Case Chronicles: What Would You Do - Craniosynostosis
Chapter 1 of 5 · Case-Based Learning
Initial concern
Presentation: Parents notice persistent narrow forehead
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Babies often lie on the same side and develop a flat spot that fills back in on its own.
The key clinical question to distinguish positional plagiocephaly from craniosynostosis is whether the head is rounding out over time or whether the same abnormal shape is persisting as the child grows.
A baby's skull is not one solid bowl but a bunch of plates with soft seams (sutures) in between them.
Sutures allow the skull to grow while the brain grows.
Sometimes one suture closes too early.
The soft spot (fontanelle) is almost always fine and is not the concern in craniosynostosis—it is the shape that matters.
A skull with one suture locked shut grows abnormally: restricted in one direction, it bulges out in another (like squeezing a long balloon).
Surgeons use the 'grocery store test': if a stranger would turn and look twice at the head shape, it should be checked out.
If left untreated, craniosynostosis deformity persists and is not just cosmetic—a growing brain needs the skull to keep growing with it, and a locked suture can make the intracranial space too tight.
Early diagnosis of craniosynostosis (when the infant is still very young and bone is soft and growing fast) allows for a less invasive surgical approach.
For early-diagnosed craniosynostosis, the surgical approach involves one small opening (no bigger than a fingernail) and allows the infant's own growth to finish the job, guided by a helmet over a few months.
For less invasive craniosynostosis procedures, Dr. Scooch performs the surgery alone and plans the whole operation on a computer first.
Most babies with a single early closed suture never actually develop increased intracranial pressure, but no one can predict which few will, so surgery is not delayed.
The postoperative helmet does not squeeze; it leaves room where the head needs to grow and blocks growth where it does not need to expand.
A slightly abnormal shaped head usually is nothing and usually rounds out; the distinguishing feature is persistence of the abnormal shape rather than severity at presentation.