Wednesday, August 5, 2009

Tips for Helping Babies with Plagiocephaly: Mis-Shapen or Flat Head

One thing I see alot of at work is babies who have a flat head in the back of their head or on one of the sides of their head. If it is severe enough it is called plagiocephaly. Some babies need helmets, others just need exercises and positional ideas given to the parents and caregivers. If the head is just mildly flat in the back, this often improves as the baby spends more time lying on his tummy for playtime and less time sleeping on his back. It may also improve when the baby is encouraged to look each way equally and not just tilt or turn his head to one side.

My son had a flat spot in the back of his head for the first few months of his life. And even though I laid him down on the floor to play on his tummy, he still had a flat head. It eventually worked itself out, but it is not as round as mine. My husband has a mildly flat head in the back so maybe it is hereditary that both of my children have this same head shape as their dad. But I somewhat blame his case of infant reflux. His reflux was so severe that he went from the 75th percentile for weight at one month of age down to the 25th percentile by 3 months of age. He was on 2 reflux medicines by 4 months of age. But prior to this, he had to be left upright beyond the suggested 15-20 minutes after being fed. Sometimes he would vomit up massive amounts of liquid even 1 hour later...later found out he also has a motility problem. He would choke in his sleep even when placed on a mattress that was inclined at bedtime and naptime. So, I put him in this soothing glider that is at the same angle as a bouncy seat but snuggles the baby in it with more curviness for the head. I hate that he had so much pressure on his head, but I could never have fallen asleep wondering if my son was going to aspirate on his spit up, and possibly lose conciousness, turn blue, or worse, die. Unfortunately, I have seen too many bad situations at work when a baby has severe infant reflux. So, the flat head is the price we had to pay.

Some tips on helping with the head shape for a baby with plagiocephaly, flat head, or just mis-shapen:

  • Let the baby play on the floor on his tummy multiple times a day for at least 5 minute increments. If he dislikes this position, then get down to talk or play with him as well as leave toys nearby.

  • If his head is flatter on one side of the head than the other, then all throughout the day, do things with him that require him to look to each side. Examples include switching the end that his head is on in the crib or diaper changing table, alternate which hip or shoulder he is being carried over, move the bouncie seat or infant swing to different places in the room so he has to look different directions.

  • Introduce infant massage to relax the muscles. Often when the child is favoring one side of his body over the other side, then he gets tightness in the neck or shoulder muscles. Infant massage also helps with improving the sensation to the side of the body that is less favored.

  • Have your doctor assess the baby's muscle tone. If the baby has low muscle tone (AKA hypotonia), he may need a physical or occupational therapy evaluation. The low muscle tone may impact his gross motor skills such as rolling and crawling, his feeding skills, and his fine motor skills to reach and grasp for toys. Some babies may also have muscle weakness, torticollis (tight sternocleidomastoid muscle- (SCM)), neurological impairments, or otherwise tight muscles. If this is the case, then therapy may help with preventing bad movement patterns and hopefully lessen developmental delays, but seeing a specialist such as a neurologist may be a good thing in order to know the reason why this is happening.

  • Do not leave the baby in positional devices that do not properly fit him and do not leave him in there for long. Many babies I work with that have leg tightness or weakness on one side are left in stand-up bouncers, swings, car seats, & bouncie seats WAY too long. They should only be in the briefly unless there is a reason such as a car ride, sleep, etc. I can definately tell you that 30 minutes for a 6 month old baby to stand up in a "Jumparoo" or "Johnny Jump Up" doorway bouncer is WAY too long, especially when he is not even angled in it correctly.
  • Offer toys to each side of the baby such as in the high-chair, car seat, on your lap as he is sitting upright, or lying on the floor.
  • Encourage the baby to ly on his side on both sides and to roll to each side (at an appropriate age)
  • Give the reflux medicines as prescribed to you by the doctor. Remember that just because your baby needs to stay upright doesn't mean he stays in a device, you can hold him upright for the 15-20 minutes post-feeding.
  • If improvements are not seen, please discuss this with your pediatrician as your baby may need a helmet to help with the head shape.

Hopefully, once your baby is sleeping less, playing more, and even crawling, the head shape will improve.

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