Head Start

by Denise Porretto

Head Start

When I held my second son after his birth, I pressed my cheek to the top of his head, barely covered with dark hair, and inhaled. He smelled of the sea  — a fresh, briny scent. He had, of course, been a marine creature for nine long months, turning and diving in his own ocean. His dimensions were otherworldly, too  — a big, wobbly head that couldn’t seem to move in sync with the tiny body it was attached to.

His newborn sea-smell lingered for weeks, then turned warmer and more musky. Over time, his head and body learned to work together more gracefully, and that big top wasn’t quite so unsteady anymore. Still, nothing else in motherhood was as intimate or intoxicating as brushing my nose against Justin’s head and inhaling his baby scent.

Although my son is now 3 years old and his newborn peach fuzz is just a memory, his head still calls out for nuzzling, which I do whenever I can pin him down. I know that one day his naturally sweet noggin may be shaved, tattooed, left unwashed, dyed an unearthly color, or become in some other way un-nuzzlable. So until then, I’ll take a deep breath and enjoy that intoxicating scent every chance I get.

Denise Porretto is a freelance writer and mother of two in Belle Mead, NJ.


Luckily for babies, beneath that sweet smell and seeming vulnerability is one hard head. It’s built to withstand the rigors of childbirth and will also accommodate the brain’s tremendous early growth. To handle both of these jobs, the skull has several unfused bones that are separated by two spaces called fontanels. The diamond-shaped fontanel on the top of the head  — commonly called “the soft spot”  — is better known, but there’s also a smaller version at the back of the head where the skull begins to slope inward. Sutures  — smaller spaces that are like seams in the skull where the bones have not yet completely knit together  — also play a role. During the journey down the birth canal, the bones shift and slide over each other, allowing the baby’s skull to change shape as needed.

Many parents are intimidated by this brand-new noggin, afraid they’ll poke their finger through the fontanel or damage the brain by shampooing over it. But though it may pulse to the baby’s heartbeat, the soft spot is not so vulnerable. “The gap is protected by a tough membrane that is like heavy canvas,” says Barbara Korsch, M.D., professor of pediatrics at the University of Southern California School of Medicine, Los Angeles. It can also help you monitor your baby’s health: If an infant is very dehydrated, the fontanel may appear sunken; and pressure inside the head, possibly indicating hydrocephalus (too much fluid on the brain), can cause it to bulge or feel tight.


While every parent will acknowledge the brain’s importance, not all will admit to the time they spend considering another part of their baby’s head: how much (or how little) hair is covering it. Whether your child looks like a hair ball or a cue ball, though, there’s no cause for concern. “Some babies are born with a great bush and then lose it; others are bald. It doesn’t mean a thing in terms of the ultimate outcome,” says Korsch. The majority, though, lose their newborn wisps early on, making way for hair that may be very different in color, texture, and quantity. (If you notice that your baby has cradle cap, a common skin condition that causes yellow, greasy scales on the head, try rubbing vegetable oil into his scalp to loosen the scales. For a more severe or persistent case, your pediatrician may prescribe a cortisone cream or medicated shampoo.)


By the time he is 5 months old  — and then again by 18 months  — a baby’s brain has doubled in weight, says John M. Freeman, M.D., professor of neurology and pediatrics at Johns Hopkins Medical Institute in Baltimore. That means that about 80 percent of brain growth occurs by the time a child is just 1 1/2 years old. To track these rapid changes, your doctor will examine your baby’s head by feeling the fontanels and regularly measuring the circumference. For the first two to three years, she’ll plot these measurements on a graph to follow your child’s progress, noting any deviation from his particular growth curve.

The average (or 50th percentile) head circumference of a full-term baby at birth is about 34 centimeters (roughly 13 1/2 inches), with the normal range being between 32 and 37 centimeters. (A centimeter is slightly less than half an inch.) On average, the head grows about one centimeter every month from birth until one year, making the typical 1-year-old’s head size about 46 centimeters, or approximately 18 inches.

