What to Know About Dolichocephaly

An elongation of an infant’s head as a result of positioning.

NICU baby

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It’s common for babies’ heads to look slightly misshapen after birth or in the first few weeks of life. This is because babies’ heads are meant to be moldable to accommodate the many changes that happen during gestation, birth, and the first year of life. Usually this misshapen look is minimal and resolves on its own.

But what happens if your baby’s head is more severely misshapen? Is this a problem? If your baby’s skull looks elongated, they may be diagnosed with a condition called dolichocephaly.

If that’s the case for you, you may have a lot of questions about this condition, what it means for your baby, and what treatment options are available.

What Is Dolichocephaly? 

Dolichocephaly

Dolichocephaly refers to an elongation of an infant’s head as a result of positioning, usually after birth, and most often as a result of a stay in neonatal intensive care unit (NICU).

According to the U.S National Library of Medicine, dolichocephaly is defined as, “a boat-shaped or elongated anterior-posterior axis as a result of skull flattening during side-to-side head positioning of infants during hospitalization.”

Baby’s heads are made of several soft plates that haven’t fully fused together at birth—this flexibility helps babies pass more easily through the birth canal, and makes the rapid brain growth that happens during your baby’s first 12 months possible.

According to the Academy of American Pediatrics (AAP), misshapen heads and skull deformities occur about 20% of the time during childbirth or as a result of a baby’s position in the womb. But most of the time, these occur after birth—within the first 4 to 12 weeks, when babies spend a lot of time lying flat and are less mobile.

Causes 

Often referred to as “NICUcephaly,” dolichocephaly generally affects premature babies who have spent some time in the NICU.

The U.S. National Library of Medicine explains that most cases of dolichocephaly occur in preterm babies who are less than 32 weeks, and as a result of the side-lying or prone (i.e., on their stomach) positions these babies are placed in while they are in the NICU.

These positions are used to protect these baby’s health—including decreasing their risk of reflux, apnea, and bradycardia—but unfortunately can result in dolichocephaly.

In some cases, the dolichocephaly resolves by the time the baby goes home, but in other cases, it remains, and babies are discharged from the hospital with cases of dolichocephaly.

Risks of Dolichocephaly

According to the AAP, most cases of misshapen infant heads or skull deformities are not serious and do not affect the health or well-being of an infant. “Positional skull deformities do not affect brain growth or intellectual development,” writes the AAP. “They are purely cosmetic, and the majority do not require surgery.”

However, some severe cases dolichocephaly can be more serious, and may affect your baby’s health and development.

As the U.S National Library of Medicine explains, “The long-term consequences of dolichocephaly are not fully known, but it has been correlated with delayed reaching skills, tightness in the spinal extensors and scapular retractors, and development of motor asymmetries.”

If you are concerned that your baby may have a severe case of dolichocephaly that may result in any developmental or other health issues, you should speak to your pediatrician.

They will let you know if any tests—such as a CAT scan—are needed to better understand the way dolichocephaly may be affecting your baby, and if any specific interventions may be required.

Dolichocephaly Treatment

Dolichocephaly may be treated by pediatric specialists; usually, this treatment is combined with at-home treatments. In some cases, at-home treatments will be all that’s required to treat dolichocephaly. In more serious cases, surgery will be required.

Specialist Treatments

Some mild cases of dolichocephaly and other instances of misshapen skulls will not require treatment, as they will generally just resolve as your baby grows.

In cases of moderate or severe skull deformity, therapies and other interventions may be necessary. This is something your doctor will discuss, as the need for these interventions are case-by-case.

According to the AAP, there are three main interventions for misshapen skulls and positions skull deformities:

  • Physical Therapy: A pediatric physical therapist can be helpful as you navigate your journey with dolichocephaly. They can look for any developmental delays your baby may be experiencing, as well as provide stretching and positioning exercises you can do at home with your baby.
  • Helmet Therapy: Some babies with misshapen heads may benefit from a molding helmet. This is usually what is suggested when your baby’s head does not reach a healthy shape by the time they are 5 to 6 months old. Molding helmets must be fitted by a specialist.
  • Surgery: Surgery for misshapen heads is only suggested in extreme circumstances, when other treatments have not worked and when necessary to help keep your child well and healthy. Usually, you will need to consult with a neurosurgeon or pediatric plastic surgeon who has knowledge about your child’s type of skull deformity.

At-Home Treatments

In addition to treatments from specialists, there are practices you can adopt at home to help your baby’s skull reach an optimal shape.

Here are some the AAP recommends you try at home:

  • Vary your baby’s position and don’t leave them in one position for too long, especially ones that put pressure on their head. For example, don’t leave your baby too long in their car seat, a bouncy chair, or baby swing.
  • Give your baby opportunities to move. Tummy time is great for this, and babies with skull deformities may need more tummy time than others. Tummy time allows your baby to move their neck, head, back, shoulder, hips, and arms in natural and beneficial ways. If your baby resists, you can start small and work your way up to longer periods of tummy time.
  • Switch arms when feeding your baby to help your baby's head grow into the proper shape.
  • Change which part of the crib you lay your baby down in; however, always lay babies to sleep on their backs.

A Word From Verywell

Caring for a baby with any sort of abnormality can be stressful. You may have fears about the future, and you may not know how to handle what is happening in the here and now.

Remember that any concerns you may have are valid. Don’t be afraid to contact your pediatrician or other provider with questions.

It can also be helpful to get in touch with other parents who have been through similar experiences, via an online or in-person support group. Most of all, know that you are not alone, and you will get through this. 

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Article Sources
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  1. Duke University. Treatment of Cranial Molding Deformities in Preterm Infants. Updated April 18, 2017. 

  2. Healthy Children. When a Baby’s Head is Misshapen: Positional Skull Deformities. Updated August 31, 2020.

  3. Likus W, Bajor G, Gruszczyńska K, et al. Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography. Scientific World Journal. 2014;2014:502836. doi:10.1155/2014/502836.