Infant Skull Shape and Infant Feeding
A newborn baby's skull is designed to be adaptable. Rather than being one solid, fused structure, it is made up of several bones separated by flexible sutures, with larger membranous areas called fontanelles between some of the bones. These are the areas commonly known as a baby's “soft spots”. This arrangement allows the skull to accommodate the forces of birth while also providing space for the rapidly growing brain (Lipsett, Reddy and Steanson, 2023; Di Ieva et al., 2017).
The skull remains relatively malleable during infancy because the cranial bones and sutures continue to develop as the brain grows. The sutures provide areas where growth and adjustment can occur, while the fontanelles provide flexible spaces between the developing bones (Di Ieva et al., 2017; Shah et al., 2016).
Because the skull is adaptable during this stage of life, its shape can be influenced by several different factors. These include the baby's position in the uterus, the amount of space available before birth, the relationship between the baby's head and the maternal pelvis, the way labour progresses, whether birth is vaginal or by caesarean section, whether forceps or vacuum assistance is used, and how the baby's head is positioned after birth.
Some changes in shape are temporary and settle naturally. Others may persist or develop further during the early months of life, resulting in patterns such as plagiocephaly, brachycephaly or dolichocephaly. There are also less common causes of unusual skull shape, including craniosynostosis, where one or more skull sutures fuse prematurely (Dias and Samson, 2017; Kapp-Simon et al., 2021).
Head shape is therefore more than an issue of appearance. Where there is marked asymmetry, there can also be differences in the relationship between the skull, face, jaw and neck. As these structures are involved in feeding, it is reasonable to consider head and body alignment as part of the wider feeding picture, while recognising that skull shape alone cannot tell us whether a baby will experience feeding difficulties.
The flexible newborn skull
A newborn baby's skull consists of several bones rather than a single solid structure. Fibrous sutures separate the bones, while the fontanelles are membranous areas where several bones meet. These areas are commonly described as a baby's “soft spots” (Lipsett, Reddy and Steanson, 2023; Di Ieva et al., 2017).
The sutures and fontanelles have important functions beyond simply making the skull flexible. They allow movement between the bones during birth and provide room for the skull to enlarge as the brain grows. The sutures therefore remain important sites of cranial growth throughout infancy and childhood (Di Ieva et al., 2017; Shah et al., 2016).
This flexibility is particularly relevant during birth because the baby's head has to negotiate the maternal pelvis and birth canal. The skull bones can move relative to one another and overlap to some degree, allowing the shape of the head to adapt to the mechanical forces acting upon it (Dias and Samson, 2017; Lipsett, Reddy and Steanson, 2023).
This temporary change in shape is known as birth moulding.
Influences on head shape before birth
The mechanical influences on a baby's head begin before labour.
As pregnancy progresses, the baby occupies an increasingly confined space within the uterus. The baby's presentation and position, the available space and the way the head and body are positioned can all influence the forces acting on the developing musculoskeletal system.
Some babies remain in a relatively fixed position for a considerable period. Research in otherwise healthy newborns has identified associations between prolonged intrauterine positioning and asymmetries involving the head, neck and face, including torticollis and craniofacial asymmetry (Stellwagen et al., 2008).
Breech presentation also creates a different mechanical environment from a head-first presentation. Depending on the baby's position and how long that position is maintained, particular patterns of elongation or deformation can develop. Dolichocephaly, for example, can be associated with prolonged breech positioning as well as prematurity (Dias and Samson, 2017).
The maternal pelvis also forms part of this mechanical environment. During a vaginal birth, the baby's head has to rotate and descend through the available pelvic space, so the dimensions and shape of the pelvis, the baby's position and the mechanics of labour all contribute to the forces experienced by the head (Dias and Samson, 2017).
None of these factors determines a baby's eventual head shape on its own. The mechanical environment is continually changing, and babies respond differently to the forces involved.
Birth moulding during vaginal delivery
During a vaginal birth, the baby's head is exposed to pressure from the surrounding soft tissues and the bony structures of the birth canal. The skull bones can move and overlap at the sutures, allowing the head to adapt as it descends and rotates through the pelvis (Dias and Samson, 2017; Lipsett, Reddy and Steanson, 2023).
This can result in a head that looks elongated, narrow or almost cone-shaped immediately after birth. The appearance can be particularly pronounced where there has been considerable moulding, but it does not necessarily represent the baby's eventual skull shape.
The amount of moulding is influenced by the baby's presentation and position, the relationship between the baby's head and the pelvis, and the mechanics of the individual birth. A prolonged labour can involve sustained pressure, but a rapid vaginal delivery can also expose the baby's head to relatively sudden mechanical forces as it descends quickly through the birth canal. A quick birth therefore does not necessarily mean there will be little moulding.
