My newborn's head is an odd shape. What can I do to make it round?

It's very common for a newborn’s head to have an odd shape.

Babies' skull bones are soft and easily moulded to help them squeeze through the birth canal during a vaginal delivery. This process is called moulding.

The gentle pressure that moulding puts on your newborn's skull may have resulted in his head looking cone-shaped, elongated or misshapen. This odd shape will even out as the soft spots close, and the bones in his head meet and fuse.

Your baby has two soft spots on his head. The fontanelle at the back of your baby’s head closes at six weeks. The other soft spot is more obvious and can be easily felt as a slightly dipped area of skin on the top of the head. This doesn't usually close until after 18 months.

It's also common for a young baby to have a flat area at the back of the head. This is usually because babies are placed on their backs to sleep, which reduces the risk of sudden infant death syndrome (SIDS).

Other reasons that your baby may have a flat area on the back or side of his head include:

• Prematurity. If your baby is premature, his bones will not have fully formed and will be very soft, meaning his head is more likely to be misshapen as he comes down the birth canal. Premature babies also take longer to control their heads than babies born at term, so they can't relieve the pressure on a particular spot until they're much older.
• Multiple pregnancy. Your baby's head may be an odd shape if he shares your womb (uterus) with one or more siblings.
• Low amniotic fluid (oligohydramnios). If you have low amniotic fluid, your baby does not have as much room to move around and is not as cushioned as babies with a higher level of fluid.
  

The medical term for the flat area on the side of your baby's head is plagiocephaly. If the back of his head is flat, this is called brachycephaly. While his head may be noticeably misshapen, it’s usually nothing to worry about.

You can help your baby's head return to a more rounded shape by altering his position while he's asleep, feeding and playing. Changing your baby's position is called counter-positioning or repositioning. It encourages the flattened areas of your baby's head to reshape naturally. For your baby's safety, always put him on his back to sleep.

There are other things you can try to encourage him not to lie on the flat part of his head:

• When you put your baby down on his back, make sure the rounded side of his head is in contact with the mattress.
• If your baby sleeps in a crib, or Moses basket, turn it around regularly so that your baby is not always looking in the same direction. If he’s in a cot or palna alternate the direction in which you place him down to sleep. Don't forget to place his feet at the foot of his bed to reduce the risk of SIDS.
• If your baby's head is flat on one side, you could change the position of whatever he loves to look at, from one side to the other. Or you could try placing black-and-white pictures on one side of the cot or palna to hold his attention.
• Encourage your baby to lie on his side when possible. It is safest to do this when he is sleeping during the day under your supervision, or if he is wide awake or in his pram. Always keep an eye on your baby when he is lying on his side to be sure nothing happens to obstruct his nose and prevent him from breathing properly.
• As your baby's neck muscles strengthen, put him on his tummy, just for a minute or two at first. By three months you should be able to play with your baby while he's on his front. Slowly increase tummy time to at least 30 minutes, three times a day. See our tummy time video to know the best and safest ways to do tummy time with your baby!
• You could try using a sling for him to sleep in for a short nap during the day. The change of position will relieve the pressure points on his head. For safety, make sure you can kiss your baby's head while he's in the sling. You should also be able to see his face by glancing down. Keep the sling tight so your back is supported, and check that his chin isn't against his chest.
• Alternate where you place your baby to play. A baby bouncer will hold his head in a different way from when he's just playing on the floor. Changing positions will give him new things to look at too.
• If your baby's bottle-fed, you may have a favourite side to feed him on, depending on whether you’re right-handed or left-handed. But changing sides regularly may encourage him to turn his head in both directions.
  

Despite popular belief, there is no evidence to suggest that applying pressure on your baby's head during a massage will make it round. Too much pressure can make him uncomfortable, or even hurt him. 

Some mothers use a horseshoe-shaped pillow in the hope that it will help make their baby’s head round. However, keep in mind that pillows are not recommended for babies under the age of one.

Any kind of pillow, soft object and loose bedding can obstruct the infant airway and pose a suffocation risk. These have also been linked to SIDS (Sudden Infant Death Syndrome) also known as cot death.

There are medical interventions that can change the shape of your baby's head, such as physiotherapy or helmet therapy. But these measures are a last resort.

Rest assured that most babies won't require any treatment at all. Your baby's head should round out naturally by the time he's six months. Once your baby can sit up, the pressure will be off his skull during the daytime and you'll start to see the difference.

If you're still worried though, or you think the irregular shape is becoming more obvious, take your baby to your paediatrician. Very occasionally, there are other reasons for a baby's head to be misshapen.

Craniosynostosis is a rare condition that causes a baby's bones to fuse too early. If your doctor is concerned that this may be happening, your baby will be referred to a specialist.

If your baby has a lot of trouble turning his head in one direction, it may be because the muscles in his neck are tight on one side (torticollis). In this case, your paediatrician may refer your baby to a physiotherapist.


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