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Question of the Week


Updated June 12, 2014

Q. I have a six week old son that we have noticed that one side of his forehead is larger than the other. The right side of his forehead bulges slightly. We thought at first that as he grows that it will straighten. And we think, maybe, it still will. Should we be concerned? Could this be a sign of something serious? John, Coweta, OK

A. Is the right side of the back of his head flat?

Is his right ear pushed forward a bit?

If so, then he could have positional plagiocephaly.

Laying in one position too long can exert a lot of force on a baby's head and cause them to develop positional plagiocephaly and for their head to become misshapened.

Since the recommendations for sleep positions changed and infants began being put to sleep on their back, this problem has greatly increased. The benefit of a lower risk of SIDS, still makes putting babies to sleep on their back very important though.

Infants can also be at risk for positional plagiocephaly if they lay in a car seat, bouncy seat, or swing too long. Alternatives, like a wrap, sling, or carrier, usually put less pressure on the back of a child's head and can be helpful to prevent a baby from getting a flat head.

Although many infants develop positional plagiocephaly because they simply prefer to lie in one position all of the time, others have this problem because they have limited neck motion and can't help laying in the same position. These children with congenital torticollis have limited motion on one side of their neck and may have a hard mass on their neck muscle.

See our guide to positional plagiocephaly for more tips and advice on helping your baby grow out of positional plagiocephaly. Keep in mind that some infants do need treatment and don't improve just with making positional changes.

And you should see your Pediatrician to confirm the diagnosis and to make sure that there isn't a different problem causing his head to be shaped this way.

Other conditions that can cause an infant's head to be misshapened include craniosynostosis. Infants with coronal synostosis, in which the coronal sutures of the skull fuse early, can get a flattening of one side of their forehead and a compensatory bulging of the forehead on the other side. The back of these infants head should appear normal though and not flat or misshapened at all.

Another form of craniosynostosis, in which the lambdoidal suture closes early can cause a flattening of one side of the back of an infant's head and bulging of the forehead on the opposite side of their head. This is in contrast to what happens in positional plagiocephaly, in which the flat side and bulging side are both on the same side of the infant's head. Keep in mind that this form of craniosynostosis is very rare.

The images on the following pages can help make this all a lot easier to understand:

  • Positional Plagiocephaly - this is the classic positional plagiocephaly that is very common these days.
  • Coronal Synostosis - note how the child's forhead bulges, but the back of his head is not flat and his ears are positioned normally.
  • Lambdoid Synostosis - see Figure 2 in this article which shows the difference between positional or deformational plagiocephaly on the left, and lambdoid synostosis on the right.

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