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Why does my baby have an unusual head shape? What is plagiocephaly? What is craniosynostosis? Are x-rays necessary? When is surgery recommended for my baby’s head?

PlagiocephalyPlagiocephaly (positional molding)

  • The most commonly encountered cosmetic abnormality of the skull.
  • May be associated with torticollis, or a twisting of the neck.
  • Is self-resolving with time, activity, positioning, and simple exercises in most cases.
  • In more severe cases, physical therapy and/or a molding band can be used to improve head shape.
  • Surgery is not used to correct the skull in this condition.
  • Treatment should be started as soon as possible after the diagnosis.


  • A rarely encountered abnormal premature cranial fusion.
  • is not self-resolving with time and is expected to produce progressive and significant cranial deformity over time.
  • In some instances, may be associated with elevated brain pressures and/or developmental concerns.
  • May affect, jaw, ear, sinus, and eye development.
  • Surgery is strongly recommended to correct the condition and is generally performed between 2 months and 10 months of age.
    • Options may vary depending on time and type of diagnosis, but early diagnosis is important as some recommendations are time dependent, and outcome may be associated with earlier treatment.
    • These include minimally invasive techniques as well as traditional cranial repair.


  • The vast majority of abnormal head shapes in infants can be diagnosed by examination alone, avoiding radiation exposure.
  • Although imaging can be avoided in most instances, in the setting of craniosynostosis or questionable head shapes, skull x-rays or CT scans may be used for diagnostic and planning purposes.

Diagnosis and Treatment

Both types of abnormal head shapes are often diagnosed by your pediatrician, but may require specialists in craniofacial care to assist in diagnosis and provide treatment recommendations. These can include:

  • Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Oral and Maxillofacial Surgery
  • May include others, such as Ophthalmology, Pediatric Dentistry, Physical, Occupational, or Speech Therapy, Genetics, and others.

At UNC, we are experts in helping families make certain their baby – and their unusual cranial shape – are carefully evaluated, while making recommendations and providing state-of-the-art treatment, both surgical and non-surgical, that will lead to optimal outcomes.

To schedule an appointment with UNC Pediatric Neurosurgery, please call (919) 445-2410.

Dr. Scott Elton, Pediatric Neurosurgeon