Birth-related swelling can also alter the appearance of a newborn's head. Caput succedaneum, for example, is soft-tissue swelling associated with pressure during labour and usually settles as the early postnatal period progresses. Cephalohaematoma can also affect the appearance of the head following birth (Dias and Samson, 2017).
The important distinction is that temporary moulding following birth is part of the normal adaptability of the newborn skull. It should not automatically be interpreted as a structural abnormality.
Caesarean and instrumental births
Caesarean birth generally involves less passage of the baby's head through the birth canal, so the pattern of moulding can differ from that seen following a vaginal birth. However, caesarean birth does not mean that a baby's head will necessarily be perfectly round. Head dimensions can change during the first days of life following both caesarean and vaginal birth (Souza, Ross and Milner, 1976).
Instrumental vaginal birth can introduce additional mechanical forces. Forceps and vacuum extraction are associated with different patterns of scalp and cranial findings, including bruising, swelling, moulding, caput and cephalohaematoma (Moczygemba et al., 2004).
The wider circumstances of birth can therefore be more informative than simply describing the birth as vaginal, caesarean or instrumental. The baby's presentation, position, speed of descent, duration and mechanics of labour, and any assistance used all form part of the history.
Research in newborns has also identified associations between birth trauma and cranial and mandibular asymmetry, while longer second stages and forceps birth were associated with some measures of facial asymmetry (Stellwagen et al., 2008).
What happens to head shape after birth?
The skull remains adaptable after birth, although the mechanical environment changes considerably.
Instead of being influenced primarily by the uterus and birth canal, the baby's head is now affected by gravity, movement, head-turning preferences and the surfaces against which the head rests. A baby who consistently turns towards one side may repeatedly place pressure on the same region of the skull.
Restricted neck movement or torticollis can contribute to this preference. Reduced movement and prolonged positioning can also contribute to positional cranial deformation (Bialocerkowski, Vladusic and Wei Ng, 2008; Zhang et al., 2024).
Research has identified several factors associated with deformational plagiocephaly, including a persistent head-position preference, reduced tummy time and particular sleeping or positioning patterns, although individual studies do not establish that any one factor will inevitably result in skull asymmetry (Zhang et al., 2024).
This means that a baby may have a head shape that reflects influences from before birth, the birth itself, and the weeks or months that follow. The shape seen later in infancy does not necessarily tell us which period contributed most to the asymmetry.
Plagiocephaly, brachycephaly and elongated head shapes
Several different terms are used to describe infant skull shape, and distinguishing between them is important because they do not all have the same underlying cause.
Plagiocephaly
Plagiocephaly describes an asymmetrical skull shape. In positional plagiocephaly, this commonly involves flattening towards one side of the back of the head.
The asymmetry may also involve the forehead, ears or face because changes in one part of the skull can alter the orientation of neighbouring structures (Dias and Samson, 2017).
Positional plagiocephaly is associated with factors including head-position preference, restricted neck movement and positional forces after birth (Bialocerkowski, Vladusic and Wei Ng, 2008; Zhang et al., 2024).
Brachycephaly
Brachycephaly describes a relatively broad and short head shape, often associated with flattening across the back of the skull.
Where pressure is distributed across the back of the head, rather than being concentrated predominantly on one side, the resulting shape can become broader and shorter. Deformational brachycephaly is generally related to external mechanical forces rather than premature fusion of a skull suture (Dias and Samson, 2017).
Dolichocephaly and elongated head shapes
Dolichocephaly describes a relatively long and narrow head shape. It can occur in association with prematurity and prolonged breech positioning, among other mechanical influences (Dias and Samson, 2017).
A long or narrow head immediately following a vaginal birth can also simply reflect birth moulding. The distinction is important because a temporarily elongated newborn head is not automatically evidence of a pathological skull shape.
Scaphocephaly
Scaphocephaly is another term used for a long, narrow or boat-shaped skull, but it needs to be used carefully.
The term is commonly associated with sagittal craniosynostosis, in which the sagittal suture fuses prematurely and restricts growth across that suture. A long head following normal birth moulding or positional forces is not necessarily scaphocephaly in this pathological sense (Dias and Samson, 2017; Wilkie, Johnson and Wall, 2017).
Other skull shapes
Other characteristic skull shapes can occur, including trigonocephaly and patterns associated with other forms of craniosynostosis.
Craniosynostosis is fundamentally different from positional skull deformation because one or more sutures have fused prematurely, restricting growth across the affected suture and producing compensatory changes elsewhere in the skull (Kapp-Simon et al., 2021; Wilkie, Johnson and Wall, 2017).
