Dr. Bob: My newborn has a misshapen head. Everyone says that it will be okay, but I am worried since it looks so different as this time. Plus, her soft spot seems to be so big. When should I get worried?
Answer: This question is a very common one. When you think about it, it is pretty amazing that babies are able to make it out of the birth canal and be so well formed. They are packaged in a very tight space. The head usually comes out first and can be quite compressed. Doctors have a lot of experience analyzing head shape to know when to worry or not.
One of the very important measurements that they obtain in the immediate newborn period is the circumference of the head. Even though the head can be compressed, this measurement usually falls in a specific range on a growth chart. If the head measurement is in this range, your doctor will just follow this measurement over time. If the measurement is out of this range, your doctor will evaluate the circumstances (delivery method, prenatal history) and consider other tests if it is smaller than expected or larger than expected. The overwhelming majority of the time the head measurement will normalize over time.
The skull of an infant is made up of many bones with growth plates (sutures) in between. These growth plates allow for the developing brain to expand the skull. The majority of brain growth after birth occurs in the first 18-24 months. The sutures are designed to allow this growth to occur.
You mentioned the soft spot. There are two soft spots (called fontanelles) typically in the newborn head. The larger one in the front is where four bones come together, and the smaller one in the back is where three bones come together. Again, these areas are designed for growth as the brain expands. Most new parents are scared that they will harm their baby by touching the soft spot. Gentle touching does no harm and allows you to assess its size as it closes. Your doctor will also follow the size of the soft spot as it closes over the first year of life.
It is not uncommon for it to pulsate slightly. You are feeling the blood flow through and around the brain.
It is important for you to follow the baby’s head growth. I don’t mean by measurement but by observation. You see the baby all of the time so if you have a concern, you can bring this to the doctor’s attention. If the sutures are fusing too soon (premature closure), this can lead to a misshapen head and slowing of skull growth. X-ray studies can help rule in or rule out such an occurrence. If it is occurring, pediatric neurosurgical intervention is usually straight forward and corrects the problem. If the sutures are not closing and the head seems too large, further study is warranted.
But let me caution you that big heads tend to run in some families, including mine (my father, me, my son and my granddaughter!). It was not unusual for me to measure the heads of parents when I saw an infant with a large head. I could reassure the family that the size was just a normal variant that runs in the family.
The skull protects an extremely valuable organ, the brain. Your concerns about head shape are valid. Continue to monitor your child’s head as they develop. Discuss any concerns with your pediatrician.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions