Newborns' Heads Still Taking Shape

The fontanelles. The newborn’s head has a considerable amount of growing to do so in the first year of life. To allow for brain growth, at birth the infant’s skull bones are not completely fused. The areas where the bones do not meet are called the fontanelles ("soft spots"). The smaller, triangular one at the back of the head is known as the posterior fontanelle and closes within the first 6 to 8 weeks of life. At the front of the head is the larger, diamond-shaped anterior fontanelle which can take up to 18 months to close. Both fontanelles are covered by a strong fibrous tissue so it is hard to injure them. Therefore, touching the fontanelle will not hurt the brain underneath. The baby’s head skull has permanently fused at the top of the head when the anterior fontanelle disappears.

It is perfectly normal for the diamond-shaped fontanelle to pulsate with each heartbeat. This pulsating action is how the soft spot got its name - fontanelle means "little fountain." On the other hand, the shape of the baby’s soft spot can sometimes indicate a serious disease. If an infant with fever is found to have a bulging, or full soft spot, that could be due to increased pressure from meningitis. This fullness can also happen when the baby cries. A sunken or depressed fontanelle in an infant who is vomiting or has diarrhea could mean the baby is severely dehydrated.

Premature closure of the fontanelle may mean that the bones of the skull are fusing too early. Should this happens, it could seriously impair the growth of the baby’s brain. One reason for measuring the baby’s head circumference during routine well-baby check-ups is to make sure that the skull is growing normally.

Molding refers to the long, narrow cone-shaped head that frequently occurs in newborns. This condition is most often seen in large babies, in first-borns, after prolonged labor or if the mothers has a small pelvis. Molding is Mother Nature’s way of protecting the brain during delivery. If the scalp did not mold, the tremendous pressure that occurs as the baby moves through the birth canal would be transmitted to the brain. One pediatrician put it dramatically when he said "better the shell should mold than the yolk gets scrambled." The head that is molded because of its journey through the birth canal generally becomes rounded in a few weeks.

Cephalohematoma. It is not uncommon for some bleeding to take place under the lining of the baby’s skull bones during delivery. This bleeding produces a soft and swollen area on the head called a cephalo- (head) hematoma (collection of blood). Cephalohematomas occur in 3 percent of births and are usually associated with large babies or a mom’s small pelvis. They are usually not noticed until the first 24 hours of life and get larger during the first week.

Physicians used to lance the scalp to remove the blood clot underneath, but too many infants developed infections. Today, cephalohematomas are treated by leaving them alone! Occasionally the hematoma becomes encased in calcium which makes the area where it was once located stronger than the rest of the child’s head.

Over the next few months, the blood in the bone organizes and eventually smoothes out to a perfectly normal skull. Cephalohematomas appear alarming but are perfectly harmless. It has nothing to do with the brain underneath, and is strictly a reaction of the skull bone to the birth process.

Torticollis. In the first several months of life, some babies will hold their head tilted toward one shoulder. The infant will resist and start to cry when a parent tries to straighten the head. This condition is known as congenital torticollis and results from an injury to the sternocleidomastoid muscle, which runs from the collarbone to the side of the child’s head. This injury can occur at birth during a difficult first-time delivery or can develop before the baby is born in utero. Congenital torticollis is usually not present at birth and appears when a blood clot develops around the injured muscle. The resulting blood clot produces a knot of tissue that shortens the muscle causing the head to be held down toward one shoulder. When the tilt is noticed early, gentle stretching exercises done at home can correct the problem. If the problem is not corrected by exercise within the first year of life, a orthopaedic surgeon may be consulted to see if surgery is necessary.

Skull Flattening. Today’s infants are placed on the backs when sleeping rather than their stomachs to help prevent SIDS (Sudden Infant Death Syndrome). This new sleeping position has produced many babies whose heads are showing some flattening, usually on one side of the back of the head. To prevent this, rotate the way the baby lays when placed on his/her back for the night, that is, head at the foot of the crib every other night. This way you are minimizing the chances of the baby’s head becoming misshapen, and the infant will still be able to look out into the room when awake. When the baby begins to roll over, the problem usually corrects itself.