![]() When discovered by a concerned parent (usually when the child is 1 to 2 months old), such a lump often prompts a visit to the pediatrician. In addition, the calcification of a healing cephalohematoma can produce a distinct lump on the skull, usually on one of the parietal convexities. Difficult deliveries that require the use of forceps or vacuum extraction can result in severe molding. During parturition, the strong forces applied to the skull as it is squeezed through the birth canal cause the bones that make it up to override one another this process can "mold" the head into various shapes. In utero, molding can result from uterine crowding, such as occurs when multiple fetuses share the same womb. Early fusion of one or more of the sutures (craniosynostosis ).Gravitational forces applied to the skull during early infancy (deformational or positional plagiocephaly).External pressure, either applied to the skull during the birthing process or resulting from uterine constraint in cases of multiple births (molding).The major forces that misshape the head include: The posterior fontanelle is more difficult to appreciate on physical examination and often closes in the first few months of life. The anterior fontanelle, easily palpated at the top of the head, typically closes by 18 to 24 months of age. The bones are able to move because they are adjoined by fibrous sutures (junctures between 2 bones) and fon- tanelles (junctures between more than 2 bones) that remain unossified throughout the first years of life to facilitate vaginal delivery and allow expansion of the growing brain. Odd head shapes develop because the bones of the newborn skull are moveable and malleable. Here we offer a practical, objective approach to determining which patients with odd head shapes require further evaluation and treatment.ĬAUSES OF HEAD SHAPE ABNORMALITIES IN INFANTS How would you respond to this parent's concern? Refer a patient to Children's Colorado."Does my baby's flat head mean he has to wear a helmet?" That question, recently posed by a concerned parent, is typical of the inquiries pediatricians hear regularly about head shape abnormalities. Pediatric neurology experts offer integrated and comprehensive treatments for all types of disorders affecting the nervous system and skull including traumatic injury, epilepsy, hydrocephalus, brain tumors, and facial and skull deformities. Treating abnormal head growth, including "flat head syndrome," at Children's Coloradoīabies with abnormal head growth and/or shapes are treated by our Pediatric Neurosurgery Program. Key education points providers should share with parents on this topic.The controversy surrounding helmet therapy for plagiocephaly.The referral and recommendation procedures for babies with plagiocephaly.The outcomes for a normal life and normal IQ post-surgery for babies with craniosynostosis.Routine follow-up care, including head circumference measurements.Partnering with referring providers after surgery has been completed.The subset of patients with craniosynostosis who receive genetic testing.Different treatment plans for children with craniosynostosis.How to talk to families of children with head shape abnormalities about next steps.When to refer children with head shape abnormalities to imaging.The impact of prolonged stays in the NICU on the development of plagiocephaly.Best practices for differentiating between unilateral positional plagiocephaly and lambdoid craniosynostosis.The main reasons to perform corrective surgery for children with craniosynostosis.The four general types of craniosynostosis in children. ![]() ![]() How to determine which category head shape abnormalities fall into.He explores the many facets of abnormal head shapes in children, including how to determine which category head shape abnormalities fall into, the four general types of craniosynostosis and how to educate and reassure parents. Todd Hankinson, MD, pediatric neurosurgeon at Children's Hospital Colorado, joins Charting Pediatrics for today's discussion. Listen to our pediatric neurosurgery expert discuss abnormal pediatric head growth Every pediatrician will encounter craniosynostosis (the early fusion of a baby's skull, which causes an atypical shape) at some point during their career. However, head shape abnormalities are very common in babies. When a parent notices their baby has an abnormal head shape, they are understandably distressed.
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