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Cone Head Babies (and Other Uneven Head Shapes in Newborns): Causes and Remedies
Updated: Mar 6
Movies inevitably show a mother who gives birth and has a perfect, cute baby placed in her arms. But this is often not the case in real life (and that movie baby might actually be two or more months old!). Birth, while natural and wonderful, can be stressful for a baby's body and can leave a mark, especially on their fragile heads. Other factors can cause babies to develop asymmetries on their heads after birth.
Regardless of the cause, an unevenly-shaped head can be a concern for parents. But Pathfinder Health is here to help! In this article, we'll explore what may lead to an uneven head shape in newborns and offer guidance on bringing balance back into your little one's life (and head).
In this article:
Factors that influence a baby's head shape
Other causes of an abnormal head shape
Remedies for uneven head shape
FAQs about a baby's head shape
Factors that influence a baby's head shape
Your baby's skull
Your baby's skull is very different from that of an adult, or even a toddler. A baby's skull is more flexible, to make it easier for their large head to squeeze through the birth canal during a vaginal birth. This flexibility also accommodates the rapid brain growth that occurs during infancy.
In an infant, the bony plates that make up the skull have not yet fused together. Instead, in between a baby's skull bones are gaps called cranial sutures that allow the skull to change shape and grow. Babies' skulls have two particularly large gaps called fontanelles, or soft spots. You can feel one fontanelle when you touch the top of your baby's head.
Newborn head molding
When a baby is born head-first, the tight birth canal exerts a great deal of pressure on their skull and can mold the head into an oblong shape, or even a cone.
Babies who are born in a breech position, where the bottom or feet come out first, generally do not experience this head molding and are born with a round head.
Likewise, babies born via cesarean section generally have round heads, unless they are born by emergency cesarean section after the mother has already labored.
Head position as a newborn
A baby's head shape can also change after birth. If a baby spends too much time lying flat in one position, the pressure on the back or side of the skull can lead to an uneven head shape. We’ll discuss ways to prevent this below.
Other causes of an abnormal head shape
There are numerous other conditions that can cause an abnormality in head shape or size, such as craniosynostosis, macrocephaly (abnormally large head size), and microcephaly (abnormally small head size). These conditions are not the result of head molding during birth or head positioning after birth and we do not discuss them in this article.
Common head shape conditions
Cone-shaped head
Sometimes a newborn's head is molded unevenly due to the tight squeeze of passing through the birth canal. This can result in an uneven head shape. To immediately dispel one myth, it is completely normal for babies to be born with unevenly shaped heads--even cone-shaped heads--as a result of the birth process.
A cone-shaped head is particularly likely to occur if a baby drops into the mother's pelvis early or if the mother has a narrow birth canal and/or a long labor.
A baby's conehead appearance after birth usually resolves on its own. Often, the head will regain its round shape after the first few days, although it may take other babies a few weeks to lose the cone shape entirely.
Caput succedaneum
Caput succedaneum is another potential side effect of birth on a baby's head. It refers to swelling, puffiness, and possible bruising of a baby's scalp as a result of vaginal birth. Caput succedaneum is most often caused by pressure from the uterus or vaginal wall during a head-first delivery, especially a long or hard delivery.
Just like a cone-shaped head, caput succedaneum goes away on its own, usually within a few days after birth.
Flat head syndrome
Plagiocephaly (commonly called "flat head syndrome") is an asymmetrical head shape or flattened spot on the back or side of a baby's head that develops after birth.
This is a common occurrence. A 2013 study found that approximately 47% of infants have some degree of flat spot and the vast majority are mild cases. This breaks down to:
There are two main causes of flat head syndrome.
Positional plagiocephaly occurs when babies lie with their heads in the same position for a long time, putting constant pressure on the back or side of their skull. Because babies' bones are more flexible, too much pressure on one area can create a flat spot.
Positional plagiocephaly can result if a baby spends too much time lying on their back in a baby swing, carrier, or infant seat.
2. Congenital muscular torticollis
Congenital muscular torticollis is a condition seen in newborns where the muscle that runs down the side of their neck is tight and shortened. As a result, the baby tilts their head to one side and has trouble turning their head to the opposite side. This could be caused by the baby's position in the womb or by an injury to the neck muscle before birth.
Because babies with torticollis have limited neck mobility and a strong preference for turning their heads to one side, they can develop a flat spot as a result of keeping their head in one position.
Remedies for uneven head shape
If your baby's head shape is uneven, don't despair! Mild cases of plagiocephaly often don't require any treatment. As your baby grows, moves around more, and naturally spends more time in different positions, their head shape will often correct itself.
