So yesterday I talked about what plagiocephaly is and what some of the effects of it are, today I’m going to talk about preventing it and treating it!
First I’ve gotta say that while you CAN be proactive with various measures, it’s not always possible to PREVENT plagiocephaly and it’s absolutely no one’s FAULT if your child has it. Often times people blame themselves for having a too small uterus or for letting their baby spend too much time in the carseat, but really, if it’s going to happen, it’s probably just going to happen.
There are two main ways to prevent plagiocephaly. First, pay attention to your baby’s range of movement. If you notice that your child definitely favors looking one way, sleeping facing one way, etc. get him or her examined by a doctor or physical therapist for torticollis. A tight neck muscle that causes your baby to never both directions causes your baby to ALWAYS lay on one side of his or her head, causing flat spots. Physical therapy and neck stretches can make huge improvements in range of motion in just a few weeks!
Many babies who have plagio never had torticollis. That’s why part two is JUST as important. Keep your little baby off their head as much as possible! Tummy time is GREAT. Not only are you building neck, trunk, and core muscles, you’re keeping pressure off that noggin! Not spending time excessive amounts of time in the carseat is also great. Yes, some babies sleep in their carseat overnight or otherwise won’t sleep at all, but that doesn’t mean your baby needs to stay in their bucket seat the entire three hour trip to the steak house or every time you go shopping. For a lot of babies, the swing is a godsend. If your baby spends all day in it, be sure to move the swing around the room so the baby has to turn his head different directions to find where the action is! Babywearing instead of stroller/carseat sitting / swinging at a young age is a very helpful alternative. The less pressure on that little noggin (in the same spot) the better!
I’ve read about special pillows and sleepers that are sworn to “prevent flat head” syndrome and they seem to have mixed results. I have heard from many parents of children who are now in a helmet who used all the special pillows from day one, so I’m going with the “Nice idea, but doesn’t work” camp. I’m sure someone will read this and tell me that it saved their kid’s head, but maybe that kid was just never going to get plagio either way, ya know?!
If at the three month point, your child’s head still seems noticeably misshapen, there are two angles to attack it from. First is aggressive repositioning. What does this mean? You reposition your child off from his or her flat area every chance you can. You physically turn their head off of it when they are sleeping. You put up toys and mirrors and fun things in their car seats, swings, etc to encourage them to look the direction that their flat spot is not on. This is the first thing most pediatricians recommend you try and it’s most successful between 3 and 5 months of age.
Using a rolled up receiving blanket to keep a baby off their flat side (from Google)
For us, we “started” aggressive repositioning at 4 months, saw his plagio get WAY WORSE because we were not aggressive about it AT ALL, and then once we got serious, we saw improvement. We would turn him off the right side of his head 5 or 6 times a night, put up a mirror in his crib, and kept him out of his carseat as much as possible. In his swing or bouncy seat, we kept a rolled up receiving blanket under his right side, forcing him to lay with his head to the left.
Aggressive repositioning works great for some babies and not so great for others. It’s a huge commitment and if you don’t have the time and patience to continually wake up and move their heads in the middle of the night, it won’t be very successful!
The other option for treatment is a helmet, like you see Mason wearing. There are three big brands of helmets – Starband (what Mason has), Hanger, and DocBand. All of the helmets, despite different brands and different shapes, work the same way. The helmet is uniquely created for each child based on either a plaster mold or digital scan of their head. The helmet is snug to their head in the area where no more growth is wanted and open where growth is needed. Any new headgrowth goes to the flat area of the head, causing it to fill in and round out. They wear the helmet 23 hours a day with 1 hour off for bath time and giving the head time to “breathe.”
Baby Ian in his DocBand
The ideal age to helmet your child is between 4 and 6 months of age. At this time, their heads are growing in leaps and bounds. I’ve read endless stories about how a child with a 20 mm offage goes down to 11 mm in just 2-3 weeks! And down to 2-3 mm in a few weeks more! These heads do some SERIOUS growing those first six months! The average younger baby is in their helmet for 8-12 weeks and nearly all achieve that 0-3 “normal” head. The helmets work up on children up to18 months, but head growth slows significantly at about 9 months and even further at the one year mark. Babies helmeted at one year or older usually are in their helmets for 6+ months and “cutting the number in half” is usually the goal instead of 0-3 mm. Mason began his helmet journey at 10 months 1 week old and his head has grown less than 2 mm since then, where it was growing 3 mm every few WEEKS when he was younger.
The biggest opponent to plagiocephaly treatment is uninformed pediatricians who label plagio as “normal” and say that the head will get better with age. While most children will see a mm or two improvement on their own, moderate to severe plagio will not fix itself. For us, even WITH aggressive repositioning, Mason’s head shape did not change at all between 7 and 9 months. Not even a fraction of a mm. It was at that point we knew that we had to decide “Leave it as misshapen as it is now or do the helmet” and our ped wanted nothing to do with that decision. Had our pediatrician been more informed about the need for more aggressive plagio treatments, Mason would have had his helmet 3 or 4 months sooner when we saw that repositioning wasn’t working well enough and would have probably only had to wear it two months. And this is a story I hear again and again and again. Yet, helmet treatments for plagiocephaly have been around for 20+ years!
I’ve seen many petitions floating around the plagio world – one being to make it mandatory for all pediatricians to take a more aggressive approach to treat plagiocephaly (instead of recommending the “wait and see” approach) and another to require more insurance companies to cover necessary treatments. I support both of these movements!
So, in a nutshell, tummy time and baby-wearing can really help prevent plagiocephaly and are great for your baby all around. If you child’s head looks misshapen past the 3 month mark, you should definitely try aggressive repositioning and keep him/her off that flat spot as much as possible. If you haven’t seen great improvement by around 4 or 5 months, get a referral to a helmet specialist! Fixing your child’s head NOW can prevent a slew of medical (and social!) problems down the road!
And, next time you see a baby in a helmet, don’t point and stare, walk right over and say “Hey, I know a baby named Mason and he wears a helmet!” – us plagio moms like to NOT feel so alone!