Flattened Heads and Little Helmets-Plagiocephaly

9 Jul


A new study came out in Pediatrics this week talking about a common problem called plagiocephaly.  You can find the study here.  Plagiocephaly is a condition where a baby’s head becomes flattened across the back.  The flattening can be straight across the back or slanted so that one side is flatter than the other.

The study was simple in design and basically showed that plagiocephaly is very common, occurring in about 50% of 2-3 month babies.  Babies are susceptible to plagiocephaly because they have squishy skulls, rapid growth of their brains and spend a lot of time of their backs.  Even though it was found to be common, about 80% of these cases were mild and thus would require no treatment.

So, what is significant?

I think the easiest way to determine severity is to look down at the top of the baby’s head to look for symmetry.  If there is a significant difference between the two sides, then therapy may be indicated.  I also look at the front of the baby to determine the position of the ears.  If one of the ears is shifted up/down or forward/backwards then it is more severe.

In those cases where treatment is indicated, the first step is usually to start physical therapy.  Often, the children are flattened on one side because they either have a preference to look towards one side or they have a tightening of the neck on one side.  The physical therapist can help with stretching exercise to help with these problems.  If you notice that your baby does seem to want to look one direction most of the time, be sure that you are putting that side against the wall when you put them to bed or are playing with them to encourage them to look both ways.  Tummy time has also been shown to reduce the risk of plagiocephaly but I have seen to many good families still struggle with the problem so I make a point to tell people that sometimes it just happens.  There’s no point feeling guilty if you’ve tried your best and still end up with a baby hockey player (plus, Halloween will be soooo easy that year).

What’s the worst case?

Finally, if therapy is not helping with treatment, helmet therapy can be in order.  I have seen some amazing outcomes with helmet therapy where some pretty flat heads have come out looking perfect.  We try to make those referrals by 6 months of age as that is when the outcomes are the best.

The problems I see with helmet therapy is that most of the indications for referral, etc are subjective.  Many of the companies will take parents on without the referral of their doctor.  Many insurances don’t cover the helmet and thus parents pay out of pocket for their expense.  I’m sure there are a lot of great companies out there but there are companies that recommend helmets for every child I’ve seen end up in their office.

So, please involve your doctor in the decision to help avoid you getting an expensive treatment you don’t need.  Remember that many babies have some flattening of their skull at 2-3 months and the overwhelming majority do not need treatment.


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