An abnormal head shape in infants can be caused by two main problems: positional
molding or craniosynostosis.
Typical Head Growth
ξ The fibrous tissues between an infant’s skull bones are called “sutures”.
ξ As a baby’s brain grows, sutures allow the skull to expand.
ξ Normally, at about 2 years old, the head stops growing.
ξ When head growth stops, the sutures close and bone develops at the suture site.
What causes Positional Molding (also called “positional plagiocephaly”)
ξ Infants may have an abnormal head shape from sleeping in the same position for a long
ξ This problem is now more common since babies are always placed on their backs to
ξ Positional molding often corrects
itself with a change in sleeping
position such as turning the infant’s
head to the other side or supervised
ξ Surgery is not needed to correct
this problem. These children have
normal brain development.
What causes Craniosynostosis?
ξ This happens when one or more of
the sutures close too early and bone
forms over the suture.
ξ The brain is still growing but the
brain cannot make the new bone
change its shape.
ξ So the brain growth pushes out the
bones on the open sutures.
ξ When this happens, brain growth
leads to an abnormal shape of the head.
Types of Craniosynostosis
ξ The shape of the skull will depend on the type of suture that closes too early.
ξ There are six main sutures that may close early and cause this problem.
o If the Metopic Suture closes early, the forehead becomes pointed like a triangle.
o If one of the two Coronal Sutures closes early, the forehead is flat on the
o If one of the two Lamboidal Sutures closes early, the back of the head is flat on
the affected side.
o If the Sagittal Suture closes early, the head is long and thin.
Types of Craniosynostosis
Medical Term for Head Shape Fused Suture(s)
Trigoncephaly Metopic and/or Coronal Sutures
Brachycephaly Both Coronal Sutures
Anterior Plagiocephaly One Coronal Suture
Posterior Plagiocephaly One Lambdoidal Suture
Scaphocephaly Sagittal Suture
Surgery for Craniosynostosis
The type of surgery depends on which sutures are involved. Your surgeons will explain the
treatment for your child. The brain surgeon work and the plastic surgeon work together to fix
There are two options for surgery:
1. Open Repair. Any infant can have an open repair. In an open repair, the surgeons
shave the least bit of hair needed. Then they make a zigzag cut from ear to ear over
the top of the head. The scalp is peeled back so they can see the skull. With the use
of plates, wires and stitches the skull is changed to a more normal shape. The head
will not reach its final shape for months. Surgery takes 4-6 hours, and when the
treatment is done, the scalp is stitched closed.
2. Endoscopic. Only young infants can have the endoscopic surgery. In this surgery, a
small camera, called an “endoscope,” is used to look at the skull through two small
cuts on the scalp. The skull is then shaped in much the same way as the treatment
discussed above. After surgery, the baby will wear a helmet for many weeks. The
helmet will need frequent adjustments by our orthotics experts.
You will need a physical exam, health review, and lab tests.
Please stop aspirin and ibuprofen for two weeks before surgery. It is alright to use
acetaminophen (Tylenol®) if needed.
You will wash with Sage clothes as instructed.
You will receive a phone call the day before surgery telling you when to stop eating and
Do not wear make-up, jewelry, or nail polish to surgery.
After surgery, your child will go to the Pediatric Intensive Care unit (PICU) for at least one
night. At first, your child will receive a stronger pain medicine. After a few days, he may only
need something like Tylenol® or Motrin® for pain.
Your child will have a thick gauze bandage on his head. This dressing will be changed in 1-3
days. It may be removed completely before going home. Also, your child’s face will be
swollen, eyes may swell shut, and the face may be bruised.
When your child is eating and drinking without feeling sick, he will be able to go home. This
often occurs in 5 days. Your child should be seen in the neurosurgery clinic 7-10 days after
surgery. The incision should be kept clean and dry until that visit.
When to Call
Please call if you have any questions or notice any of these symptoms:
ξ Fever greater than 101.5 θ F
ξ Drainage from the incision
ξ Redness or swelling at the incision site
After hours, weekends and holidays, call the paging operator (608) 262-0486. Ask for the
neurosurgeon on call. Give your name and phone number with the area code. The doctor will
call you back.
To schedule an appointment or to speak with the nurses, call (608) 263-6420.
If you live out of the area, call 1-800-323-8942.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor.
This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because
each person’s health needs are different, you should talk with your doctor or others on your health care team
when using this information. If you have an emergency, please call 911. Copyright © 3/2017 University of
Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5436