This is why an unusual skull shape that does not fit the expected pattern of birth moulding or positional deformation warrants appropriate medical assessment.
The relationship between skull shape and feeding
The possible relationship between skull shape and feeding is not simply about whether a baby's head looks symmetrical.
The skull, cranial base, face, temporomandibular joints, mandible, neck and spine all contribute to the physical organisation of feeding. The infant needs to bring these structures into a position that allows the mouth to approach the breast or teat while coordinating sucking, swallowing and breathing.
Where there is significant cranial asymmetry, the relationship between the skull base, temporomandibular joints and mandible may also be asymmetrical.
Research involving infants with deformational posterior plagiocephaly has identified anterior displacement of the temporomandibular joint on the affected side together with apparent rotation of the mandible towards that side (St John et al., 2002). Other research has similarly identified differences in mandibular and temporomandibular joint relationships in infants with different patterns of plagiocephaly (D'Heilly et al., 2007).
These findings do not demonstrate that plagiocephaly causes feeding problems, nor do they mean that an infant with plagiocephaly has a temporomandibular joint disorder. They do, however, provide an anatomical reason to consider the relationship between skull shape, jaw position and feeding mechanics when an individual baby is experiencing difficulties.
Breastfeeding itself involves coordinated movements of the tongue, lips, mandible and surrounding oral structures, alongside the wider postural and respiratory organisation of the infant (Paglia, 2026). This makes it more useful to consider the whole feeding mechanism than to look at skull shape in isolation.
The jaw, neck and spine are part of the same feeding picture
Feeding does not take place through the mouth alone.
The head is supported by the neck, which connects with the spine, trunk and pelvis. The position of these areas can influence the way the infant brings their mouth towards the breast or teat and the freedom they have to make the movements needed for attachment and feeding.
This is particularly relevant where there is torticollis or another positional asymmetry. Clinical literature has described associations between torticollis, craniofacial and spinal asymmetry and breastfeeding difficulties, with positioning adaptations and physical therapy sometimes forming part of management (Genna, 2015).
Research into effective breastfeeding has also identified aspects of infant positioning and latching, including allowing the baby's head to remain free of restriction, as relevant elements of effective feeding (2025).
The intention is not to place a baby into one rigid “perfect” position. Rather, the baby's body needs enough support to remain comfortable and organised while still allowing the head to move freely, extend towards the breast or teat, open the mouth and establish the attachment.
How feeding may look when alignment is different
Where head, neck, spinal and jaw alignment are contributing to feeding mechanics, the signs can be subtle and may not be present at every feed.
A baby may consistently prefer turning their head in one direction, find one breastfeeding position more comfortable than another, or appear less settled when feeding from the opposite side. Some infants with mandibular asymmetry have been described as having difficulties maintaining an effective latch or seal, with head-turning preference and torticollis also appearing in clinical case reports of breastfeeding difficulties (Wall and Glass, 2006).
The same principles of alignment and movement apply to bottle feeding. The baby's body position, head and neck position, bottle angle, teat characteristics and milk flow can all influence how comfortably sucking, swallowing and breathing are coordinated.
A difference between feeding positions can therefore be useful information. If a baby consistently feeds more effectively in one position, observing what changes between the two positions can sometimes provide more information than looking at head shape alone.
Feeding position as part of the wider assessment
There is no single feeding position that works for every baby.
For breastfeeding, the relationship between the baby's body and the feeding parent's body, the direction from which the baby approaches the breast, the freedom of the head and neck, the latch and the baby's ability to maintain a comfortable attachment all form part of the feeding picture. NHS guidance similarly describes the importance of the baby's ear, shoulder and hip being aligned and of allowing the baby's head to tip back rather than holding the back of the head in a way that restricts movement (NHS, 2025).
For bottle feeding, positioning, pacing, teat flow and the way the bottle is offered similarly influence how easily a baby can coordinate sucking, swallowing and breathing.
Further information on breastfeeding positions, breastfeeding latch, bottle feeding positions and paced bottle feeding is available from D-Restricted Ltd®:
These aspects can be considered alongside the baby's head, neck, spine and body alignment rather than using skull shape as an explanation for feeding difficulties in isolation.
When head shape needs medical assessment
Most positional skull-shape changes are considered benign and many become less noticeable as babies grow, develop stronger head control and become more mobile. Positional plagiocephaly is common, and its prevalence tends to decrease as children grow (Bialocerkowski, Vladusic and Wei Ng, 2008).
There are nevertheless situations where an unusual head shape warrants further assessment. These include a shape that appears unusual from birth and does not fit the expected pattern of birth moulding, a palpable ridge along a skull suture, an unusually small or early-closing fontanelle, abnormal head growth, or other clinical findings that raise concern (Kapp-Simon et al., 2021).
