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Lisa Black

Guidance is offered for the primary care provider on recognizing and referring families to specialists for early care of craniosynostosis.

The American Academy of Pediatrics in a new clinical report describes infant head shape abnormalities and treatment, detailing the differences between a common condition, positional plagiocephaly, and more severe diagnoses that require surgical intervention.

The report, “Identifying the Misshapen Head: Craniosynostosis and Related Disorders,” is published in the September 2020 Pediatrics (published online Aug. 31). The report reviews the most recent literature on craniosynostosis, a birth defect in which the bones in a baby’s skull join together too early, before the baby’s head is fully formed.

“The guidance is intended to help inform pediatricians about the various forms of disorders affecting the head shape, and what factors to consider when deciding next steps,” said Mark S. Dias, MD, FAAP, FAANS, lead author of the report, produced by the Section on Neurological Surgery and Section on Plastic and Reconstructive Surgery.

“Parents of infants whose babies sleep on their backs as recommended and exhibit a flattened head – or positional plagiocephaly -- can be reassured that this is solely an aesthetic condition, with no credible medical evidence suggesting that it affects brain development or causes any other medical condition,” Dr. Dias said.

This common head shape abnormality is called deformational (also called positional or nonsynostotic) plagiocephaly (DP) or brachycephaly (DB). The incidence of DP/DB has been estimated at 20% to 50% in 6-month-old children. About 80% of cases are noted during the first 4 to 12 weeks after birth, and reflect a rise in cases that have occurred since the 1992 “Back to Sleep” campaign was launched to decrease the incidence in sudden unexpected infant death.

The head shapes of children with positional plagiocephaly often improve as the child develops and lies less frequently on the flattened side, research finds. The AAP recommends supervised “tummy time” as well as varying head position. Infants are advised to always sleep alone on his or her back and in a crib, the clinical report notes. More details on DP/DB treatment options, such as use of a molding helmet, can be found in a recent publication by the Congress of Neurological Surgeons and endorsed by the American Academy of Pediatrics.

Craniosynostosis is a congenital condition in which the skull bones are congenitally fused, and leads to changes in the infant’s head shape that are present at birth and usually distinguishable from DP/DB. The report reviews the types of head shape changes that occur from craniosynostosis as well as possible increased pressure in the head and cognitive impairments, and recommends that children with craniosynostosis be referred early to surgical specialists for surgical repair.

The AAP website for parents,, offers updated information here: When a Baby’s Head is Misshapen: Positional Skull Deformities


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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