And even if your baby does need treatment, there are many remedies and therapies that can correct their head shape, many of which you can do with your baby at home.
If you're concerned about your baby's head shape, talk with your baby's health care provider. But ultimately, remember that most people don't have perfectly round heads--don't agonize over every small bump!
At-home remedies
Changes in the way you position your baby can help correct unevenness in their skull. Your healthcare provider may suggest that you do the following:
Change your baby's sleep position. Your baby should always sleep on their back. But you can alternate the direction your baby's head faces in the crib. For example, if your baby always turns their head towards the window, place them with their head at the "foot" of their crib so they have to turn the other way to face the window. Alternate ends of the crib each night. Or try hanging a mobile over the crib to encourage your baby to move their head.
Alternate sides for feeding. Similarly, if you bottle feed your baby, try alternating the arm that you hold them with for each feeding so that their head is not always facing the same direction while they eat. If you breastfeed, you are most likely already alternating sides during a feeding.
Hold your baby frequently. Hold your baby upright as much as possible while they are awake to reduce the pressure on their head.
Maximize tummy time. Place your baby on their tummy to play as often as possible when they are awake. Be sure to use a firm surface for tummy time and supervise your baby closely.
For more information about tummy time, see My Baby Hates Tummy Time: Everything You Need To Know and 20 Tummy Time Activities To Try With Your Baby.
Physical therapy
When an underlying muscular issue, such as torticollis, causes a baby to hold their head tilted to one side, physical therapy is usually necessary.
Physical therapy can help stretch and strengthen the affected neck and head muscles so that the baby can change their head position more easily and reduce pressure on one spot.
Helmet therapy
If the at-home changes and physical therapy don't work or if the head asymmetry is severe, your pediatrician might prescribe helmet therapy with a molding helmet (also called a cranial helmet or cranial orthosis). A molding helmet is designed to relieve pressure on the flat side of your baby's head and is custom fit to each child.
Babies generally wear a molding helmet for 23 hours per day, with a break for bath time. Most babies quickly become accustomed to wearing a helmet and do not experience any discomfort. If your baby does seem uncomfortable, their helmet may need to be adjusted.
Helmet therapy is most effective between the ages of four and twelve months, when your baby's skull bones are most flexible and their brain is still growing rapidly. After age one, head growth slows down and the skull plates fuse together, so helmet therapy is unlikely to be effective.
Helmet therapy will generally be the most effective and take the least time if it begins as early as possible. A baby will usually need to wear a helmet for several months, and in some cases may need a second helmet.
Above all, don’t worry if your doctor recommends a helmet for your baby. This treatment is fairly common and will not hurt your baby. They'll be done with their cute headgear before you know it!
FAQs about a baby's head shape
Q: Should I worry about my baby's cone-shaped head?
No. Approximately one third of babies born vaginally will temporarily have a cone-shaped head. This will generally resolve itself within days or weeks after birth.
Q: Will an uneven head shape lead to developmental delays?
A flat spot is generally considered a cosmetic issue. It does not cause brain damage.
However, if a flat spot interferes with normal head and neck movement--for example, if it is caused by torticollis--it can in some cases impact a baby's motor development. For example, it might make it harder for a baby to learn to roll or sit up.
To learn more about motor delays, see When Should You Be Concerned About Your Child's Development?
Additionally, an abnormal head shape may cause social difficulties when a child is older.
For these reasons, you should consult with your healthcare provider as soon as possible if your baby has an uneven head shape so that they can begin any treatment and have the best possible result.
Q: Will a cone-shaped head lead to flat head syndrome?
It shouldn't. A cone-shaped head usually resolves quickly after a baby's birth and should not affect the position in which they hold their head. However, you should always make an effort to vary your baby's head position to prevent flat head syndrome.
Q: Does my baby need a cranial helmet?
If you are concerned about the shape of your baby's head, you should consult with your healthcare provider. They will evaluate your baby's skull and recommend any treatment they might need.
The Takeaway
Babies can be born with uneven head shapes or can even develop them from spending too much time in one position. But don't worry--this is common and doesn't mean that something is wrong with them. Often your baby's head will correct itself on its own. There are also many steps you can take to help your baby's head regain its rounder shape.
If you need more reassurance, reach out to a medical professional who will be able to help you further understand how best to get that precious head back into form!
Sources:
Mawji A, Vollman AR, Hatfield J, et al. The Incidence of Positional Plagiocephaly: A Cohort Study. Pediatrics (2013) 132 (2): 298–304. https://doi.org/10.1542/peds.2012-3438
