Does your baby need a helmet?

Plagiocephaly, or flat head syndrome, is a common condition that research has shown affects nearly 30% of babies by the time they see a doctor for their 2-month well-child visit.

Linda Wolfe-Stine, an occupational therapist at Advocate Children’s Hospital’s Pediatric Development Center says some babies can be born with congenital plagiocephaly, while others develop it. Factors that can cause and contribute to plagiocephaly include premature birth, multiple births, position in the womb, use of extended time in car seats, swings, and bouncy seats, lack of tummy time, sleep position and torticollis, which is a condition commonly associated with plagiocephaly and can be a congenital or acquired condition.

“Torticollis is a condition in which the muscles that control neck extension, rotation and tilt are weak or tight,” says Wolfe-Stine. “Torticollis limits the baby’s ability to turn toward the affected side, causing them to consistently hold their head in one position. Over time, the one-sided positioning can flatten one side of the head.”

Dr. Frank Vicari, Chief of Pediatric Plastic Surgery/Craniofacial Surgery and director of the Head Shape Evaluation Program at Advocate Children’s Hospital, says the environment kids are growing up in today – spending more time in car seats, swings, exersaucers– is contributing to higher incidence of plagiocephaly because infants have little opportunity to strengthen their head and neck muscles.

“Infants sleep 10 to 14 hours a day, so there are very few hours to work on normal neck strengthening processes, which leads to prolonged supine positioning. This is why engaging in tummy time is so important. If their neck is weak, stiff and they are always supine, there will be a strong tendency for them to get a flat head,” says Dr. Vicari.

Luckily, plagiocephaly and torticollis are treatable, especially when intervention starts early. Physical and occupational therapists who specialize in working with infants can evaluate the baby’s posture, assess any other weakness or asymmetries that the baby may be developing, as well as range of motion, strength, reaching and grasping skills, visual skills, movement patterns and milestones and reflexes.

About 70% of infants who develop plagiocephaly can be successfully treated by conservative measures. Roughly 30% of infants who develop plagiocephaly could be candidates for cranial orthosis, or helmet therapy, which Dr. Vicari helped pioneer. A 1.5 second scan is performed to take measurements for the child’s custom-made helmet. Children wear the helmet 23 hours a day, seven days a week until their head shape grows into the mold of the helmet and is no longer misshapen. Infants are usually fitted for a helmet between three and five months of age and typically wear it for several months.

It should be stressed that practicing tummy time early and often is key to preventing plagiocephaly. Dr. Vicari and Wolfe-Stine suggest parents begin tummy time as soon as possible with their newborn. Wolfe-Stine says parents are often apprehensive to start tummy time because they worry the baby is fragile or not ready, but that babies are born ready to practice.

“Tummy time should start the day a child is taken home from the hospital, which means parents need to know how to do tummy time with their newborn child,” says Dr. Vicari.

Wolfe-Stine says families can practice tummy time with infants during every awake time, even if just for a minute or two. Frequency of tummy time throughout the day is more important than the intensity. A few minutes here and there is very effective. She also suggests parents limit prolonged time in car seats, reclined positioners, standing devices and baby walkers. Most importantly, don’t delay in seeking help if you think something is wrong.

“If parents are concerned about their baby’s head shape and are considering therapy and a cranial orthosis, there is a window of opportunity to make the decision regarding a cranial orthotic. This is typically between four and six months but depends upon the severity of the problem and the baby’s age,” says Wolfe-Stine.