What to Know About Dolichocephaly

NICU baby

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It’s common for babies’ heads to look slightly misshapen after birth and even in the first few weeks that follow. 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 (also known as scaphocephaly). 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 refers to an elongation of an infant’s head caused most often by positioning after birth. It is commonly, though not exclusively, a result of an extended stay in neonatal intensive care unit (NICU).

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

Dolichocephaly has two primary causes: craniosynostosis or positioning.

Craniosynostosis

Babies' skull bones contain spaces in between them that are filled with a flexible substance called sutures. Because sutures are fluid, they allow the brain to grow and develop.

Craniosynostosis is a birth defect in which the bones of the baby's skull fuse together prematurely before the brain has fully developed. In babies with craniosynostosis, the brain stops growing in the part of the skull that has closed too quickly, while other parts of the brain continue growing. When this occurs, the skull forms an abnormal shape.

While there are several types of craniosynostosis, sagittal synostosis is most commonly linked to dolichocephaly. Sagittal synostosis is the premature closing of the sagittal suture, which runs from the top of the baby's head near the soft spot, all the way to the back of the head. The sagittal suture usually begins closing later in life, at around 21–30 years of age.

Prolonged Side or Prone Positioning

Sometimes casually referred to as "NICUcephaly," some cases of dolichocephaly affect 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 born at less than 32 weeks gestation, and because of the side-lying or prone (i.e., on their stomach) positions these babies are commonly placed in while they are in the NICU.

These positions are used to protect premature babies' 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 dolichocephaly.

Risk Factors

Dolichocephaly can develop in an otherwise normal developing skull when a baby spends too much time in certain positions. While some research suggests genetic factors are linked to craniosynostosis-related dolichocephaly specifically, the true etiology of the condition is not yet fully understood.

Complications

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 of 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."

A more significant deformity can also impact a person's self-esteem and confidence as they grow into adulthood. Surgery in infancy can improve head shape and prevent psychological issues that can stem from a severe cosmetic concern.

If you are concerned that your baby may have a severe case of dolichocephaly that may result in any developmental, health, or psychological 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.

Treatment

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 with you, as the need for these interventions is case-by-case.

According to the AAP, there are three main interventions for misshapen skulls and positions skull deformities: physical therapy, helmet therapy, and surgery.

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 and 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 often recommended when a baby’s head does not reach a healthy shape by the time they are 5 to 6 months old. A specialist must fit molding helmets.

Surgery

In more serious cases, surgery will be required. This is true for more severe cases of sagittal craniosynostosis. During surgery, the affected suture is removed to correct the baby's head shape. Ideally, the surgery takes place in the early months of life for optimal results.

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, shoulders, 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. While you should always lay babies to sleep on their backs, you can change where you lay them in the crib for sleep.

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 healthcare provider with questions.

It can also be helpful to get in touch with other parents who have been through similar experiences through 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. American Academy of Pediatrics. When a Baby’s Head is Misshapen: Positional Skull Deformities. Healthy Children. Updated August 31, 2020.

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

  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.

  4. Kyutoku S, Inagaki T. Review of past reports and current concepts of surgical management for craniosynostosisNeurologia Medico-Chirurgica. 2017;57(5):217–24. doi:10.2176/nmc.ra.2017-0006