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Common Types of Head Shape Abnormalities

Posted on Oct 04, 2021

The most common cause of head shape abnormalities in children is positional plagiocephaly, with flattening in the back of the head. Less common is craniosynostosis, in which one or more of the growth plates of the skull fuses prematurely and affect skull and brain growth. On this week’s On Call for All Kids, Matthew D. Smyth, M.D., FACS, FAAP, FAANS, chief of Pediatric Neurosurgery and a professor (PAR) of Neurosurgery, Pediatrics and Plastic Surgery at Johns Hopkins All Children’s Hospital, shares information with parents about various head shape abnormalities.

What are the causes?

Plagiocephaly is caused by positioning infants on the back of the head (Back to Sleep campaign). In some cases, it is caused by torticollis, a condition that causes a child’s neck muscles to tighten and the head to tilt to one side. Craniosynostosis may have a genetic component or may happen randomly in about one of 2,500 births.

How is it diagnosed?

The care team conducts a physical exam. Sometimes skull X-rays or CT scans are needed, particularly when synostosis is suspected.

What are the treatments?

Plagiocephaly is treated non-surgically, with positioning, physical therapy and sometimes custom helmet therapy. Synostosis is treated with surgery (larger open surgery for older children, smaller minimally invasive surgeries for younger children under age 6 months).

When should I see a specialist?

Most pediatricians can distinguish plagiocephaly and determine if a referral to a pediatric neurosurgeon or craniofacial plastic surgeon is needed. If there is any doubt, we are happy to see any child in one of our Head Shape Clinics.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit each Monday for the latest report.

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