authors note. But it does suggest that we might need to rethink the how we view “normal births,” which are typically defined as natural births that happen with “only a few maternal expulsive efforts.”

“This definition does not take into consideration the ability of the fetal head to deform,” the researchers explain. “If the fetal head’s compliance is high, the skull and brain may undergo significant deformation as the birth canal is crossed, and the child’s condition at birth may not be good.”

Revelations about the stresses that come with fetal head molding might also explain why some babies are born with retinal and brain hemorrhages, the latter of which can lead to complications like cerebral palsy, Edwards reports. And though the study is small, the researchers say the high quality imaging could inform efforts to develop a “more realistic simulation of delivery” that will help medical experts predict which mothers are at risk of running into biomechanical complications during childbirth—and intervene before harm comes to the baby.

When Nikki and her husband arrived at the hospital for the birth of their second child, she was four days past her due date. She was also nine centimeters dilated — her little boy was coming, and fast.

The only issue? He was positioned slightly sideways, which meant a little extra work for Nikki. “Her son’s head was a little bit crooked in the birth canal but her body and the baby knew what to do,” Kayla Reeder, the couple’s birth photographer, told GoodHousekeeping.com. “She pushed him out without intervention.”

K. Reeder Photography

After an hour of labor, little Graham entered the world — with an oblong head.

K. Reeder Photography

It looks shocking (disfigured, even) in photos, but for babies of vaginal births, newborn head molding is more common than you’d think. At the time of birth, a baby’s skull is soft and malleable, with gaps in between the plates of the bone (this is why babies have a soft spot at the top of their head!). Pressure on a newborn’s head — like the pressure exerted during vaginal childbirth — in addition to the fluid and blood that collects in and around the brain during delivery occasionally results in a cone-like head shape. This is 100% normal and subsides in a couple of days. Babies born breech (feet first!) or via C-section usually don’t experience this and are, therefore, born with a round head.

K. Reeder Photography

“He was perfect, even with his extreme molding,” Reeder explained. “Just hours after birth the molding had gone down and a couple days later you couldn’t even tell.”

K. Reeder Photography K. Reeder Photography

As Reeder’s powerful photos demonstrate, Graham’s family saw perfection in their newest addition. “The love, adoration, relief that he was finally here radiated through the family,” Reeder told PopSugar.

Unusual infant head shapes can be caused by a number of factors, including traumatic pressure on the head in utero or during delivery, regular sleeping position, or rarely, genetic abnormalities. Depending on what type of head deformation an infant has, doctors may recommend allowing it to resolve itself with time, minor non-invasive interventions, or major surgery. Throughout this page, we’ll review some of the more common causes of misshapen heads in babies.

Background Information on Infant Skull Development

A baby’s skull consists of overlapping bone plates, connected by junctions called sutures. New bone emerges from the suture lines, allowing a baby’s head to grow symmetrically. Normally, the sutures close between 2-3 years of age. This allows the skull to expand and accommodate a growing brain. Before suture closure, newborn skulls are very soft and malleable.

The Effect of Traumatic Pressure

Because of the flexibility of infant’s heads, pressure on one or more parts of the skull can cause it to take on an abnormal shape. This is referred to as deformational molding. Deformational molding can occur in utero, during labor and delivery, or in early infancy.

Deformational Molding in Utero or During Birth: Risk Factors

If an infant’s head is pressed upon in utero or during the birthing process, this can lead to deformational molding. Some pregnancy and birth-related factors that can contribute to deformational molding include:

  • Cephalopelvic disproportion (CPD): When an infant’s head is too large to fit through the mother’s pelvis.
  • Oligohydramnios: Insufficient levels of amniotic fluid
  • Twins/multiple births
  • Prolonged or arrested labor
  • Breech birth

Physicians are supposed to pay close attention to the health and well-being of the baby during prenatal tests and delivery. If there are signs of any of the above conditions, some form of medical intervention (such as an emergency C-section) may be necessary. Failure to diagnose and act quickly increases the infant’s chances of experiencing severe head trauma during vaginal delivery. It is also important to note that cerebral compression injuries can have catastrophic consequences without external signs of damage. These consequences can include seizures, fetal stroke, or intracranial hemorrhages.

Types of Head Molding Caused By Birth Injuries

There are several types of head molding that can occur as a result of birth injury in late pregnancy or during labor and delivery. Here are a few examples:

Cephalohematoma

Cephalo- means “head” or “skull,” and a hematoma is a blood clot that occurs outside of a blood vessel. A cephalohematoma is a clot that occurs in the area between the skull and the periosteum (the membrane that covers the skull) as a result of ruptured blood vessels. Infant cephalohematomas are associated with the use of birth-assisting tools like forceps or vacuum extractors or prolonged or traumatic labors. Usually, a cephalohematoma will manifest as a raised solid bump on a baby’s head. It appears several hours to a day after birth and is often largest on the second or third day. Infant cephalohematomas usually heal without any major medical intervention, but if improperly treated, the consequences can be more serious.

