![]() ![]() 8,9Ĭraniosynostosis occurs much less frequently-in an estimated 1 in 2000 live births. 8 This is significantly higher than the 1 in 300 rate typical in decades past the increase correlates with the initiation of the AAP Back to Sleep campaign in 1992. Many, if not most, newborns display some degree of molding, especially if born via a vaginal delivery.Īmong children beyond the immediate newborn period, a 2004 report revealed that approximately 1 in 68 infants displays significant cranial asymmetry from positional or deformational plagiocephaly. Hutchison and colleagues 7 found that head shape in otherwise normal children varies to a great extent in the first 2 years of life and that misshapen heads eventually improve as infants age. Posterior plagiocephaly (trapezoidal-shaped head) arises from lambdoid craniosynostosis this is a very rare form of craniosynostosis.Brachycephaly arises from bilateral coronal craniosynostosis.Turricephaly (a tower-shaped head) arises from coronal plus sagittal craniosynostosis.Scaphocephaly arises from sagittal craniosynostosis.Trigonocephaly (a triangular-shaped head) arises from metopic craniosynostosis.Different head shapes result (see Figure 1) depending on which suture or combina- tion of sutures has fused: Brain growth occurs in the direction of the open sutures. ![]() When craniosynostosis occurs, the growth of the skull is impeded in a plane that is perpendicular to the fused suture, but the skull continues to grow in the parallel plane. Dubowitz syndrome 5 is associated with marked microcephaly and facial anomalies (as well as other features) Treacher Collins-Franceschetti syndrome 6 is associated with severe craniofacial abnormalities and hearing loss. Apert syndrome is also associated with significant craniofacial deformities, hydrocephalus, and exophthalmos, along with mental retardation and syndactyly. 4 Craniosynostosis may also be an asso- ciated feature of several genetic syndromes, including Apert, Crouzon, Dubowitz, and Treacher Collins- Franceschetti syndromes.Ĭrouzon syndrome is associated with various facial and skull deformities, exophthalmos, and hydrocephalus. Exactly why sutures fuse early is not known, but genetic and environmental fac- tors-such as single gene mutations, teratogen exposure, and fetal constraint-probably play a role. Reassure parents that a cephalohematoma poses no long-term risk.īecause molding secondary to the birthing process typically resolves in hours to weeks, persistent or progressive shape deformities beyond that time should raise suspicion for deformational plagiocephaly or craniosynostosis.Ĭraniosynostosis. 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? "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. ![]()
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