March 28, 2006

The changing shape of infant heads


The normal head shape of American infants has changed from mildly dolichocephalic to mildly brachycephalic. Although normalcy is redefined, societal or parental expectations do not change immediately. Some parents become concerned, perceiving their infant’s head shape as abnormal. Although some parents may respond to reassurance, others search for solutions, such as head-molding helmets or more invasive options such as surgery.
Advances in Neonatal Care
Volume 5, Issue 6 , December 2005, Pages 329-340

Impacting Infant Head Shapes

Pat Hummel RNC, MA, NNP, PNP et al.


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.


With the continued success of the “Back to Sleep Campaign,” infants will have a
more rounded head shape than cultures that previously put their infants to sleep
on their stomachs. The current normative CI is 86% to 88%, and it is relatively
rare to encounter a dolichocephalic infant in cultures whose infants sleep
The Journal of Pediatrics
Volume 146, Issue 2 , February 2005, Pages 253-257

Deformational brachycephaly in supine-sleeping infants
John M. Graham, Jr. MD, ScD


Medical dictionaries and anthropologic sources define brachycephaly as a cranial index (CI = width divided by length × 100%) greater than 81%. We examine the impact of supine sleeping on CI and compare orthotic treatment with repositioning.

Study design

We compared the effect of repositioning versus helmet therapy on CI in 193 infants referred for abnormal head shape.


Eighty percent of the infants had a pretreatment CI > 81%. Their initial mean CI at mean age 5.3 months was 89%, and after treatment, their mean CI was 87% (±2 SE = 0.9%) at mean age 9.0 months. For 92 infants with an initial CI at or above 90%, their initial mean CI of 96.1% was reduced to a mean of 91.9%.


Post-treatment CI was 86% to 88%, CI in neonates delivered by cesarean section was 80%, and CI in supine-sleeping Asian children was 85% to 91%, versus 78% to 83% for prone-sleeping American children. Repositioning was less effective than cranial orthotic therapy in correcting severe brachycephaly. We recommend varying the head position when putting infants to sleep.


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