Stork bites, breast buds and sticky belly button may not sound like medical terms to you, however, they are some of the most frequently discussed health topics during a child's first year. Cara Natterson is a pediatrician in Los Angeles and is the author of a new book titled, "Your Newborn Head to Toe: Everything You Want to Know About Your Baby's Health Through the First Year.” She discusses the book on “Today.” Read an excerpt here:
Head shape
In order for a baby to be able to travel through the birth canal, the head must be small enough and flexible enough to fit. Fortunately the brain is only a fraction of its adult size at birth. The bones that surround it are also able to mold into different positions. This explains why most babies that have been resting low in their mother’s pelvis, waiting for delivery, have long pointy heads just after birth.
While the head must be extremely moldable, it must also be very sturdy. The skull is responsible for protecting the brain beneath it. It must be strong enough to endure bumps and bonks during delivery and thereafter. And, in order to grow and develop complex language and thought, the brain and its surrounding skull must be able to expand. Therefore both the brain and its protective shell are designed to change shape and grow over time. For something so hard to the touch, the bony skull is amazingly malleable.
Head growth is greatest in the first year of life. As the skull grows, it changes shape. Therefore, when a baby is placed in various positions over and over again, the pressure on one particular part of the skull can cause flattening of that area. While children and adults have relatively fixed head shapes, babies do not. The range of skull shapes and the speed at which the skull changes shape are remarkable.
Pointed head (molding)
(Birth)
What is happening inside my baby’s body?
The bones that make up your baby’s skull are designed to move around so that the head can pass through a tight space when the baby is born. In fact the skull bones look like big pieces of a puzzle: they fit together, but they are not firmly attached.
When a baby hangs upside down and low in her mom’s pelvis for days (or weeks), the bones of her skull mold to fit the mom’s pelvis. This is why many newborn babies have pointed heads — a phenomenon called molding. This is a good strategy for a delivering baby because it may help her to pass through a very narrow birth canal. Some babies do not hang upside down in the pelvis for long (or at all), so they have perfectly round heads at birth. This is especially true among babies born by cesarean section.
The fact that the bones of a baby’s skull can move around allows humans to have rapid brain growth, not just while developing inside the womb but after birth as well. In the first two years of life, the human head grows an average of 40 percent, allowing a newborn to be delivered while her brain is still quite immature. In fact humans are the only species born with brains that are so immature that a baby is entirely dependent upon a parent. Think of horses — they are able to walk within hours of birth. Humans cannot even crawl yet. Why does this happen? Because humans are born with immature brains that can ultimately develop a level of sophistication that no other animals have. Again, this is all thanks to a moldable head and movable skull bones. The only alternative in evolution allowing for massive human brain size and sophistication would have been for moms to have gigantic hips!
Molding lasts only a few days after the baby is born. Remarkably the head rounds itself out quickly once a baby has been delivered. Within a week the head assumes a standard round shape, with a soft spot at the very top toward the front and another, smaller soft spot at the top toward the back. These spots — called fontanels — are simply normal spaces between the bones of the skull. They allow for even more growth of the brain and skull after birth. The fontanel at the back of the head typically closes between two and twelve weeks of life; the one at the top of the head usually closes sometime between six and eighteen months of age.
What can I do?
Parents do not need to do anything to resolve molding. The head will usually round itself out. However, in some cases, parts of the skull become flat over time. To avoid this, you should put your baby down to sleep on her back, with the head in slightly different positions throughout the day and night. Sometimes the head is turned to one side, sometimes to the other, and sometimes it is placed in the middle. This strategy, which allows the head to continue to round itself out, is covered in more detail in the section on plagiocephaly that follows.
When does my doctor need to be involved?
Doctors do not need to do anything about head molding. The changing shape of the head in the womb is normal and goes away quickly after birth.
What tests need to be done, and what do the results mean?Tests are unnecessary in the case of molding because the shaping of the skull in the womb is normal.
What are the treatments?
Head molding does not require treatment; it will resolve itself. However, to avoid future flattening of certain parts of your baby’s head, you should rotate her sleep position so that she is not continually resting on one part of her head. This is covered in the section on plagiocephaly that follows.
What are the possible complications?
There are no complications from head molding. It resolves quickly on its own.
