Craniosynostosis: Premature Suture Closure

As the parents of a new child with craniosynostosis, the diagnosis can be scary. The experts at Texas Children’s Hospital are here to help you better prepare yourself for caring for your child with craniosynostosis and put your fears and concerns at ease. Texas Children’s Hospital provides a multidisciplinary team of specialists to help you understand your child’s condition and determine the optimal course of treatment for your child with craniosynostosis.

Craniosynostosis is a birth defect in which there is premature closure of one or many sutures of the skull. Your child’s skull is made up of several bony plates. Between these plates, there are small gaps called sutures that allow for the rapid brain growth that occurs early in your child’s life.

When craniosynostosis occurs, your son or daughter’s brain cannot grow as it would naturally and expands in the direction of least resistance. This often results in an abnormal head shape and may cause increase pressure on the brain.

For some patients, craniosynostosis can be associated either with an underlying brain abnormality or with a genetic syndrome. The team of specialists here at Texas Children’s Hospital are very familiar with this condition and can help determine whether this is an isolated condition or something associated with a genetic syndrome. It is important to be evaluated early so that this determination can be made and appropriate treatment can be performed.

The treatment for craniosynostosis generally requires surgical intervention to help separate the fused bones and allow for normal head growth, development and shape. The type of surgery is dependent on which of the many sutures are fused and the resulting head shape. The craniofacial team, led by the Division of Plastic Surgery at Texas Children’s Hospital, is experienced in caring for and treating all types of craniosynostosis and providing the appropriate surgical management for each child.

The goals of surgery for craniosynostosis are to allow for normal expansion of the brain, relieve the pressure caused by the early suture closure, and restore or improve your child’s appearance and head shape.

As the misshapen skull, slow or absent head growth, and increased pressure within the skull may not be present at birth, it is important to discuss these findings with our team should you start noticing these signs or symptoms. We can help answer any questions you may have and provide the proper evaluation and counseling.

It is important to note that not all abnormal head shapes are a result of craniosynostosis. A flattened area of your baby’s head may be due to the positioning of your child that results in molding of child’s head shape. If this is the case, surgery is not required to treat the abnormal head shape.

If you have any questions or would like more information on craniosynostosis, please feel free to comment below.


About Dr. Larry Hollier, Chief of Plastic Surgery

I am the Chief of Plastic Surgery at Texas Children's Hospital and Baylor College of Medicine.

I treat infants, children and teenagers with a wide variety of plastic surgery related conditions. I specialize in pediatric craniofacial surgery, hand surgery, facial fractures, cranial vault remodeling, and midfacial and mandibular distraction.

Posted in Parenting, Plastic Surgery, Surgery

29 Responses to Craniosynostosis: Premature Suture Closure

  1. Concerned Mother says:

    When my youngest child was born, his head circumference was 13 inches, which was around 8th percentile. He was just shy of 39 weeks and weighed 7 lb 10 oz. His head was still at 8th percentile at his 2 week checkup. At 2 months, it was 7th percentile. At four months, it was approximately 15.5 inches and 2nd percentile. The pediatrician said that his sutures were still open and we would check his HC again at his 6 month appointment. Developmentally, he’s ahead (rolling over both directions before 4 months). My other children had normal head sizes, so this is concerning to me. His head size still looks tiny to me, although it is normal shape.
    Could this be craniosynostosis?
    What is the criteria for determining when to have it evaluated by a specialist?
    What type of specialist should be seen if the pediatrician doesn’t believe that the sutures have closed prematurely, the head shape is normal and other development continues to be normal?

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      Hello. thank you for your questions. My best advise to you would be to make an appointment with our physicians so that they can evaluate your son. We have a team of physicians which includes Plastic Surgery and Neurosurgery. Both of which are specialized in craniosynostosis and everyone works together to complete the assessment of our kiddos.

      To make an appointment please call 832-822-3189, and we can get you and your baby in to see our specialists and determine what is the best course of action to take for your baby. If you have any further questions, please do not hesitate to contact me at 832-822-3184.

      Thanks again.

  2. SHARON says:

    Hi my name is Sharon and I’m 32 yrs old. I have a 7 yr old boy named Xander and a 18 month old girl named Holley Pepper. She is why I’m reaching out to the community. She was born November 30, 2011 with Saggital Craniosynostosis and had the open cranial surgery one day after 5 months old. Now here’s the thing, FINALLY the word and information can be heard about this condition. I have finally found one of my local news stations to cover my/my daughters story. But I need help, I only need one thing to make this a go. I need to find one other mom that is dealing with the same condition Saggital Craniosynostosis, just a little in earlier stages of that of my daughter. Maybe like early stages of healing. If you live in Houston, Tx and would love to work with me I would love to work with you and Channel 11 will do OUR story and we will finally get the word out about this condition, they need to know about this and this needs to be known. Thank you so much. I will keep checking to see if I found you.

