Understanding Head Shape Deformities
A deformed or misshapen head can result from a variety of causes, which differ significantly between infants and adults. In babies, the skull bones are soft and not yet fully fused, making them pliable and susceptible to external pressures. In adults, the skull is rigid, meaning deformities are typically caused by congenital conditions, trauma, or previous surgeries.
Infant Head Deformities: Positional vs. Congenital
For infants, the most common type of head shape deformity is deformational plagiocephaly, often referred to as 'flat head syndrome.' This is a condition caused by repeated pressure on the same area of the skull, which can occur while the baby sleeps on their back. It is distinct from craniosynostosis, a more serious but rarer condition where one or more of the fibrous sutures in an infant's skull fuse prematurely. Correct diagnosis is crucial to determine the right course of action.
Adult Skull Irregularities
In adults, skull irregularities can be the result of a congenital condition that was not addressed in childhood, such as an untreated craniosynostosis. More commonly, they are a result of trauma, bone diseases (like Paget's disease), or previous surgeries. For adults, simple repositioning is ineffective, and correction almost always involves surgical intervention.
Treatment Options for Infants
For babies, the timing of treatment is critical due to the rapid growth of the skull during the first year of life. Early intervention, ideally before six months of age, offers the best chance for successful correction.
Repositioning and Tummy Time
For mild to moderate cases of positional plagiocephaly, simple repositioning strategies are often recommended first. This approach encourages the baby to spend less time with pressure on the flattened area.
- Alternate sleep position: When putting your baby to sleep on their back, as recommended to prevent SIDS, change the direction their head is facing in the crib every night. This encourages them to turn their head in different directions.
- Increase tummy time: Supervised tummy time, where the baby lies on their stomach while awake, helps strengthen neck muscles and removes pressure from the back of the head. Aim for several short sessions throughout the day.
- Vary carrying and holding positions: When carrying or feeding your baby, switch sides and hold them in different positions to prevent pressure on one specific area.
- Use different equipment sparingly: Limit the amount of time the baby spends in car seats, swings, or bouncers, which can put consistent pressure on the back of the head.
Helmet Therapy (Cranial Remolding Orthosis)
For more persistent or moderate to severe cases that don't respond to repositioning, a custom-fitted cranial molding helmet may be prescribed.
- How it works: The lightweight helmet applies gentle, constant pressure to the more prominent areas of the baby's head, encouraging the flat spots to round out as the skull grows naturally.
- Duration: Treatment typically lasts for a few months, with the helmet worn for up to 23 hours a day. The duration is dependent on the baby's age and the severity of the deformity.
- Timing: Helmet therapy is most effective when started between 3 and 7 months of age when the skull is still growing rapidly.
Surgical Intervention for Craniosynostosis
If the head deformity is caused by craniosynostosis, surgery is required. The specific procedure depends on which sutures are fused.
- Minimally invasive endoscopic surgery: Performed on very young infants (typically under 6 months), this involves small incisions and the use of an endoscope to release the fused suture. It is often followed by helmet therapy.
- Open cranial vault remodeling: This traditional, more extensive surgery is typically performed on older infants to reshape the skull bones. No helmet therapy is required afterward.
Treatment Options for Adults
Correcting a deformed head shape in adults is a more complex process and is almost always surgical, as the skull is no longer growing and reshaping naturally.
- Skull contouring (Burring): For minor irregularities or bumps, a surgeon can use a burring tool to carefully reshape and smooth the bone.
- Custom implants: For more significant deformities, such as a flattened area, custom-designed medical-grade implants (e.g., made of polymethyl methacrylate or hydroxyapatite) can be created from a CT scan and permanently placed under the scalp to restore a more symmetrical shape.
- Trauma or disease correction: In cases resulting from injury or bone disease, reconstructive surgery may be performed to repair or rebuild portions of the skull.
Repositioning vs. Helmet Therapy: A Comparison
| Feature | Repositioning (Infants) | Helmet Therapy (Infants) |
|---|---|---|
| Best For | Mild to moderate positional plagiocephaly, preventative measures | Moderate to severe positional plagiocephaly or post-endoscopic surgery |
| Treatment Method | Varied positioning during sleep, tummy time, holding | Custom-fitted helmet worn for up to 23 hours/day |
| Effectiveness | Can be very effective, especially with early and consistent use | High success rate, especially when started between 3-7 months |
| Duration | Ongoing practice until baby is mobile | Average 3-6 months, varies by age and severity |
| Cost | Minimal to none | Can be expensive, insurance coverage varies |
| Requires Monitoring | Parent-led monitoring, follow-up with pediatrician | Weekly or bi-weekly checkups and adjustments |
The Importance of Medical Consultation
Before taking any steps, the first and most important action is to consult with a qualified medical professional, such as a pediatrician, craniofacial specialist, or neurosurgeon. They can accurately diagnose the cause of the head shape deformity, rule out conditions like craniosynostosis, and recommend the most appropriate and safest course of treatment.
For comprehensive information on pediatric craniosynostosis, visit the American Association of Neurological Surgeons website.
Conclusion
A deformed head shape, whether in an infant or an adult, can be a cause of concern. However, effective treatments are available. For infants, simple repositioning often works for mild cases, while helmet therapy is highly effective for more severe positional issues. For congenital skull fusions, surgery is necessary. Adults have surgical options, including contouring and custom implants, for correction. The path to resolution always begins with an accurate diagnosis from a medical expert to ensure safety and the best possible outcome.
