What a Beautiful Head you Have!


What could be more precious than your sweet baby’s adorable little face staring back at you?  Nothing!  It’s a pure lovefest.  Which is why I try to tread carefully when pointing out any functional or structural irregularities of your baby’s head.  Please know that they are beautiful and perfect just the way they are!  I point them out if they are present so that they can be addressed.  It is my goal to assess anything that may be causing them issues now or in the future and develop a treatment plan to correct it.


So let’s talk about that head from the bare bones – literally.  A baby’s skull is composed of a number of separate cranial bones.  It is necessary for these bones to have gaps between them so they can move, allowing the head to fit through the birth canal during delivery.  You are aware of the “soft spot” in the front part of the baby’s head.  This is called the anterior fontanelle and it typically closes anywhere between 9 – 24 months. On average it is usually gone around 18 months.  There is also another smaller soft spot towards the back of the baby’s head.  This is the posterior fontanelle and it closes much sooner at around 2-3 months old.


Another extremely important reason that the cranial bones need to move is because once the baby is born, the brain continues to go through a large growth in the first months of life and the skull must be able to expand to accommodate this growth.  The bones are like puzzle pieces attached on a sheet of tissue.  If properly positioned, they will come together during delivery and then expand as needed for brain development.


Often times, the cranial bones are shifted out of their proper positioning and their motion becomes restricted,  How does this occur?  Perhaps it was an abnormal position prior to birth, trauma during contractions of labor as the baby tried to descend the birth canal or pressures applied to the head by your doctor as the baby was being delivered.  Vacuum extraction and forceps delivery can be extremely debilitating to the cranial bones due to the pressures exerted on them.  In any of these ways, the cranial bones may overlap and/or become restricted, thus causing a “ridge” appearance and bumpy feel.  A baby’s head should be a nice, smooth, round little ball.


Some parents may think this is normal and that it will resolve on its own or they may be concerned from a cosmetic standpoint.  Immediately following delivery, some babies do look like “coneheads” and if this was due to a slightly sustained period in the birth canal, the cranials will shift back to their proper position once the abnormal forces on them are no longer present.  More often than not, though, at least some of the  cranial bones are “stuck” and have a hard time gliding back to their proper position on their own.


The cosmetic appearance of this is the least of the issues.  More importantly, many problems can arise due to these cranial misalignments both immediately and down the round.  The baby may be uncomfortable lying down or held with pressure on certain areas of the head.  Nursing can be impacted for a number of reasons.  Firstly, the position during nursing can create pain and discomfort if there is pressure on an area of the skull or jaw that is not aligned properly as the baby is trying to feed.  Secondly, the jaw may be affected by cranial misalignments causing difficulty with latching and sucking.  Often times moms will report more trouble nursing on one side versus the other and one of these can often be the culprit.   Thirdly, the openings for the cranial nerves are small in an adult – so imagine how tiny they are in a baby’s skull.  If the cranial bones are misaligned, the cranial nerves can be affected and this can cause a myriad of symptoms.  For example, the hypoglossal cranial nerve goes to the tongue and if it is not functioning properly then the baby’s tongue function and sucking motion may be greatly affected.


Another cranial nerve that can cause many issues is the vagus nerve.  The vagus nerve is the “rest and digest” nerve of the body.  If this is impacted in any way, the resulting symptoms can be reflux, poor digestion, irritability, as well as heightened sensitivities to sound or other stimuli.  The baby is unable to relax and be calmed as expected.  Lastly, a number of the cranial bones actually make up the hard palate (“roof”) in the baby’s mouth.  If these bones are affected the baby may have a high arch or some other configuration that can affect sucking, swallowing and orthodontic issues later.


Down the road, depending on the cranial bones that are misaligned, the child can be more prone to sinus and allergy issues, orthodontic issues, speech and learning issues, hyperactivity, sensory issues, ear infections, and digestive problems, to name a few.


For this reason, it is so important to have your baby’s head evaluated by a practitioner experienced in evaluating these factors.  Likewise, the sooner this can occur, the better, so that treatment can occur and alleviate symptoms and/or further issues before they arise.  Time is of the essence since the posterior fontanelle closes within the first few months and most of the other fontanelles are closing within the first year.  The more opening between the bones, the easier it is to move and realign them.


So how are the cranial bones aligned if they are restricted?  A very light touch is applied to guide the bones into their proper alignment.  Imagine the weight of a nickel on the pad of your finger and that is the amount of pressure that is used when working on the cranial bones.  Think of this scenario:  you have a little wooden boat in a pond attached to a string.  If you gently pull the string, the boat will glide easily over the surface of the water in the direction you are pulling it.  If you tug hard on the string, the front of the boat will be submerged under water and there will be resistance as you try to pull the boat, making it harder to move.  Such is the case with the cranial bones so a very light touch is utilized. The amount of cranial work needed depends on how bad the restrictions are and how diligent parents are about following at home instructions given by the doctor.


Cranial work can be performed on children and adults but the actual movement occurring is different depending on the age of the patient.  Prior to fontanelles closing, there is actual bony shifting of the cranial bones that can occur with treatment.  After this point, up until around 6 years of age, the cranial bones will not have any visible movement but there is still movement that can occur because the cranial sutures (fibrous connections between cranial bones) have not completely fused.  With an adult, cranial work can still have an amazing impact but because the skull bones are fused, the results occur more due to the impact on the underlying facial tissue as opposed to actual movement of the cranial bones.