Just as for weight and height, though, some babies are at the lower end of the charts and others are at the higher end. Your pediatrician is likely to become concerned only if there’s a notable, consistent discrepancy between head size and body size. “If the child has a 90th-percentile head, you want to know if he is proportionately at the 90th percentile in height and weight too, or if, for example, he is at the 5th percentile,” explains Marvin Fishman, M.D., chief of neurology services at Texas Children’s Hospital in Houston. “These measures are all in the normal range, but a discrepancy may be significant.” An intracranial lesion (a pooling of blood or fluid within the skull), an in utero injury, or another problem can interfere with proper growth.

Any persistent, dramatic increase or decrease in head size should also be monitored. Excessive growth may indicate hydrocephalus, which can be caused by an abnormality at birth, an infection, or, in rare cases, a tumor. A too-small head  — called microcephaly  — can be the result of premature closure of the fontanels or sutures or slowed brain growth.

Or a worrisome head measurement may simply be the result of inaccurate measuring. That’s why your baby should be checked over several months to see if a trend persists. If your child seems to have a bigger or smaller head than his peers do, your doctor may want to merely observe him for a time, particularly if the head size is common in your family.


An uneven head shape in babies  — especially a flattening of the back of the head  — has become more common in recent years. It’s not hard to figure out why: Experts say this condition, known as “positional molding,” can be traced to the American Academy of Pediatrics’ “Back to Sleep” campaign to prevent sudden infant death syndrome (SIDS). While SIDS cases have dropped dramatically, the incidence of head flattening has risen because babies  — particularly babies too young to turn over on their own  — are spending more time on their backs.

Flattening can be prevented and in most cases reversed simply by varying a baby’s head position or the direction she’s facing when placing her in her crib. Parents can also hang a mobile in a different spot so the baby doesn’t always turn her head the same way, suggests Jeffrey L. Marsh, M.D., a professor of plastic and reconstructive surgery at Washington University School of Medicine in St. Louis. If the flattening remains, talk to your doctor. He will want to monitor the unevenness and may recommend different measures to correct it. Once a child is able to roll over, head shape may return to normal. But in severe cases a special headband or helmet is worn for about six months to reshape the baby’s head.

Distortions in shape occasionally signal something more serious. When a baby’s head is very long and narrow or round and broad, craniosynostosis  — the premature closure of one or more sutures or fontanels  — may be the cause. Because the closure blocks the brain’s normal expansion, the baby’s head becomes asymmetrical. If your doctor suspects this condition  — which affects as few as 1 in 2,000 infants  — he may order X rays. Surgery is usually necessary to reopen the suture or fontanel and allow normal growth.


Your unsteady new walker has just taken a tumble headfirst. What should you do? If your child is unconscious after a fall or a blow to the head, don’t hesitate to call for help. But if she’s conscious, first take a few seconds to assess her: Is she alert? Are her eyes moving normally? Both are good signs, as are tears. “Crying is reassuring, while lying quietly and not moving is more worrisome,” says Korsch. But inconsolable crying, profuse bleeding, irritability, unusual sleepiness, and persistent vomiting all warrant prompt medical attention.

Over the next few hours, watch for changes in balance or gait if your child is walking (this may be hard to discern in a toddler), and differences in personality or appetite. Check the fontanel periodically; bulging could mean excessive pressure. If your child falls asleep, gently wake her every now and then to make sure she’s conscious. Call the doctor if she’s not or if she’s lethargic or weak on one side of her body days or even weeks later; either could indicate slow bleeding in the brain. A CAT scan can determine whether this is the case.

By comparison, the “egg” that develops with a minor head injury is usually not cause for worry. It’s harmless bleeding under the scalp that can be treated with TLC and a cold compress, if your baby will let you get near her with ice. You can give acetaminophen to relieve her discomfort if she’s 4 months old or more, but call your pediatrician if you suspect your baby is still in pain or if she is younger than 4 months.