Deformational Scaphocephaly
If you’ve noticed that your baby’s head seems a little longer or narrower than those of other infants, you’re not alone—and you’re not imagining things. It may be something called deformational scaphocephaly, a type of head shape difference that occurs when pressure on certain parts of a baby’s soft skull causes it to grow in a more elongated manner.
Fused bones or birth defects do not cause this. It’s usually the result of how babies lie or sleep in the first few months of life.
Deformational scaphocephaly occurs when the sides of a baby’s head, typically around the temples and parietal bones, become slightly flattened. As a result, the head grows longer from front to back to accommodate the growing brain. When you view the baby’s head from above, it may appear more oval or boat-shaped than round. That’s actually where the term “scaphocephaly” originates—skaphos means “boat” in Greek [1].
Parents may first notice this during bath time or in photos, where the head appears stretched out and narrow. Some babies may have a more prominent forehead or a back of the head that sticks out a little more.
What It’s Not
It’s essential to understand that deformational scaphocephaly differs from a condition known as sagittal craniosynostosis, where the sagittal suture, a seam in the skull, closes prematurely. That condition typically requires surgery because it restricts the skull’s growth. However, in deformational scaphocephaly, all the skull sutures remain open, meaning the bones can still shift and reshape over time [2].
How It Differs from Other Flat Head Shapes
There are a few types of head flattening you might hear about:
Plagiocephaly: Flattening on one side of the back of the head, often caused by a baby repeatedly turning their head in the same direction.
Brachycephaly: A condition characterized by a wide, short head with a flat back, often resulting from prolonged periods of lying on one’s back.
Scaphocephaly: The head is long and narrow, typically resulting from pressure on the sides of the head [3].
All of these are considered “positional” head shape differences. They’re not dangerous and don’t affect brain development, but they can be noticeable.
Who Is Most at Risk?
These head shape changes have become more common since the 1990s, when doctors began encouraging back-sleeping to reduce the risk of SIDS. That change saved lives—but it also meant babies spent more time on their backs or in one position, leading to an increase in cases of flat spots [4].
Premature infants are especially at risk for deformational scaphocephaly. Their skulls are softer, and they often need to spend long stretches lying on their sides or backs in the NICU. Some studies have found that over half of very premature babies develop this long-head shape during their hospital stay [5].
Signs to Look For
Parents often notice something is off just by looking. You might see:
• A head that looks long from front to back
• Narrow sides near the temples
• A slightly protruding forehead or back of the head
• There is no ridge on the top of the head (which would suggest fused bones)
• Standard head size and growth
If you’re concerned, a pediatrician or craniofacial specialist can examine your baby’s head from different angles, palpate the sutures, and measure head proportions (such as the cephalic index, which compares width to length) [6].
In some cases, the doctor may recommend imaging—such as an ultrasound or a simple X-ray—to ensure the sutures are open and confirm it’s not craniosynostosis.
What Can Be Done?
The good news: most of the time, treatment doesn’t involve surgery. Here’s what typically helps:
Repositioning: This means varying the way your baby lies down or turns their head. Engaging in plenty of tummy time while awake, limiting time spent in bouncers or swings, and alternating head positions during sleep can help [7].
Physical Therapy: If your baby has a tight neck muscle (a condition called torticollis), a physical therapist can guide you through stretches and exercises to help them turn their head more evenly.
Helmet Therapy: If the head shape doesn’t improve by around 4–6 months of age, or if it’s more severe, your doctor might recommend a custom helmet. These helmets don’t force the head to change shape—they guide the growth, creating space where needed and supporting the areas that have grown too much [8]. They’re usually worn for about 3–6 months, depending on the baby’s age and how quickly the head shape responds.
No Surgery Needed: Unless it turns out your baby has craniosynostosis (which is rare), no surgical intervention is necessary for deformational scaphocephaly.
What’s the Outlook?
Deformational scaphocephaly is mostly a cosmetic issue. It doesn’t affect brain function or cause pain. Many mild cases improve on their own as babies grow and spend more time sitting up, crawling, and moving around [9].
For babies who need helmet therapy, results are often very positive, especially when treatment starts early. The sooner the shape is addressed (ideally before 12 months), the more room there is for improvement.
Even without a helmet, most head shapes improve with time. By the time the child is a toddler, many parents say the difference is hardly noticeable—especially once the hair starts to grow.
