By Laura Jana, MD, FAAP & Jennifer Shu, MD, FAAP
Many parents have been mistakenly led to believe that all newborns are born picture-perfect, with pretty little round heads. Let us just say that for anyone who has gone through or will experience vaginal delivery, it is nothing short of a blessing that a baby’s skull is made up of soft bony plates that are capable of compressing and overlapping to fit through the narrow birth canal—a process referred to as molding.
For some babies—such as those who "drop" well in advance of being born (in other words, settle themselves head first deep into their mother’s pelvis well in advance of delivery), or those who must endure long labors and narrow birth canals—the result is often a newborn head shape that more closely resembles a cone than a nice round ball.
If you run your fingers over your newborn’s skull, you may also find that you can feel ridges along the areas where the bony plates of the skull have overlapped. In short, slightly misshapen heads are quite common right after birth.
Fortunately, over the next several weeks the bones of your baby’s skull will almost assuredly round out and the ridges will disappear—assuming, that is, that your baby doesn’t spend too much time on their back with his head in any one position. This is a common but easily avoidable cause for the development of a flat back or side of the head known as plagiocephaly.
The soft spot
You will notice one to two areas on your baby’s head that seem to be lacking bony protection. These soft spots, referred to as fontanelles (anterior for the larger one in the front, posterior for the smaller and typically less noticeable one in the back), are normal gaps in a newborn’s skull that will allow your baby’s brain to grow rapidly throughout the next year.
Many parents are afraid to touch these soft spots, but you can rest assured that, despite their lack of a bony layer, they are well protected from typical day-to-day baby handling. Other things to know about the soft spot(s) include:
- In young infants, a sunken soft spot (when combined with poor feeding and dry diapers) can suggest dehydration. Our advice to you: Don’t read too much into this because it can be a subtle finding or sometimes be present in normal babies. Instead, make sure you have a good grasp on how to recognize dehydration and check with your doctor if you have any concerns—with or without a sunken soft spot.
- In some instances, the soft spot on the top of your baby’s head may seem to be pulsating. There is no need to worry—this movement is quite normal and simply reflects the visible pulsing of blood that corresponds to your baby’s heartbeat.
Bumps & bruises
In addition to molding, a bit of swelling or bruising of the scalp immediately following delivery is not uncommon for newborns. The swelling usually is most noticeable at the top back part of the head and is medically referred to as a caput (short for caput succedaneum). When bruising of the head occurs during delivery, the result can be a boggy-feeling area, called a cephalohematoma.
Bruising and swelling are usually harmless and go away on their own over the first days and weeks, but can be a contributing factor for jaundice.
Gone today, but hair tomorrow
Sure, babies are sometimes born with full heads of hair, but it’s far more likely for them to be born with little to none. And those with hair today are likely to find it gone tomorrow. That’s because any hair your baby is born with is likely to thin out significantly over the next few months before ultimately being replaced with "real" hair. It is also entirely possible that whatever hair your newborn does have will change color by several shades and several times over their lifetime.
About Dr. Jana
Laura A. Jana, MD, FAAP, is a pediatrician and mother of 3 with a faculty appointment at the Penn State University Edna Bennett Pierce Prevention Research Center. She is the author of more than 30 parenting and children's books and serves as an early childhood expert/contributor for organizations including the Maternal and Child Health Bureau, Primrose Schools, and US News & World Report. She lives in Omaha, NE.
About Dr. Shu
Jennifer Shu, MD, FAAP serves as the medical editor of HealthyChildren.org and provides oversight and direction for the site in conjunction with the staff editor. Dr. Shu is a practicing pediatrician at Children's Medical Group in Atlanta, Georgia, and she is also a mom. She earned her medical degree at the Medical College of Virginia in Richmond and specialized in pediatrics at the University of California, San Francisco. Her experience includes working in private practice, as well as working in an academic medical center. She served as director of the normal newborn nursery at Dartmouth-Hitchcock Medical Center in New Hampshire. Dr. Shu is also co-author of Food Fights and Heading Home with Your Newborn published by the American Academy of Pediatrics.