Babies with an abnormal head shape

Dr. Ed Buchanan, a pediatric plastic surgeon, discusses craniosynostosis - a condition when the baby's head is shaped abnormally
Family Health Advice | Craniosynostosis - when your baby has an abnormal head shape at birth
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Babies with an abnormal head shape

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So craniosynostosis is a condition we see in some newborn babies in which portions of their skill are fused too early. So what does that mean? Essentially when a baby is born, it has 8 bones that make up its skull. Those 8 bones are separated by something called a suture. And that suture allows the baby’s head to mold and shape as it exits the birth canal but also to grow quite rapidly in the first 2 years of life when the brain is growing. If for some reason one of these sutures fuse too early, the shape of the head will grow abnormally. And if that’s the case, then oftentimes a pediatric neurosurgeon and a pediatric plastic surgeon will have to work together to restore that normal head shape. And that’s done via surgery. The timing of surgery is dependent upon which of those sutures has fused prematurely. So it’s important for that child to be evaluated within the first few months of life so we can put that baby on the correct therapeutic sequence. So when it comes to craniosynostosis, there are different kinds of craniosynostosis that we see. These kinds are dependent upon which of the cranial sutures that are fused prematurely. The most common suture that will fuse prematurely is the sagile suture, and that is the suture that is directly in the middle of the head. Essentially the abnormal head shape that will grow because of that is a long head that’s narrow. And that suture needs to be operated on usually between 3-6 months depending on the center that your’e being treated at. The other common sutures that we see being fused prematurely are the metopic suture, which is the one that’s right down the middle and will give the baby a pointed forehead, and then the coronal suture, which is one of the sutures off to the side and the front. And that will give the baby an appearance of a flat forehead on the one side with a more protruding forehead on the other side. So craniosynostosis affects approximately 1/1000 babies, the most common being sagile suture craniosynostosis, the next most common being metopic, and then coronal or uni-coronal. Some families can be confused because there’s another situation in which a baby’s head shape can be slightly abnormal. And this affects more children than craniosynostosis. This condition is called deformational plagiocephaly. This is when a baby’s head is growing and for some reason they’re laying more on one side than the other or maybe there was some compression intrauterine and the baby’s head was twisted and the baby’s head will grow flat on one of the sides or in the back. Now if that’s the case, the baby will normally grow out of that and they will not need surgery. It will normally take 1-2 years for the baby to grow out of that. However, there are some centers that will put a baby into a helmet in order to treat this. And this is called helmet therapy. When they put the helmet on, they usually do it within 3-6 months of life and the baby will need the helmet adjusted every month. And they’ll keep the baby in the helmet until the head shape has returned to a more normal appearance. A lot of families ask me whether it’s necessary to have a baby in a helmet for that long or to have a baby in a helmet at all. And I normally tell them that their baby’s head will most likely correct as the brain grows. And so the helmet isn’t 100% necessary. If they want to have a quicker correction, then they should go with the helmet therapy.

Dr. Ed Buchanan, a pediatric plastic surgeon, discusses craniosynostosis - a condition when the baby's head is shaped abnormally

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Edward Buchanan

Pediatric Plastic Surgeon & Author

Dr. Edward P. Buchanan is an Assistant Professor of Surgery in the Division of Plastic Surgery at Baylor College of Medicine in Houston, Texas.  He is the Chief of Cleft and Craniofacial Surgery at Texas Children’s Hospital. Before coming to Houston, he trained in Plastic Surgery at Stanford University and did further training in Pediatric Plastic Surgery and Craniofacial Surgery at Seattle Children’s Hospital in Seattle, Washington.  Although he performs all kinds of Plastic and Pediatric Plastic Surgery, his main focus of practice is Cleft Lip and Palate Surgery as well as Craniofacial Surgery.When he is not in Houston, Dr. Buchanan enjoys traveling to countries across the globe to teach and learn from other surgeons.  His most recent trip was to Lilongwe, Malawi, where he was a member of the Texas Children’s Hospital Global Surgical Initiative to help perform and teach Cleft and Pediatric Plastic Surgery.He recently wrote a children’s book entitled, “The Adventures of the Prickly Pear and the Happy Hoglet: Beginning the Journey of the Mental Ninja.” The book is intended to help children begin to develop a healthy self-image so that they can begin their Journey to becoming Mental Ninja’s (mentalninja.org).  The story was inspired by the children and family’s Dr. Buchanan has cared for over the years. 

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