Sunday, August 7, 2016

Pediatric Continuing Education- August Special!

For the month of August, enjoy a discount on the popular course Evaluating and Effectively Treating Torticollis and Plagiocephaly.  
Learn the important components of treating torticollis and plagiocephaly with the convenience of an online course.  

6.0 Contact Hours for the discounted price of $150!  

For more information and to register visit:

Thursday, May 5, 2016

It Won't Just Go Away!

In treating torticollis and plagiocephaly, I speak with a variety of parents who are referred by a variety of pediatricians.  One of the biggest misconceptions I hear is the phrase, "The doctor said she will outgrow it and we shouldn't worry about it."  This is not only false but can be detrimental to the development and growth of a child.  In my sixteen years of practice, I have never seen a problem just go away by ignoring it.  Usually, the problem gets worse and starts to affect different areas.

Speaking specifically about torticollis, if it is ignored, as the child continues to grow it will likely get worse as bone typically grows before muscle.  The bone grows, the muscle gets tighter.  The resulting head tilt can cause issues with the jaw opening and closing which could lead to future TMJ issues.  A head tilt can also cause an altered sense of upright in the inner ear.  If the head is always tilted to one side, the brain resets this plane as horizontal so when the head is actually straight, it will give the sensation of leaning to the opposite side.  This is how habitual torticollis develops.  Along with the inner ear being altered, vision can be adversely affected for the same reasons.  Untreated torticollis can also lead to shoulder issues and the mechanics of the shoulder-neck complex will be compromised as the child grows.  The spine is at increased risk of scoliosis due to the compensation of the rest of the back for the head tilt.  All of these issues can contribute to developmental delay and abnormal movement patterns of a developing child.

Untreated moderate to severe plagiocephaly can lead to various issues as well.  A shifted forhead will affect vision.  Preferred head rotation with plagiocephaly can lead to opposite side neglect in a developing infant which would have significant ramifications on the development of motor milestones with underlying muscle imbalances.  A flattening of one side of the head can affect facial features as well leading again to TMJ issues.  Once the fontanelle or soft spot closes, the head shape will remain largely unchanged through the life of the child making that window of opportunity as an infant so critical in obtaining a rounded head shape.  Shifted facial features or a flattening of one side of the head will make it difficult to wear glasses, properly fitted football, softball, baseball or motorcycle helmets increasing the risk of head injury during those activities.

The bottom line is this: if nothing changes with the way the infant is cared for, torticollis and plagiocephaly will not improve on their own.  Something must be different for issues to resolve.  If you are advised that a condition with your child will "just go away", dig further and seek treatment.  You will be glad you did!

Tuesday, February 10, 2015

Evaluating and Effectively Treating Torticollis and Plagiocephaly

The continuing education course Evaluating and Effectively Treating Torticollis and Plagiocephaly is now available as an online course.  Designed for Physical Therapists, Physical Therapy Assistants, Occupational Therapists, Occupational Therapy Assistants and Orthotists, learn the important components of treating these two diagnoses at your convenience.  

For more information, visit the newly redesigned website at 

Wednesday, October 22, 2014

NICU Babies at Risk for Plagiocephaly

Who is at risk for plagiocephaly or head flattening?  The answer is every baby regardless of whether they are born vaginally, via c-section, full term or premature.  It is very important to be aware that gravity starts acting on a baby at birth making him or her susceptible to flattening of the skull right away.  Changing a baby's head position throughout the day is essential to ensure a rounded skull appearance.  The variety not only helps head shape, but it also aids in the increasing the tensile strength of the bone.

Often times when babies are born prematurely, they can spend anywhere from a few days to several weeks in the neonatal intensive care unit (NICU) depending on how premature they are.  Along with the increased level of prematurity comes the amount of intervention, tubes, machines, etc. hooked up to the baby.  Most of the time, all of the equipment is placed on one side of the isolet or bed. Potentially, a baby can spend days with his or her head turned to the same side.  I see many premature patients in the clinic, especially twins, for plagiocephaly because of lengthy NICU stays.  It is the nature of the situation.  I am not sure how feasible it is to move the equipment from side to side of the isolet, but it definitely would be helpful in ensuring round head development in our tiniest babies.  And if moving the equipment is not an option, why not move the baby from the head of the bed to the foot of the bed with each diaper change so that his or her head is turned the opposite way on a regular basis.

Having two premature babies myself, I know how important it is to keep the baby calm, reducing the amount of activity to a minimum for oxygen saturation and heart rate, but a little long term planning would really benefit these babies once they get out of the NICU and move on with development.  Remember, it is always easier to prevent head flattening than it is to correct it.

Thursday, August 7, 2014

Gravity, Pressure and Plagiocephaly

When treating plagiocephaly, parents are instructed to keep their baby off of the flattened spot as much as possible to prevent worsening.  Often, parents translate this to keeping the baby upright as often as possible with no pressure on the head at all in hopes that this will round out the head shape.  One frequent question I field in my practice when dealing with babies who have plagiocephaly is, "If I just keep him off his head, it will round out?"  It would seem a logical solution, but in fact, allowing the baby to lay on the rounded area is actually more beneficial.  The brain grows in the path of least resistance, therefore, if you put pressure on the right side, the brain "moves" left.  The scenario I use for parents is this: think of a tennis ball in a water balloon.  If you put pressure on one side of the balloon, the ball shifts to the opposite side.  When the soft spot and sutures are still open, the head is very much the same way albeit not as pliable.  Therefore, placing the baby on the rounded part of the skull actually acts to shift the head to a more rounded position.  This is same concept of cranial remolding helmets.  These orthotics hold the high points (rounded parts) of the skull and take all pressure off of the flattened areas to encourage brain growth in the desired direction, simply put.  Conservatively, placing the baby's head on the rounded area follows the same concept.  

