Baby's head shape may change as brain, skull develop


January 26, 1993|By Dr. Modena Wilson and Dr. Alain Joffe | Dr. Modena Wilson and Dr. Alain Joffe,Contributing Writers

Q: Our first grandchild was born this summer, and we are thrilled. Since we live at some distance, we didn't see him till the holidays. We were taken aback. His head is so long! No one in our family has a head like that. When I mentioned it to my daughter, she said she thought it was the way he sleeps. Should we do anything?

A: Your description raises several possibilities. First, babies born early often have relatively long, narrow heads. We are assuming, however, that your grandson was not premature. During the first few days of life, the head of any baby may be different from the final shape because of pressure on the head during the birth process, but your grandson is several months old.

Another possibility -- craniosynostosis -- is one that your daughter may wish to discuss with her baby's doctor. Literally, the word means "union of the bones of the skull." Let us explain.

When a baby is born, its skull is made up of a number of separate pieces. It is not yet a complete bony box. This permits continued growth inside. As the brain grows, the bones enlarge at their edges. When brain growth is complete, the bones knit together at seams called "sutures."

Occasionally, one or more of the skull's suture lines close early causing the growing brain to push in the directions of the still-open sutures. In other words, the head grows where it can -- producing an unusual shape. The exact shape will depend on which sutures are open and which are closed. An elongated head can be one of the results.

Craniosynostosis is not very common. It probably happens in no more than one in 1,000 babies. Many times it is relatively mild and causes no harm. But if too many sutures close prematurely, the brain may not have enough room to grow. That problem should be detected by the baby's doctor, who measures the head at each "well baby" visit. Most cases of craniosynostosis are of a milder type and the brain keeps right on growing. However, if head shape becomes quite odd because of it, surgery to open the sutures can improve appearance. Since the surgery is complex, most doctors don't recommend it where hair growth will hide a mild problem.

In the end we want to stress most babies we see whose heads look a bit odd do not have craniosynostosis. They are just expressing their own individual growth pattern and will look just fine as they get older.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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