Deformed skull of prehistoric child suggests that early humans cared for disabled children

By Ed Yong | March 30, 2009 5:00 pm

Blogging on Peer-Reviewed ResearchFor all appearances, this looks like the skull of any human child. But there are two very special things about it. The first is that its owner was clearly deformed; its asymmetrical skull is a sign of a medical condition called craniosynostosis that’s associated with mental retardation. The second is that the skull is about half a million years old. It belonged to a child who lived in the Middle Pleistocene period.

The skull was uncovered in Atapuerca, Spain by Ana Gracia, who has named it Cranium 14. It’s a small specimen but it contains enough evidence to suggest that the deformity was present from birth and that the child was about 5-8 years old. The remains of 28 other humans have been recovered from the same site and none of them had any signs of deformity.

These facts strongly suggest that prehistoric humans cared for children with physical and mental deformities that would almost have certainly prevented them from caring for themselves. Without such assistance, it’s unlikely that the child would have survived that long.

Before moving on, a point of clarification: when I say “human” in this piece, I mean the genus Homo, which the child certainly belonged to, rather than the species Homo sapiens, which it certainly did not (its skull is too old).

Garcia found Cranium 14 in many different pieces over two years, but the fragments were preserved so well that she could reconstruct the skull very accurately. On doing so, she found it clearly belonged to an immature child. Its brain volume was within the adult range, but certain connections between the different bones of its skulls hadn’t fully matured. Based on that, Garcia guesses that the child was about 5-8 years old when he or she died.

Garcia also found that two of the bones in the child’s skull – the left parietal and occipital – had fused far too prematurely. When humans are born, our skulls consist of 45 different bony elements. These plates are separated by connective tissue and they can move and flex against each other. That’s necessary to allow for the growing brain room to expand. As a child matures, the bones of its skull start to fuse together and lose mobility. Eventually, many become joined by rigid sutures.

In Cranium 14, one of these sutures – the lambdoid suture – had closed too soon on the left side but not on the right. This premature fusion restricted the growth of its skull and as a result, it had become twisted and asymmetrical – a condition known as craniosynostosis. It’s estimated to affect 1 in 2,000 babies, although It’s a rare disorder, with cases involving the lamdoid suture, as in Cranium 14, are the rarest type, affecting just 1 in 40,000.

It’s not clear why the child’s skull developed abnormally. Even for modern humans, the causes of craniosynostosis are difficult to work out, but Gracia has some ideas. The dimensions of the other bones and sutures suggest the lamdoid suture fused while the child was still in the womb, during the third trimester. The timing suggests a couple of possible causes – some sort of physical trauma experienced in the womb, or a metabolic disease like rickets or anaemia. Of these options, Gracia thinks that trauma is the more likely, for rickets and anaemia tend to develop after birth.

Whatever the cause, the early closure of the lamdoid would have put a lot of pressure on the growing brain. The skull reveals that this was a remarkably severe case of craniosynostosis, and Garcia suggests that the child would have experienced motor problems, developmental delays and, possibly, mental retardation. In some cases, this condition has been linked to mental retardation and can lead to motor problems and developmental delays in modern-day children. With such disabilities, the child would have been unable to reach the age of 5-8 without the care of its peers.

Gracia says, “It is obvious that [this] hominin species did not act against abnormal/ill individuals during infancy.” There are a couple of other specimens that support this idea. One skull recovered from Georgia was 1.77 million years old and the owner had clearly lost all but one of its teeth several years before it died. According to the authors, the individual may have depended on others to make up for their inability to chew. Another skull unearthed in China showed signs of a substantial head wound that had subsequently healed.

That may not be surprising news for some of us, but remember that humans have not always behaved in such an altruistic way throughout our history. As just one example, the bones of several children with craniosynostosis were uncovered in the cemetery of the Medieval Hospital of St James and St Mary Magdalene in Chichester, England, a 15th century almshouse where deformed children were clearly abandoned.

Reference: Gracia, A., Arsuaga, J., Martinez, I., Lorenzo, C., Carretero, J., Bermudez de Castro, J., & Carbonell, E. (2009). Craniosynostosis in the Middle Pleistocene human Cranium 14 from the Sima de los Huesos, Atapuerca, Spain Proceedings of the National Academy of Sciences DOI: 10.1073/pnas.0900965106

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Comments (24)

  1. Okay, here’s a potentially horrible question: Why would it be advantageous to “sink” your group’s resources and energy into a “dead-end” kid? If this was half a million years ago, and humans were still hunter/gatherers, that’s some serious sacrifice! What are the evolutionary advatages to keeping “flawed” (genetically) individuals alive? Do other animals try to keep unfit babies alive in the same way?
    Or is this the result of our overriding desire to care for our young? That is, have we sacrificed triage because we’re so dedicated to raising very few young?