An unusual head shape does not itself mean that a baby has craniosynostosis, but craniosynostosis needs to be considered where the shape or examination findings are atypical. Early recognition is important because its management differs substantially from positional skull deformation (Kapp-Simon et al., 2021; Wilkie, Johnson and Wall, 2017).
Everyday ways to support healthy head movement and shape
For babies with positional plagiocephaly or brachycephaly, everyday positioning can help reduce the amount of time spent putting pressure on the same area of the skull. What is appropriate will depend on the baby's age, development, neck movement and the pattern and severity of the asymmetry.
During awake periods, giving the baby opportunities to move their head freely can help vary the areas of the skull that are exposed to pressure. Supervised tummy time is one way of doing this, and short, frequent periods can be incorporated into ordinary daily activities such as being held, playing on the floor or spending time with a caregiver (Kluba et al., 2017; Zhang et al., 2024).
When a baby consistently looks towards one side, everyday activities can sometimes be arranged so that there is an interesting reason to look towards the less-preferred side. For example, during awake and supervised floor time, a caregiver can position themselves, toys or other visual interest on the side the baby is less inclined to turn towards. Varying which arm the baby is carried in and changing the direction from which interaction takes place can also provide opportunities for the baby to look in different directions.
For many babies, positional flattening becomes less noticeable as they develop stronger head control, spend more time upright and become increasingly mobile. The appropriate approach therefore changes with the baby's development rather than relying on one particular positioning strategy (Bialocerkowski, Vladusic and Wei Ng, 2008; Zhang et al., 2024).
Infant body therapies and hands-on approaches
Some families seek an infant body-therapy or hands-on approach when a baby has a positional preference, musculoskeletal asymmetry or concern about cranial shape.
Different approaches have different proposed mechanisms, scopes of practice and evidence bases, so evidence relating to one intervention should not automatically be applied to another. The evidence also needs to be considered in relation to the outcome being studied. A study looking at a change in cranial measurements, for example, does not necessarily tell us whether an intervention improves breastfeeding, sucking, milk transfer or another aspect of feeding.
Osteopathic treatment is one example that has been studied in infants with positional cranial deformation. A 2022 randomised controlled trial reported greater improvement in measured cranial asymmetry among infants who received six sessions of osteopathic manipulative treatment alongside repositioning than among infants who received repositioning with light-touch treatment (Bagagiolo et al., 2022).
A more recent randomised controlled trial investigated osteopathic treatment intended to prevent positional cranial deformity in newborns considered to be at risk. It did not find a statistically significant reduction in plagiocephaly or brachycephaly, although the study ended early because recruitment was lower than planned and was therefore underpowered to determine whether a smaller effect might exist (Genelot et al., 2025).
These studies illustrate why the evidence needs to be considered carefully rather than treating a change in skull shape as equivalent to an improvement in feeding function. A reduction in measured asymmetry does not, by itself, demonstrate improved sucking, milk transfer or breastfeeding outcomes.
For families considering an infant body-therapy or hands-on approach, it is reasonable to look at what the practitioner is proposing, their relevant qualifications and scope of practice, and the evidence available for that particular intervention. This can sit alongside appropriate medical and feeding assessment rather than being presented as an alternative to either.
Looking at the whole feeding picture
A baby with an asymmetrical head may feed comfortably and effectively, while another baby with relatively subtle asymmetry may experience difficulties with attachment, endurance or milk transfer.
The visible shape of the skull therefore cannot tell us whether feeding will be affected.
A useful feeding assessment considers the relationship between the baby's head, neck, spine, trunk, jaw and mouth and, where possible, observes how these structures work together during an actual feed. Milk flow, feeding method, the baby's state, oral anatomy, sucking and swallowing, breathing, milk transfer and the comfort of the feeding parent or caregiver are also relevant.
This wider view is important because asymmetry does not necessarily originate in the skull. A baby may have restricted neck movement, a positional preference or another musculoskeletal difference that influences both head shape and feeding position. In other circumstances, a visible skull asymmetry may be present without causing any functional difficulty.
The useful question is therefore not simply what shape the baby's head has, but how the baby's head, neck, spine, jaw and mouth are working together during feeding and whether there is evidence that this relationship is affecting function.
When feeding concerns need prompt attention
Whatever a baby's head shape, feeding concerns need to be considered in their own right.
A baby who is feeding poorly, is difficult to wake for feeds, has significantly fewer wet nappies than expected, shows signs of dehydration, is repeatedly vomiting, appears unwell or is not gaining weight as expected needs appropriate clinical assessment.
These concerns should not automatically be attributed to head shape without considering the wider clinical picture.
References
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