  3. Sarah says:

    My son was just diagnosed with complex crainiosynostosis. He is eight weeks. I notice this is a non profit hospital, do you charge patients on a sliding scale according to income? Do you accept medicaid? We have not yet been assigned a specialist, but my sons ped said this is the most severe case (most bones fused) that she has come across. We are very low income, but still want the best for our son.
    Thank you

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      Yes, we do take Medicaid here at Texas Children’s Hospital. We see all types of craniosynostosis whether complex or simple. We would be happy to see you at any time in our Craniofacial Clinic. Please let me know how we can help! Contact us at our office number 832-822-3180 or the appointment line 832-822-3189.

  4. elizabeth adame says:

    Hello I just got told today that my 4 month olds son has his skull sutures fused.. Don’t exactly know which ones.. What I want to know is how common is this at your hospital because I am getting referred there on Monday.. And how is the surgery done or what is done and any complications for this surgery… Please I have so many questions and im so scared knowing it is a surgery.. I think anyone hearing the word surgery gets scared.. Thank you

  5. Brittany says:

    Hi. My son is 3 years old. Within 24hr of his birth, he was diagnosed with Sagital Craniosynostosis. He had surgery at ACH at 4 months of age. I have been noticing his head is growing more in length. It’s elongated. I finally convinced the neuroplastic surgeon to do a ct scan on my son. I received the results today. It indicated that there is possible pressure on the brain. I am meeting with them this Friday to discuss options. I guess my question is if he does need surgery again, am I making the right choice on location? Is there a particular university or hospital that specifically specializes in this condition? And if he does have this surgery, will it help with the size of his head in the long run? How common is it for a child to need more than one surgery? Did they take him out of the helmet too soon?

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      It is not uncommon for there to be some abnormalities in the growth of the child’s head following surgery. It is relatively uncommon for them to develop increased pressure following the surgery. If this is indeed the case then your child should be evaluated by a pediatric neurosurgeon and, depending upon the severity, may well have to undergo another procedure. It may be that this involves another remodeling of the skull or it is possible that the child may just need a shunt to relieve this pressure.
      Although I’m sure that they can do this where you are, please realize that at Texas children’s we have the largest team of pediatric neurosurgeons and pediatric craniofacial surgeons in the United States. We would be happy to evaluate your child.

      Larry Hollier

  6. TCH Craniofacial Team says:

    The Texas Children’s Hospital Craniofacial Team has neurosurgeons, plastic surgeons, and many other specialists all working together to provide the specialized care your child needs. We have expertise in craniosynostosis, including complex cases such as recurrent synostosis with developing pressure on the brain. We will provide the information, answers, and experienced care your child needs. Please feel free to call the appointment line above, or directly to 832 822 3950. We look forward to helping your family through this difficult time.

  7. Shandi says:

    Dr. Hollier and his team at TCH is the best. My son who is now 6 years old had two sutures fused at birth, sagittal and coronal. He required 2 surgeries one at neurosurgery with Dr. Luerssen at 7 weeks and then plastic surgery at 6 months. I was scared, as any mother would be, but the team at TCH quickly answered questions and concerns and I was confident my son was receiving the best care by the time we left our initial appointments. He was released to do anything he wants to do in school before he started pre-k and now is at the top of his class. They have great staff and follow up care to go along with the wonderful doctors! Thanks TCH team for helping our family..

  8. Emily says:

    We began to notice a ridge on my now 13 month olds forhead a couple months ago. He was confirmed to have a premature metopic suture closure at 10 months. His head shape is very normal, he does not have any triangular shape. His head seems to be growing fairly normal, though it hasn’t been a long time to monitor growth. I feel a slight gap in the ridge on the side of his head, is this normal? Is there anything I need to be watching for? We have not seen a specialist, our primary said because his head is so normal and symmetrical besides the slight ridging, there is no reason to treat. Thank you for any advice you have!

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      I feel that it is unlikely that your child will need any surgery as long as his head shape continues to appear normal. The gap that you feel is also likely normal. He should be followed up every few months or so by your pediatrician or by one of our surgeons

  9. Wandana says:

    Hi, I have previously put a comment here. And it has been deleted. Not fair I would say. I would like to ask a professional’s opinion about my daughter’s condition. I have an MRI and a CT scan. Would you mind giving your professional opinion please? My email is provided.

