I'd like to share a case study of an infant I have been seeing for ~5 months. He was first referred to me in the clinic for flattening of the back of the skull (positional plagiocephaly) at 4 months old. We started on a stretching program to stretch his neck muscles that were tightened (torticollis) and a positioning program to correct the flattened area of the skull. He made a full recovery from the tightened neck muscles and his head rounded out to within a few millimeters difference from left side to right side. A few months later, he returned for developmental delay due to a weak trunk and not sitting. Through the course of treatment, his mother, pediatrician and myself noted a protrusion on his forehead that was becoming more prominent. After a trip to Vanderbilt to consult with a cranio-facial surgeon, he was diagnosed with single suture craniosynostosis. There exists in the skull a series of sutures that are open at birth to allow an infant to pass through the birth canal. These "soft spots" remain open through the first year to accommodate the growing brain and fully fuse by adulthood. If any one of these sutures closes prematurely, it is termed craniosynastosis.
After some research, it became evident that although craniosynostosis is rare (reports stating 1 in 2000 to 1 in 4000) it is important for parents and physical therapists alike to be aware of it when it comes to plagiocephaly (misshapen head). It is therefore encouraged for pediatric physical therapists to check whether the soft spots are still open with each baby with a diagnosis of plagiocephaly. This is especially true with babies with a diagnosis of brachycephaly- a type of plagiocephaly. Fusion of the metopic suture (the suture on the forehead) causes a triangular shaped head with a narrow forehead and wide back of the head which is also the cranial shape with brachycehpaly. In my travels across the country, I have spoken with many PT's and orthotists alike who say "It is more difficult to treat a baby with brachycephaly with a cranial remolding helmet," with some claiming very little success with this head shape type. Perhaps it is actually a single suture craniosynostosis of the forehead suture (metopic) rather than a failure of the helmet in these cases.
Every tool we can put in our case is a benefit to a child. If you have a story you would like to share on this topic, I'd like to open it for discussion.
Plagiocephaly is on my list of posts for my Hot Topics! Great post. Great information to consider with each of the sweet babies we see. I'm curious about the correlation between "back to sleep" and plagiocephaly and if there has been an increase in number of cases and therapy referrals. I once had a pediatrician tell me he'd, "rather have a baby with a flat head, torticollis, and developmental delay over a law suit." Thank you for sharing!
ReplyDeletePlagiocephaly has increased in incidence by 48% since the inception of the Back to Sleep program and torticollis by 84%. The sentiment that particular pediatrician holds is rather narrow minded and short sighted considering that positional plagiocephaly, subsequent torticollis and related developmental delay is preventable while adhering to the principles for keeping a baby safe. It is possible to do both! I for one would never suggest putting a baby in harms way for the sake of a rounded head. At the same time, I could never justify knowingly limiting a child's future.
ReplyDeleteHi Stephanie, I came across your blog from a Facebook page in which I belong. I see this post is over a year old, but wanted to share my story. My son was diagnosed with metopic craniosynostosis at 2 months of age. I am a pediatric occupational therapist, and knew that his head looked misshapen immediately after his birth. I was told by many nurses and physicians that it was a typical conehead from a vaginal birth and me pushing for almost 3 hours. It took me almost 2 months to find a specialist who believed me. A pediatric craniofacial surgeon took one look at my son and immediately diagnosed him. My son underwent a craniotomy at 4 months of age to open the sutures. He is almost 3 years old and is a happy, healthy, developmental on-target little boy!! Unfortunately, there is a chance he will need another surgery as the sutures that were opened during the craniotomy have yet fully closed. I am writing my story for 2 reasons: 1. To encourage therapists to look beyond the written diagnosis, as you stated in your piece. 2. To encourage parents to trust their instinct. Had my son not received the craniotomy when he did, he could have started to have seizures, vision impairments and muscle paralysis. Thank you for your information and for the platform in which to share my story.
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