Additional Resources:http://www.cdc.gov/ncha/about/major/nhanes/growthcharts/charts.htm
Flat head (plagiocephaly)
(1–9 Months)
What is happening inside my baby’s body?
Just as the head was shaped in the womb by mom’s pelvis, the head is subject to reshaping after birth too. This is because the plates of the skull are pliable, so positioning of the head can dramatically affect its shape over time. When babies are laid down to sleep in the same position over and over again, specific spots on the skull receive more pressure just from the weight of the head on that area. If the position of the head is not rotated regularly, then the part that repeatedly bears the weight will flatten. For some babies the flat part is on the back of the skull, but for others it is on one side or the other. Noticeable flattening is called plagiocephaly.
Plagiocephaly can also result from repeated positioning while sitting up. When your baby sits in a car seat, his head flops to one side or the other. Head-and-neck pillows help to keep him supported, but sometimes a baby prefers to turn his head in one particular direction, or the seat is arranged so that he is in the same position each time. Again, gravity and the weight of the head can put pressure on a specific part of the skull, and this can contribute to flattening of one side of the head.
Babies with torticollis have uneven neck muscles. These babies hold their head cocked to one side. They are more likely to develop plagiocephaly simply because they position their own heads in one direction most of the time. Torticollis is covered in more detail in chapter 17.
What can I do?
You can rotate your baby’s sleeping position regularly. Your baby should sleep on his back, with his head turned alternately to one side, then the other, and then kept in the middle. He can be slightly propped up on his side using a wedge (triangular-shaped pillow) or a rolled blanket tucked behind him. Any material used to position a baby should be placed below the shoulders so that, in case he squirms and flips over, there is no chance that the material will block the nose and mouth. If a flat area has begun to form on the skull, then an effort should be made to avoid laying the baby on that side until the skull has rounded out again.
If you notice that your baby prefers to look in one direction and this is contributing to flattening of the head on one side, then try to provide entertainment in the opposite direction. Toys can be placed in the crib in such a way that the baby turns his head to look at them. In the car, a mirror can be placed on the backseat so that he will turn his head to catch a glimpse of himself. When trying strategies like these, you should remember to put the target objects in a place that entices the baby to look in the opposite direction from his favored glance.
When does my doctor need to be involved?
If you notice an area of flattening on the head, let your doctor know.
What tests need to be done, and what do the results mean?
If a baby has plagiocephaly, then tests are usually not necessary. The treatment will typically be the same regardless of any tests that may be done.
What are the treatments?
Helping your baby to round out his head can be difficult because once he has developed a comfortable flat place to rest his head, you will need to do some maneuvering to get him to sleep or to just hold his head in a different position. If repositioning and placing toys and mirrors have not helped, and if the head flattening has become severe, then a helmet may be used. This is unusual.
Helmets help to round out the head. They are firm, so they place gentle pressure on the parts of the skull that are more rounded and no pressure on the areas that are flat. Over time (usually months), the flattened parts of the head become round. Helmets are almost never used until a baby is 4 to 6 months old — the head will usually round itself out well before then. Helmets are rarely used after a child is 10 to 12 months old, because the bones of the skull are far less moldable by this point.
What are the possible complications?
The only complication of plagiocephaly is a cosmetic one: a permanently flattened head. This is usually hidden by hair, especially when the flat spot is in the back. But in rare cases, one side of the skull is significantly flatter than the other, and the cosmetic effect can be noticeable. If a person has very thin or sparse hair, then the flat spot is more obvious.
Additional Resourceshttp://www.hmc.psu.edu/neurosurgery/pservices/helmet.htm
Bald spots
(2–6 months)
What is happening inside my baby’s body?
Almost all babies develop bald spots on the back of the head, just above the neck. This was not the case when babies were put to sleep facing down, but now that they are placed on their backs, it is the norm. The cause of balding is repeated pressure and friction on one spot on the scalp. This spot will lose hair. The principle is similar to head flattening, but this problem is much easier to solve, because as a baby becomes stronger and lifts his head, he reduces the scalp friction and the hair grows back normally.
What can I do?
Parents can try to alternate a baby’s sleeping position, but balding happens quite easily, with very little friction along the scalp. Therefore there is little a parent can do except wait.