  2. Zach – this doesn’t have to be adaptive, but can be a by-product. So you can have a behaviour like “care for the kid” – a pretty good behaviour generally, but might not have a specific adaption turning it off for “dead-end” kids.

  3. How severe would the child’s impairments have been? Occurrence of craniosynostosis can vary widely in children depending on severity and whether there are other abnormalities as well. It may not be possible to make a clear determination on how much a burden the child was on others based on the skull alone.

  4. So the harder question would be whether deformed individuals are under-represented in fossil finds, and if so whether the underrepresentation resulted from neglect/abandonment. A few examples doesn’t rule out this possibility.
    Years ago I worked with a hill tribe group in eastern Burma. I was struck by the fact that I only saw two children my entire time there with birth defects, one of whom lived with a preacher. I had some suspicions.

  5. Rob Jase

    Can we be sure this wasn’t the alien Starchild’s cousin or something?
    I have a headache.

  6. HP

    As a child (late ’60s – early ’70s), I remember reading about a Neandertal skeleton that showed advanced age (well past reproductive peak — maybe 35 or 40), multiple healed skull fractures, and advanced arthritis. It must’ve been a fairly well-known case for me to have heard of it as a kid. Anyway, it was held up as evidence that Neandertals cared for the sick, injured, and elderly.
    For years afterward, in popular depictions of Neandertals, they’d often include a depiction of that guy. Blind on one eye, staggering along on a badly-set broken leg and arthritic joints. And I’d see it and say, “Hey, it’s that guy.”
    I haven’t heard much about that guy in the last 20 years or so. I know they’ve since discovered that, a) arthritis and bone fractures are fairly common in elderly chimps in the wild, yet chimp troupes don’t just abandon them to their fate, and b) Neandertals were apparently tough as nails, and massive healed injuries that would’ve felled a gracile sapiens were apparently quite common.
    So, to tie this back to your post, I find myself completely unsurprised that a 500Ky-old human with multiple birth defects would survive as long as feasible.
    Anyway, I still wonder about that one guy from time to time. He was the first extinct hominin I ever got to know as an individual.
    Does anyone know the individual Neandertal to whom I refer? And what’s the current thinking?

  7. boo

    HP, sounds like the “Old Man of La Chapelle-aux-Saints”:
    “Many of the teeth were missing, and the bone that had surrounded these teeth showed evidence of healing after tooth loss. This means that the individual lived for a considerable time after losing many of his teeth.”
    http://anthropology.si.edu/humanorigins/ha/lachap.htm

  8. It’s amazing how much can be learned from a skull and bones. Altruism is part of the spectrum of human behaviour as is cruelty. It’s not surprising to see that behaviour go far back.

  9. Marcin Ryszkiewicz

    Hi HP, your Neanderthal guy was from Shanidar in Iraq (about 60 000 years ago), unearthed in 1960 by Ralph Solecki. He was also known as Old Man (or Nandy), not to confound with that from La Chapelle-aux-Saints. I reconstructed the scene of his burial on the exhibition here in Warsaw :)

  10. Damien R. S.

    “It is obvious that [this] hominin species did not act against abnormal/ill individuals during infancy.”
    That seems like a rather amazing generalization to leap to. The only thing that’s obvious is that this individual wasn’t acted against. It tells us nothing about what was normal, if that even makes sense across different environments. Chimps and humans vary in their parenting based on personality and circumstances, why wouldn’t these hominins?

  11. Pen

    Most modern day children are pretty much of a burden till they reach 5-8 years aren’t they? I wonder what the child died of and until when it would have been cared for?

  12. Phimon

    Is this the most ancient skull with craniosynostosis in the world? Any others?

  13. van veelen

    Isolated lambdoid synostosis is only in a minority of cases associated with mild cognitive or motor delay, this in contrast to multiple suture synostosis. The kid was probably just looking a little bit funny.