    • admin says:

      Hi Wandana,

      We’re sorry your original comment was taken down. Our spam filters were not working properly. The problem has since been fixed. We will let you know if we get a profession response to provide you with. Thank you for commenting on Texas Children’s Blog.

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      We would be happy to. Please feel free to call our office for an appointment. You can reach us at 8328223195.

  10. Wandana says:

    Well the problem is that I live in another country. I would like to send an email. I cannot call nor come by for an appointment.

  11. Dennis says:

    Good morning Dr Larry

    I feel very sad that my nephew was diagnosed with craniosynostosis, we live in Honduras and we are making every effort to transfer to United States.

    the baby have 3 months and I was wondering if you recommend any hospital which has much experience in this type of surgiereis or someone we can contact


    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      Texas Children’s Hospital in Houston is the largest Children’s Hospital in the United States and has an excellent team capable of taking care of your nephew. We would be more than happy to see you here in our clinic whenever he can make it to the United States.

  12. Nancy K. says:

    Hello Dr. Hollier,
    My neighbor’s baby boy was born on 3-11-15. He has been diagnosed with craniosynostosis by the doctors in Indianapolis at Riley’s Children’s Hospital. I am not sure how many sutures are involved. I am starting a fund raising event for them since they are on Medicaid and have no money to travel to Texas to see you. I want the baby to have the best care possible and after much investigation I feel that is you. If we send you the records will you consider treating this precious little person? He only weighed 4 lbs. 7 oz. when he was born a month ago and is so tiny. They have him scheduled for surgery in June 2015. They said they want him to gain more weight before then. Please respond.

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      We would be more than happy to treat this child. Please feel free to have them contact us and we will see them at any point. We have the largest team of pediatric plastic surgeons in the country and are well-equipped to handle these type of problems. Thank you very much for bringing this to our attention.

  13. Jasmine Dixon says:

    My son is about to be 4 in November and does have Medicaid. He’s always had a larger head and has been in the 90th percentile for his head since he was born. When he was 6 months old I noticed his head was flat and I took him to 2 different pediatricians both stated he doesn’t need a helmet and said it would get better over time. At around 2.5 closer to 3 I noticed he had an indention on the front right side of his head. His newest pediatrician confirmed he does have Craniosynostosis but said surgery is not necessary and for cosmetic reasons only. I was never referred to a Neurosurgeon. He is very smart and has no developmental delays. Would there be complications due to his age? Do you guys require a referral to be seen? I find it very hard to get referrals to specialists while under Medicaid.

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      We are very happy to see your son. I think he should be evaluated by our multidisciplinary team which includes a neurosurgeon and one of our plastic surgeons. There are no real problems that I see because he is older now.

  14. Kate says:

    I noticed that our 8 week old son has no soft spot on his head. It’s is virtually gone. Our doctor said there was nothing to be concerned about because his head was not mishaped yet. I am still concerned. Should I get another opinion?

  15. Kay says:

    My son will be a teenager in may. He was diagnosed with sagittal craniosynostosis very late (at the age of 2). His father and I could never come to an agreement about surgery. He was more fearful than I so we never took the risk. We took him to see two plastic surgeons and a neurologist when he was 9yrs old. The neurologist said that surgery at this age would be pointless and there may be only a 50 percent improvement to my son’s head shape. My son really wants to pursue finding help. Do you think, because of his age(12), we would be wasting our time?

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      It is not a waste of time at all. We would be more than happy to see him and have a conversation with him about the benefits and potential risks of any corrective surgery.

  16. Melissa says:

    My 2 yr old son was just diagnosed with Sagittal Craniosynostosis. He has a regular shape to his head (it is somewhat flat in the back) and has always been in the 90th percentile in head size. He does have two indents on his skull approximately where the coronal sutures are located (just behind his forehead). Other than the indents, he has no other effects that we notice. He is very smart and functions perfectly. Is surgery always required or is it mostly cosmetic? Could this be something that might possibly affect him later in life or would the effects already be noticeable ( brain function and pressure)? Any information you have would be greatly appreciated.

    • Dr. Larry Hollier, Chief of Plastic Surgery Dr. Larry Hollier, Chief of Plastic Surgery says:

      The issue is typically one more of appearance than anything else. There can be problems with increased pressure on the brain but usually we can tell by exam and CT scans if that is the case. Understand that over time the appearance often tends to get worse without surgery

  17. Maria Perez says:

    Good day Doctor, this pass month of March my baby been a craniosinostosis surgery. All the process with him was perfect but after the surgery he has the right side with liquid on the head , the neurology doctor say that his body will be absorbed this liquid but we don’t see that the liquid reduce in 8 week; my question is it is a normal process after the surgery? Why the liquid is only in one side? The baby is ok, no fever, eat good .

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