Caput Succedaneum

A caput succedaneum is a swelling in the skin and tissues surrounding the skull. It most often forms after a difficult delivery. It can often be the result of vacuum extraction or premature rupture of membranes. Symptoms include scalp swelling and bruising, usually on the part of the head that presents first. Sometimes this can give an infant a “conehead” appearance. If bruising is involved, the infant may also develop jaundice. Generally, the caput succedaneum goes away without intervention within a few days.

Skull Fractures

Infant skulls are also susceptible to fractures. Sometimes they appear as crater-like indentations and can be called “ping-pong” fractures because the size and shape resembles half of a ping-pong ball. These can be caused by difficult labor or a lack of space in utero. Depending on the severity, ping-pong fractures may require surgical correction. They are also associated with other complications such as hematomas.

Positional Molding in Early Infancy

In order to avoid Sudden Infant Death Syndrome (SIDS), the American Academy of Pediatrics recommends that infants be positioned on their backs for sleeping. While this is a very important safety measure, having babies spend too much time with one part of their head pressed against a surface – even something soft like a bed or a car seat – can cause that part of their skull to flatten. Exactly what shape the skull takes on depends on their most common sleeping position.

Brachycephaly

The change in skull shape may not be very noticeable in infants who tend to lie with their faces pointed toward the ceiling, because their hair might cover the flat spot on the back of their heads. This type of positional molding is referred to as brachycephaly.

Plagiocephaly

Depiction of a child with torticollis.

Some infants, when placed on their backs, have a tendency to turn their heads a bit to one side or the other. Infants who have torticollis are especially prone to this. Torticollis is a condition that can emerge as a result of a difficult pregnancy or delivery. Infants with torticollis hold their heads at an angle due to asymmetrical stretching of neck muscles; if they do this while sleeping, it can result in a type of positional molding called plagiocephaly. Infants with plagiocephaly have a more asymmetric face shape.

Scaphocephaly

Infants who always lie on their sides (which is generally not recommended because this is considered a risk factor for SIDS) tend to develop long, narrow heads. This condition is called scaphocephaly, or sometimes dolichocephaly.

To prevent or treat positional molding, you can rotate your baby’s head from side to side throughout the night (while still ensuring that they lie on their back to prevent SIDS). This can sometimes be accomplished by changing the direction in which the baby lies in the crib, or the location of the crib so that they are encouraged to look in a different direction as they are falling asleep. When awake and under close supervision, infants can also spend time on their stomachs. If positional molding is not resolved after an infant is four to eight weeks old, your doctor may recommend that they wear a cranial molding helmet. Cranial molding helmets are soft and designed to reduce excessive growth in bulging areas while allowing it in flattened areas. They need to be adjusted as babies grow. Usually, the helmets are worn for 3-6 months.

In most cases, positional molding is largely a cosmetic concern and easily reversible, but it is important to know that similarly misshapen heads can be a sign of a more serious condition: craniosynostosis.

Craniosynostosis

Craniosynostosis is a condition in which one or more of the skull sutures close prematurely. In some cases, the skull may begin to push on the brain and hinder cognitive development. Craniosynostosis can be caused by pressure on the skull while in utero, or by genetic factors.

Although there are certain indications that an infant has craniosynostosis rather than positional molding, such as the lack of a ‘soft spot,’ the presence of a raised ridge along sutures, or a lack of head growth, the difference is not always easy to recognize. To diagnose craniosynostosis, your doctor may order an x-ray or CT scan. Treatment for craniosynostosis generally involves surgery to relieve pressure on the brain, allow for future brain growth, and improve physical appearance. If surgically corrected in a timely manner, the prognosis is often good. However, if left untreated, craniosynostosis can lead to seizures and developmental delays.

Note: Some of the terminology used when discussing positional molding, such as brachycephaly, plagiocephaly, and scaphocephaly, can also be used to describe types of craniosynostosis with similar outward appearances. If you are at all confused about what a medical professional is telling you, ask for a clarification.

The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. If you have questions about an infant with an unusual head shape, please consult with a medical professional.

About ABC Law Centers

ABC Law Centers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as oxygen deprivation, infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.

If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources.

If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win.

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  1. Craniosynostosis
  2. Caput succedaneum
  3. Depressed Skull Fracture in a Term Newborn Infant
  4. Misshapen Heads in Babies: Position or Pathology?
  5. Head Shape in Infants: Synostosis and Plagiocephaly
  6. Deformational Plagiocephaly
  7. Wong HW, Perry L. Maternal Child Nursing Care. 2006

My newborn’s head is an odd shape. Will it always be like this?