  14. Melanie

    Thank you Van(and Rob perhaps you should keep your rude comment to yourself and learn something)
    I was a taken aback by the sentence that falsely states craniosynostosis is associated with mental retardation. The writer of this article has just misinformed thousands of people. Did you know craniosynostosis effects one in 2000 births every year and positional plagiocephaly one in 800? Most individuals that I work with are not even close to mentally retarded even when multiple sutures and/or syndromes are involved. In fact a majority are very smart and well adapted individuals. True some learning delays and more major brain damage can occur when severe pressure from the fused sutures is untreated along with hydrocephaly. More than likely this child was perfectly normal mentally due to only one suture being fused and suffered only from an abnormal headshape. I understand the thought behind the article to inform that prehistoric humans cared for their children despite their disabilities but I believe the facts could have been handled a lot more delicately. Perhaps stating if the evidence of severe pressure was found on the inside of bone(even modern day many neurosurgeons and plastic surgeons can find evidence of pressure when the operations are preformed on children with craniosynostosis.) or adding more information on craniosynostosis and researching more and not writing the false sentence at the beginning of the article ” its asymmetrical skull is a sign of a medical condition called craniosynostosis that’s associated with mental retardation.” More information on craniosynostosis would have been better. You make craniosynostosis seem extremely rare by stating only the statistical numbers of occurrence for Lambdoid. As I said earlier craniosynostosis in a whole happens one in 2000 births not the staggering number you presented. Awareness and understanding is the key for children getting the treatment they need so they can grow to be normal without the delays, mental retardation, and motor problems that you associated with craniosynostosis twice in this article. Your failing to post more accurate statements only sets back our communities push for more awareness. I ask that you add a correction for this article stating further facts on craniosynostosis instead of misleading the general public.
    Thankyou
    “Beauty is not in the face; beauty is a light in the heart.” ~Kahlil Gibran

  15. craniokid myself

    As a mom born with craniosynostosis and i have a daughter with craniosynostosis and also a fan of anthropology, i want to say that the information in this article is very misleading and/or inaccurate. Craniosynostosis is not a detrimental disease in most cases. If there is enough room for the brain, then there would be no retardation factor. Issues arise when there is intercranial pressure. Reconstructive surgery for this condition has only evolved in modern times, so there have been many children in the past who have grown to adults and live normal healthy lives. I know many that have.
    I highly suggest anyone reading this article to do your research. Also, causes of cranio are not just linked to trauma, rickets, or vitamin D deficiency, but also genetics and other miscelaneous factors. In very few cases, retardation MAY occur with syndromic craniosynostosis such as certain types of Pfeiffer’s syndrome. Also the occurance factor in modern time is 1 in 2000 infants, although lambdoid suture involvement is more rare.
    Please do your research.

    On a side note, i think the find is pretty awesome. What a rarity to find such a preserved item with this condition!

  16. Amy

    Craniosynostosis is NOT synonymous with mental retardation. There are many adults in the world to day that are living with untreated craniosynostosis and live full and productive lives. It is wonderful to know that early man loved and cared for their children regardless of physical traits but it can not be said that this particular condition would have caused the child to be a burden upon it’s family. The child may certainly have looked a little different, but as I just met a 3 year old with uncorrected Lambdoid craniosynostosis 2 months ago who gave no evidence of any type of delay I disagree wholly with the assumption “special needs”. I am married to a sagittal craniosynostosis adult and mother to a perfectly developing one as well, both have had surgical correction. I would offer a hypothesis as to why this condition isn’t seen more frequently in anthropologic discoveries, yes it is a reasonably rare condition, 1 in 2000 to 1 in 40,000 depending on suture involvement… but these skulls don’t collapse properly to pass down the birth canal. Most likely the vast majority were never born and died in childbirth with their Mothers. So any condition with a congenital skull malformation would be an rare find.

  17. Mel

    As many others have pointed out, I am saddened by the lack of research done on craniosynostosis. I was shocked to read that it is associated with mental retardation, especially since my son, being a single suture cranio kid, is no where near mentally challenged. The experts that treated him also provided no concern over possilbe delays. Although my sons cranio was surgically treated, there are many adults and children, that have uncorrected cranio that are leading perfectly normal lives with no signes of “special needs”. There are of course reported cases where inter cranial pressure, caused by the premature skull fusion can cause delays, but that is found more often with multiple suture fusions. It angers me to think that a site such as this would not take the time to research the condition more and not mis-inform it’s readers.

  18. Janet

    My daughter was born with Metopic synostosis. She met all her milestones before and after the surgery to correct her skull. I really feel that you need to do more research on craniosynostosis before making such statements as you did in the above article.

  19. Ann

    I join with the others in asking that you please research things thoroughly before publishing. Craniosynostosis, as all the others have pointed out is NOT, i repeat, NOT associated with mental retardation……you need to publish immediately a correction to the article above, as it is misleading and inaccurate. Thank you. Below you will find a link on what is Craniosynostosis………………borrowed from………http://www.craniosynostosis.info/

    Craniosynostosis refers to the early (premature) fusion of the sutures of the bones of the skull. Premature fusing of the sutures restricts and distorts the growth of the skull. These cranial growth restrictions often results in increased cranial pressure growth which can cause vision problems and impede intellectual development. In addition, abnormal head shape is associated with low self-esteem and behavioral problems. Correction of these deformities can relieve cranial pressure and in the long-term, improve the child’s self-esteem.

