To the Editor.—

The evaluation and management of infants with potentially misshapen heads need not present “challenges” and usually need not involve a pediatric subspecialist.

As indicated in the accompanying article by Jimenez et al, a long narrow head with a “keel” is caused by sagittal stenosis. Unilateral or bilateral coronal stenosis is readily recognizable based on the craniofacial deformities they produce. The closure of the sutures can be confirmed radiologically and referred to a pediatric neurosurgeon.

Unilateral or bilateral lamboid stenosis is, on the other hand, very rare and presents with unilateral or bilateral flattening of the posterior quadrant of the head. A far, far more common cause of occipital flattening is positional plagiocephaly attributable to the “Back to Sleep” program. The same flattening can also be seen in hypotonic infants who do not move their heads; in those with substantial developmental delay; or asymmetrically in...

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