When does my doctor need to be involved?
Doctors do not need to be involved because bald patches on the back of the head are normal and temporary.
What tests need to be done, and what do the results mean?
Because this is a normal phenomenon, tests do not need to be done.
What are the treatments?
Time is the only real cure for balding, but repositioning a baby so that different points of the scalp receive pressure and friction may help to minimize the bald spot.
What are the possible complications?
There are no complications. The hair will grow back.
Additional Resourceshttp://www.choc.com/dev/pediatric/hhg/hairloss.htm
Soft spots (fontanels)
(Birth–12 months)
What is happening inside my baby’s body?
The soft spots (also known as fontanels) are the connections between the skull bones. There are actually four of them at birth, but only two are noticeable. The bigger one at the top of the head is called the anterior fontanel; the smaller one in the midline of the back of the head is called the posterior fontanel. The fontanel system allows a baby to be delivered with ease because it makes the head more malleable. With loose connections between the bones of the skull, the head can mold into a long narrow shape in order to travel more easily through the vaginal canal.
The soft spots may feel delicate, but they are remarkably tough. Many parents are afraid to touch them, but there is nothing to fear because the overlying tissue is very strong. The fluid surrounding the brain sits underneath the soft spots, so when you touch the area it can feel boggy.
The posterior fontanel closes first because it is the smaller of the two soft spots. On average, it closes between weeks 2 to 12. But the anterior fontanel stays open much longer, closing anytime between 6 to 18 months.
What can I do?
Nothing special needs to be done to the fontanels. You don’t need to avoid touching the area or brushing the hair there.
When does my doctor need to be involved?
Fontanels usually look flat or very slightly raised or sunken. Call your doctor if the fontanel is noticeably bulging or sunken. A bulging fontanel can be the sign of infection in the fluid surrounding the brain. A baby with an infection around the brain will usually look very sick — he will almost always be very fussy or sleepy (or both) and have a high fever. A sunken fontanel can be a sign of dehydration. A cushion of fluid surrounds the brain, and as the body gets increasingly dehydrated, fluid from every compartment diminishes. When this happens, the fontanel looks like a deep crevasse. A dehydrated baby usually looks quite ill. This is described in more detail in chapter 28.
What tests need to be done, and what do the results mean?
Normal fontanels require no tests. In rare instances, if the child is very sick or the fontanel is bulging, then a spinal tap may be considered. This test checks the fluid that surrounds the brain. The fluid is drawn from the lower back, where the base of the spinal cord sits. It is never drawn from the fontanel. Occasionally a CT scan or ultrasound of the head may be done as well. These tests look at both the fluid surrounding the brain and the brain itself. Ultrasounds are particularly useful in a baby whose anterior fontanel is still open. But once it closes, an ultrasound on the skull is useless. Spinal taps, CT scans, and ultrasounds are described in chapter 29.
What are the treatments?
A fontanel will close on its own and requires no treatment. If the fontanel is truly bulging or sunken, then the underlying cause requires treatment. An infection causing a bulging fontanel will usually be treated with antibiotics. Dehydration causing a sunken fontanel will be treated with fluids for hydration. Each of these is covered in more detail in chapter 28.
What are the possible complications?
A fontanel can close too early or stay open too long. If the fontanel closes too soon, then the shape of the head may be affected. Remember that the fontanels are open spaces between some of the skull bones; there are also sutures between all the skull bones that hold neighboring bones together tightly. If these sutures fuse too early, then the shape of the head can be profoundly affected. This is called craniosynostosis. If only the fontanels close early but the sutures remain normal, then the head will maintain a normal shape.
A fontanel that stays open too long may signal some other underlying problem. Babies with thyroid disease or malnutrition may have delayed closure of the fontanels. Some genetic syndromes also cause delayed closure. And bone diseases such as rickets may slow the process as well.
Additional Resourceshttp://www.nlm.nih.gov/medlineplus/encyclopedia.html (Click on “Cp–Cz,” then scroll down to “cranial sutures.”)
Excerpted from "Your Newborn: Head to Toe: Everything You Want to Know About Your Baby's Health Through the First Year." Copyright © 2004 by Cara Familian Natterson, M.D. Reprinted by permission of Little, Brown & Company. For more information you can visit: