Skull Malformation

My son is 6 months old. The plate in the back of his skull is not formed into a normal position. His doctor said to get a CT to see if they are fused. If so, an operation would be needed to correct it. How dangerous is this operation, and is there any real threat in not having it done?

Skull Malformation

Dr. Greene’s Answer:

When we recognized that kids sleeping on their backs were much less likely to have a problem with SIDS, we started seeing more and more babies with the back of the skull flattened from spending so much time on it. This is a condition called plagiocephaly and will usually stop getting worse and start improving when kids start to spend most of the day up out of that position. Often it corrects all the way on its own and if not, it is just a cosmetic issue.

But there is a different condition called craniosynostosis where the bones in the skull fuse together too early. This gets worse over time and sometimes it is just cosmetic, but sometimes it can decrease the space for the brain to grow (usually this means a lot of fusing). If your child does have this fusing, it would be important to evaluate how much worse it is likely to get over time.

Consulting with a pediatric neurosurgeon, or craniofacial surgeon, is a good way to do that, depending on when your child starts spending most of the day off of the back of his head.

It might be worth talking with your doctor about waiting a month or two before the CT to see if the condition is improving, or at least not getting worse. Another approach would be to seek specialty surgical referral before getting the CT. On the other hand, sometimes the diagnosis is clear from the exam. Your doctor may have good reason to suspect that it is craniosynostosis. If it is, the earlier you correct it the easier it is.

Evaluation by a neurosurgeon and CT scanning are necessary to determine the severity of the problem. These steps do not mean that you are on an inevitable path to surgery. Most kids in this situation do not need surgery in the end.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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