    The child’s head takes on a distinct form which depend on the fused suture (or sutures):

    Premature fusion of the coronal sutures forces the skull to grow wide relative to its length (see brachycephaly).
    Premature fusion of the sagittal suture forces the skull to grow long relative to its width (see scaphocephaly).
    Premature fusion of the metopic suture (metopic craniosynostosis, also know as trigonocephaly) produces a narrow, triangular forehead with lateral pinching of the temples. (see ).
    Premature fusion of one of the coronal or lambdoid sutures results in asymmetrical head shape with flattening (see plagiocephaly).
    Premature fusion of both the coronal and sagittal sutures (oxycephaly) results in a an abnormally high conical head shape.
    Premature fusion of the coronal, lambdoid and posterior sagittal sutures [a rare condition] results in a cloverleaf skull (also known as kleeblattschadel).
    Craniosynostosis occurs in isolation but is also present in many syndromes, such as Apert, Crouzon, Pfeiffer, Saethre-Chotzen, Carpenters and Opitz-C (also known as Opitz Trigonocephaly) syndrome.

    Incidence:

    Diagnosis: A distorted head shape is not always the result of craniosynostosis. The diagnosis of craniosynostosis begins with an examination by a pediatrician, pediatric neurosurgeon or craniofacial surgeon. The initial examination involves questions about gestation and birth, in utero position, neck tightness and post-natal positioning (for example, sleeping position). The physical examination includes inspection of the infant’s head and may involve palpation (carefully feeling) of the child’s skull for suture ridges and soft spots (the fontanelles) as well as checking for neck tightness and other deformities. The physician may also request x-rays or computerized tomography (a CAT scan, a series of photographic images of the skull). These images provide the most reliable method for diagnosing premature suture fusion (craniosynostosis). In addition, the physician may make (or order) a series of measurements from the child’s face and head [more on cranial anthropometry]. These measurements will be used to assess severity and monitor treatment.

    Treatment:
    The treatment of craniosynostosis requires surgical correction. Please consult a pediatric neurosurgeon or a craniofacial surgeon to discuss treatment procedures.

    Support Groups:

    The Craniofacial Foundation of Arizona
    Cranio Support (aka CranioChat)
    Opitz Trigonocephaly Syndrome Family Network
    CAPPS Kids
    Craneosinostosis.org.es (en Español)
    .

  20. Heather

    You just completely discredited this entire journal by printing such misleading information about craniosynostosis. Next time do some scientifice, fact based research first. Craniosynostosis does not cause retardation unless is remains uncorreced and there is intracranial pressure. And even then, it would be rare. Also, you stated that craniosynostosis occurs in 1 in 40,000 births. Not true. It occurs in 1 in 2,000 births. Perhaps Lamboid is 1 in 40,000 since it is much more rare. I highly doubt this child was a burden on his parents as you stated. He simply had a mishappen skull. In todays day…it is easily corrected with surgery.

  21. Becky

    Being the mother of a perfectly normal and well balanced left coronal cranio child I find it very difficult to read such inacurate information about craniosynostosis. Such statements could frighten the living daylights out of poor parents just discovering their child has cranio sending them into unbeleivable amounts of anguish that there son/daughter could be retarded in some way. Im only glad I didnt read this article before my son was diagnosed.
    Before you go writing such articles please do some in depth research and get yout facts right. Craniosynostosis does not affect 1 in 40,000 it affects 1 in 2000.

  22. Hi folks,

    My sincere apologies for the distress that this article has caused. I have made changes above to address the points that you raised:

    - I’ve removed the mention of mental retardation from the opening line.
    - While the original text attributed the correct stat of 1 in 40,000 to lambdoid cases, I’ve added in a bit to reflect the higher prevalence of craniosynostosis in general.
    - The second mention of mental retardation has been cut, but I’ve stuck in an extra sentence to clarify that according to the authors, this was an unusually severe case of craniosynostosis that was probably associated with similarly severe symptoms.

    As a journalist, I frequently rail against incorrect information in science coverage, and as an employee of a medical charity, I’m all too aware of the consequences of misleading medical information on disease awareness. So I’m doubly embarrassed at the errors, and
    I hope this addresses your concerns sufficiently.

  23. Melanie

    Thankyou Ed your appology is appreciated as is your editing. I applaud you for making corrections so quickly where in the past other publications have ignored request on correcting false information on articles written and didn’t so much as issue a small appology for misrepresenting craniosynostosis and positional plagiocephaly.
    I also want to say thank you for sharing this find. It is interresting to me that craniosynostosis has been present since ancient times yet so many modern physicians are still ignoring warning signs and dismissing parents concerns.
    Thank you again for correcting and appologizing I hope we will soon see an article on craniosynostosis and positional plagiocephaly.

  24. Ann

    Thank you Ed, we really appreciate your apology and also that you cared enough to edit the article almost instantly. I also join with Melanie by saying that this article really opens up our eyes, knowing that Craniosynostosis has been around so long.

    So again I say thank you for editing so quickly and for your apology. I too hope that you will do an article on craniosynostosis.

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