There’s no need to worry if your newborn’s head is an odd shape. It’s common and should soon even out.
There are two soft spots on your baby’s skull, which are known as fontanelles. They are there so that her head can easily pass through the birth canal. This process is called moulding.
If you had a vaginal birth, the gentle pressure that happens during moulding may have resulted in your baby’s head becoming misshapen. This odd shape will even out as the soft spots close, and the bones in her head meet and fuse.
The soft spot at the back of your baby’s head is called the posterior fontanelle. It is often difficult to feel and usually closes at six weeks.
The other soft spot is called the anterior fontanelle. It is more obvious and can be easily felt as a slightly dipped area of skin on the top of your baby’s head. This doesn’t usually close until your baby is between 10 months and 18 months, although some will take longer to close.
Most cases of misshapen heads result from vaginal or assisted birth. If your baby was born by planned caesarean, unplanned caesarean before the pushing stage or vaginal breech birth, her head is more likely to be round.
Many babies also have flat areas on the back of their heads because they are placed on their backs to sleep, which reduces the risk of sudden infant death syndrome (SIDS).
Other reasons that your baby may have a flat area on the back or side of her head include:

  • Prematurity. If your baby is premature, her bones will not have fully formed and will be very soft, meaning her head is more likely to be misshapen as she comes down the birth canal. Premature babies also take longer to control their heads than babies born at term, so they can’t relieve the pressure on a particular spot until they’re much older.
  • Multiple pregnancy. Your baby’s head may be an odd shape if she shares your womb with one or more siblings.
  • Low amniotic fluid (oligohydramnios). If you have low amniotic fluid your baby does not have as much room to move around and is not as cushioned as babies with a higher level of fluid.
  • Tight neck muscles. Your baby may develop a flat area on the back or side of her head if she has tight neck muscles (torticollis). This tightness makes it more likely that your baby will prefer to lie with her head in one position.

The medical term for the flat area on the side of your baby’s head is plagiocephaly. If the back of her head is flat, this is called brachycephaly. While her head may be noticeably misshapen, it’s usually nothing to worry about.
Support your baby’s development Gets tips from our health visitor on helping your newborn’s developmentMore baby videos You can help your baby’s head return to a more rounded shape by altering her position while she’s asleep, feeding and playing.
Changing your baby’s position is called counter-positioning or repositioning. It encourages the flattened areas of your baby’s head to reshape naturally.

For your baby’s safety, always put her on her back to sleep. There are other things you can try to encourage her not to lie on the flat part of her head:

  • When you put your baby down on her back, make sure the rounded side of her head is in contact with the mattress.
  • If your baby sleeps in a crib or Moses basket, turn the crib or basket around regularly so that your baby is not always looking in the same direction. If she’s in a cot, alternate the direction in which you place her down to sleep. Don’t forget to place her feet at the foot of her bed to reduce the risk of SIDS.
  • If your baby’s head is flat on one side, you could change the position of whatever she loves to look at, from one side to the other. Or you could try placing black and white pictures on one side of the cot to hold her attention.
  • You could try using a sling for her to sleep in during the day. The change of position will relieve the pressure points on her head. For safety, make sure you can kiss your baby’s head while she’s in the sling. You should also be able to see her face by glancing down. Keep the sling tight so your back is supported, and check that her chin isn’t against her chest.
  • Alternate where you place your baby to play. Give her time on her tummy during the day. A baby bouncer will hold her head in a different way from when she’s just playing on the floor. Changing positions will give her new things to look at too.
  • If your baby is bottle-fed, you may have a favourite side to feed her on, depending on whether you’re right-handed or left-handed. But changing sides regularly may encourage her to turn her head in both directions.

Avoid using pillows or mattresses which claim to change the shape of your baby’s head. Using these increases your baby’s risk of SIDS.
If your baby has difficulty turning her head, physiotherapy may help loosen and strengthen her neck muscles.
There are specially designed helmets that some people claim can help improve the shape of a baby’s skull as they grow. However, these aren’t generally recommended as there isn’t a lot of evidence that they work. They are expensive and may also cause skin irritation and rashes.
Rest assured that if your baby has mild plagiocephaly, the shape of her head should improve by the time she’s one or two years old, if you follow the steps above.
More severe cases will often get better over time, although some flattening will usually remain. As your baby becomes more mobile and her hair grows, the appearance of her head should improve. By the time your child reaches school age it’s very unlikely that the issue will be noticeable enough to cause problems such as teasing.
Rarely, a baby may have a misshapen head because of a condition that isn’t plagiocephaly or brachycephaly. Other conditions that may cause a misshapen head include:

  • When a baby’s skull bones fuse prematurely (craniosynostosis).
  • When a baby has an abnormality affecting her neck bones (cervical spine abnormality).
  • When a baby has a fibrous mass in her neck muscle (sternomastoid tumour), which can lead to torticollis.

If you’re concerned about the shape of your baby’s head, have a chat to your GP or health visitor.
Learn when your baby will be able to control her head movements.
Last reviewed: July 2018