In addition, according to Wolf's law, bone will adapt to the load placed on it and actually make structural changes to become stronger the more load it is experiencing.  In essence, the skull gets stronger by having the baby lay on it.  This is important in protecting the brain making lying on a firm surface essential.  Prolonged lying on soft surfaces will thwart this process of strengthening of the bone.  

Once the soft spot and sutures of the skull close, the head shape will remain unchanged, for the most part.  Eighty percent of head growth occurs in the first year of life making this the perfect window of opportunity to ensure a nice rounded head for the future.  The best practice is to place your baby a variety of positions on a firm surface for a rounded skull and a strong skull.  If high points or rounded areas exist, think of the path of least resistance and encourage the baby to lay on those areas of the head.  

Sunday, October 13, 2013

How to Prevent Head Flattening and Shortened Neck Muscles in Your Infant

I thought it most beneficial to post a simple check list of the most effective ways to prevent flat spots on the head or misshapen head (plagiocephaly) and shortened neck muscles (torticollis) in your infants. 

*Avoid prolonged use of car seats, bouncers, swings, and the like.

*Only use car seats in the CAR not as a place to sleep at home.

*Allow baby plenty of play time lying flat on the floor, crib, bassinet, play yard.

*Tummy Time, Tummy Time, Tummy Time!

* Carry your baby in your arms as often as possible.

*Make sure your baby is turning the head to both directions daily.

*Be safe!  DO NOT PUT soft, plush items in the baby's sleep area to reduce the risk of suffocation!

Sunday, November 18, 2012

What SIDS is NOT!

I had the distinct opportunity to attend the Collaborative Improvement and Innovation (COIN) meeting for the Safe Sleep initiative in Alabama this week and met some motivated leaders in the field who are passionate about making a difference in the arena of protecting infant life.  This initiative will be collaborating with the Safe to Sleep campaign through the National Institute of Health.  Encompassing 13 states, the five areas of focus for COIN are 1) Safe Sleep 2) Perinatal Regionalization 3) Smoking Cessation 4) Interconception Care and 5) Elective Deliveries before 39 weeks.  All five focus areas have a single goal: lowering the infant mortality rate- saving babies' lives.

During the meeting, a common theme resounded.  The second leading cause of death in children under the age of 18 years old is sleep related deaths.  The first leading cause is attributed to vehicle accidents.  Astonished?  I am, too!  What that means is in the state of Alabama the second leading killer of children is PREVENTABLE!  In order to break this down, I feel it is first essential to explain and over explain what SIDS is not so that people realize they can prevent infant death....they can save babies' lives. 

SIDS is the unexplained death of an infant under one year old diagnosed after autopsy, death scene investigation and child/family medical history review.  If the cause of death remains unclear or unknown it is labeled SIDS.  I bring this up again because many people think of any infant death as SIDS and that there was "nothing that could prevent it". If it is a true SIDS case and all of the requirements are met, then yes, you can't prevent it when you don't know happened.  The actual SIDS rate is very low.  However, if the death was preventable, IT IS NOT SIDS!

What is preventable?  Sleep related deaths.  And because they are preventable, they are NOT SIDS.  A sleep related death is when a baby suffocates laying in an adult bed.  A sleep related death is when a baby is trapped under another child and smothered during sleep.  A sleep related death is when a baby is left to sleep in a car seat, his or her head falls forward and cuts off the airway causing the baby to stop breathing.  A sleep related death is when a baby slips between the crib and the mattress because it is not properly fitted and becomes trapped.  A sleep related death is when a baby is smothered by pillows, blankets and stuffed animals in the crib.  It is gruesome, it is gory, but it is absolutely necessary for all of you to understand you can prevent sleep related deaths.  And it is also essential to understand that we are not fighting SIDS here, we are fighting accidental deaths. 

I firmly believe people have it in their minds that sudden infant death has us all clutched in its grasp with no recourse.  It is simply not true.  We must, MUST understand the distinction between SIDS and a sleep related death if we are ever going to move forward in lowering the infant mortality rate.  What you know can save your baby's life. 

It is a grave injustice for parents to be given a SIDS diagnosis for the death of their infant when in fact it was a sleep related death.  This only puts future children at risk for an accident of the same kind.  Being told "there was nothing you could have done, it was SIDS" when it was actually an accidental suffocation, entrapment or parent overlay will do nothing to help those parents.  We have a responsibility as a medical community to be honest and upfront so parents can not only protect their own children, but also become advocates for other parents as well in safe sleep practices for infants. 

Safe sleep means:
1) An infant should have their own sleeping environment with a firm sleep surface (crib, play yard) where they sleep alone
2) Nothing soft or plush should be put in the baby's sleeping area like heavy, thick blankets, pillows or stuffed animals
3) A baby should not sleep in an adult bed, on the couch or in a recliner due to the risk of suffocation
4) A baby should not sleep in a car seat, swing or bouncer due to the risk of closing off the airway

Be safe out there and know that you can protect your baby's life!