Impacting Infant Head Shapes

Pat Hummel, RNC, MA, NNP, PNP; Dana Fortado, OTRL


Adv Neonatal Care. 2005;5(6):329-340. 

In This Article

Abstract and Introduction

Infant sleep position impacts the development of head shape. Changes in infant sleep position, specifically the movement toward supine sleep, have led to a redefinition of normal head shape for infants in the United States. Historically, a dolichocephalic (elongated) head shape was the norm. Currently the norm has changed to a more brachycephalic (shorter and broader) shape. Since the American Academy of Pediatrics' Back to Sleep Campaign, the incidence of positional plagiocephaly has increased dramatically with a concurrent rise in the incidence of torticollis.

Infants who require newborn intensive care, particularly premature infants, are more prone to positional plagiocephaly and dolichocephaly. Both can be prevented or minimized by proper positioning. The infant with an abnormal head shape requires careful evaluation; treatment varies according to the etiology. Craniosynostosis, a less common but pathological etiology for plagiocephaly, should be considered in the diagnostic process. Successful treatment of positional plagiocephaly and dolichocephaly includes systematic positioning changes to overcome the mechanical forces of repetitive positioning, physical and/or occupational therapy to treat underlying muscle or developmental challenges, and in some cases, molding helmet therapy.

Variations in head shape are often seen in the neonatal intensive care unit (NICU). Term and preterm infants may develop abnormal head shapes due to medical treatment, nursing care practices, positioning limitations, and underlying muscle tone abnormalities. Preterm infants often develop a dolichocephalic head shape as a result of frequent prone positioning. Term and preterm infants frequently develop a head turning preference, which leads to positional plagiocephaly. This preference may be further reinforced by common care practices in the NICU. The bedside nurse is responsible for positioning infants in the hospital; therefore, neonatal nurses should be knowledgeable about head shapes and learn to position infants correctly to avoid, minimize, or treat misshapen heads.

Although a less-than-perfect head shape is not a life-threatening problem, cosmetic differences may have enduring effects on quality of life.[1,2] Parents are naturally concerned about their infant's appearance and can be taught strategies that they can use to promote normal head shape in the hospital and after discharge.


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