FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

INFANT'S "POINTED HEAD" SHOULD PROMPT DOCTOR VISIT

Question: My grandson was born one month ago. My daughter's labor was long, and the delivery was difficult. Fortunately, both mom and baby are fine. My concern is that he seems to always hold his head with it turned to the left side, and also his head hasn't become round. He had a "cone head" for about one week after his birth that has since gone away. Now, his head looks a bit pointed in that same area. Should I worry about these things?

Answer: Absolutely, you should worry. It is unlikely that any of us would have survived to adulthood without our mothers' and grandmothers' loving attention. At times this caring also entails periods of worry. The important question then is how much worry is appropriate. The good news for your grandson is that these symptoms are unlikely to be signs of serious problems, so your level of worry should just be great enough to encourage mom to bring these symptoms to the doctor's attention.

A persistent turning and tilting of the head is usually caused by spasm or injury to the neck muscle that produces this motion. The sternocleidomastoid muscle (SCM) attaches to the head just behind the ear. This area is called the "mastoid" portion of the skull, and since muscles are named for the places where they attach, this part of the skull gives its "mastoid" name to this muscle. The other end of this muscle attaches to the upper portion of the breastbone (sternum) and the collarbone (clavicle). As this muscle contracts it causes the chin to turn to the opposite side and the neck to bend to the same side. Therefore, your grandson probably has a problem with the SCM on his right side.

Large babies, particularly if there was a difficult delivery, are likely to have injury to the SCM muscle. This bruising or partial tearing causes the muscle to contract and, thereby, turns the head. We doctors call this condition "torticollis" or some times apply the term "wryneck." If you feel along this muscle you will probably find a "knot." This is the area that was injured.

The baby's doctor or physical therapist will probably instruct you in simple, gentle exercises that you should do with the baby to facilitate healing of the muscle and thereby eliminate the torticollis. Some X-rays or other test may be necessary beforehand, however. You see, other problems including malformations of the spine, particularly in the neck region, can cause torticollis too. Fortunately, this type of disorder is uncommon. As you undoubtedly know, the bones of a baby's skull aren't completely formed at the time of birth. This allows the head to "mold" to the shape of the birth canal to facilitate passage through the canal. In difficult deliveries or long labors the head often becomes distorted. This can produce an asymmetry of the face, back of the head, or both. In your grandson's case it resulted in the "cone head" your described. This type of injury usually subsides in a week or two, just as his has. The underlying pointed or misshapen head often takes two to three months to resolve. The constant tension of the injured SCM muscle can even be part of the problem because it creates a steady asymmetrical pull on the head.

The chances are very good that your grandson's condition will improve with little more than the passage of time, but I'd sure recommend that you take him to his doctor. Be sure to explain your concerns. Don't just wait for his next routine "well baby checkup" because of the worry you and his mother are having over this.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.