Cranial Remolding Helmets: To Be or Not to Be?

It is common for parents to have many questions about cranial remolding helmets or orthotics.  Here is what you need to know about them:

What is the helmet and what does it do? There are several different types (helmets, headbands) that all have the same goal of remolding the shape of your baby's head.  The type used on your baby will be determined by the orthotist or cranial remolding center you go to for treatment.  The theory is that the brain grows in the path of least resistance.  The helmet or headband works by maintaining the high points or rounded areas of the skull allowing the flattened areas to round out as the brain continues to grow.  Optimally, the helmet is fit by nine months old and is worn anywhere from two to nine months depending on the severity of the head deformity.  The baby wears the helmet 23 hours a day and you must return to the orthotist or cranial remolding center for adjustments on a regular basis.  Insurance does not always cover this treatment with the average costs of head remolding orthotics ~$3000. 

Is there another option for treating a misshapen head? The short answer is yes!  Conservative measures are very successful when a positioning program is put in place right away.  This can mean from day one after birth to prevent head deformity in the first place or as soon as a flat spot is detected.  A positioning program is clinically proven to work and involves changing the position of your baby every time you put him or her down.  This means sometimes on the back, sometimes on the stomach, sometimes on the right side and sometimes on the left side.  The variety of positions ensures equal forces on the head to allow a rounded head appearance as well as developing equal muscle strength on all sides.  Head movement also develops the balance system itself.  Another must is limiting the time your baby spends in carseats, swings and bouncers as all of these items contribute to flattening of the skull.  These apparatuses are ok for brief periods to ensure not only a rounded head shape, but also developmental milestone acquisition. 

Who should get a cranial remolding orthotic? In my experience, there are two groups who could benefit from a helmet for the treatment of a misshapen head (plagiocephaly).  The first group are infants with a diagnosis of hydrocephalus or similar internal disease process that effects the shape of the head.  With hydrocephalus, once the spinal fluid is properly regulated and shunted off the brain, the head may have an abnormal appearance.  Where conservative methods could also work depending on severity, a helmet or headband would assist in the process of reshaping. 

The second group is if the parents/caregivers do not have ample time to institute a positioning program.  There is no judgement passed here, it is reality as we know it today in our busy world with both parents working, single parenthood, etc.  And the daycare is not always willing, able or allowed to assist in the positioning program.  A baby who spends the majority of his or her time confined in a carseat, bouncer or swing or flat on his or her back for whatever reason with little opportunity for floor/play time could benefit from a helmet or headband to ensure optimal rounding of the head if flattening exists.  Be aware that people rarely go to an orthotist or a cranial remolding center to inquire about a hemlet without walking out of there with one--often regardless of how minimal or severe the case.  So be prepared and stand your ground if you have reservations. 

Look for upcoming posts on why treating a misshapen head is so vitally important to your child.  In the meantime, I am happy to answer any questions you may have.  Good luck out there! 

Book Review

I am happy to share a book review from Australia by Whatson4.com.au: (http://www.whatson4littleones.com.au/review-parenting-support.asp)

"When I first began reading this book, I thought it may have been too scientific and not "easy reading" which is all I can cope with these days (new mother!).  But I found it so informative, I couldn't put it down!  I found the author's personal experiences portrayed in the book to be really honest, without being scary and gave some good advice on finding the right balance between following the SIDS recommendations and incorporating tummy time in your baby's day.  There are some sections that were more scientific and statistical which would make it a very valuable resource for a health professional and a great resource to have as part of a library." 

~Anna, mother to 1

Guest Post- Tummy Time and Infant Development

"Thank you, Stephanie, for the opportunity to write a guest post for your blog.  We share a passion to teach parents and others about the importance of infants being on their tummies. 

Many facets of human development are dependent on infants being in the prone position.  One important, yet often overlooked, facet is sensory development.  We all learn in preschool about our senses.  Those senses are the way we learn about our world and our place in it! 

Hearing

Our sense of hearing has two components, 1) the structure of the ear receiving sound appropriately and sending those signals to the brain and, 2) processing of those signals once received in the brain (commonly called auditory processing).  Both are stimulated for an infant by being on their tummy.  Foundational reflexes that are available ONLY in the prone position are developed during infancy.  Development of bi-aural hearing (using both ears simultaneously) is done on the stomach. 

Feeling

If an infant is not overdressed and is on their tummy moving and exploring their world, the opportunities for “tactile stimulation” are almost limitless.  They spend time flexing their fingers or seemingly “scratching” the floor, the blanket, the sofa and anything else they can reach.  Rolling around on the floor or in the grass gives a whole-body experience to our sense of feeling.  This also stimulates our sense of balance—which relates directly back to hearing and auditory processing.  If you have seen the popular movie “A Christmas Story”, you may remember when the younger brother has been almost mummified in winter clothing as he walks to school.  On his way, he falls into the snow and cannot move.  He can’t feel a thing, and thus he can’t move!  We can’t move what we can’t feel.  (Just try to walk after sitting on your foot too long!)  Allowing our children to have their arms/legs/feet/hands bare as much as possible while prone is one of the best ways to encourage their mobility and their interaction with their world.

Seeing

Babies are born not seeing very well.  Their vision is not yet developed---and they do that developing best----you guessed it----on their bellies.  They can begin to understand the images around them within a very short distance—and it is easiest for them when it is “finite”.  In other words, it is easier for them to see the short distance to the ground from their belly, than it would be for them to be on their back and try to see an object above their heads.  It would be very easy to lose focus on an object in the vast expanse over their heads when supine---the ground gives a definite endpoint.

Children in populations where tummy time doesn’t happen, don’t develop the ability to focus or “converge” their eyes on a single object.  The ability to converge their vision is the foundation for depth perception. 

Parents sometimes think the senses just automatically develop, but nothing could be farther from the truth.  Time in the prone position has far-reaching effects that last a lifetime---starting today!

Guestpost written by Donna Bateman, a Neurodevelopmental Specialist and the mother of eight children.  Mrs. Bateman knows the importance of tummy time and understands the negative consequences throughout the developing years if this step to development is denied.  You can read more about her and her practice (Parents With Purpose) at http://www.parentswithpurpose.com/ ."

Co-Sleeping vs. Bed Sharing

While giving a presentation at a local hospital yesterday, the coordinator asked me if I followed the research of Dr. McKenna on infants and sleeping.  Evidently, there are a couple of Dr. McKenna's but the one she was referring to was James McKenna who often writes about the sleeping debate.  After scrolling through a few of his blogs, I was entertained to find that he separates out the terms co-sleeping and bed sharing.  Unfortunately, most others use these terms interchangeably.  So to clarify,  in the last entry entitled, "Co-sleeping, is it safe?"  I am referring to a baby sleeping in the same bed with adults or other children.  Room sharing is another topic all together and is recommended by not on the AAP but many others.  Room sharing is where the baby sleeps in the same room as the parents but in a separate sleeping environment- a crib or bassinet, etc. 
Hope this clears everything up! 

Co-sleeping, is it safe?

According to research, one of the greatest risk factors for infant death is co-sleeping, yet, it is still a common occurrence either intentionally or unintentionally.  I say unintentionally because we have all experienced the terror of accidentally falling asleep while nursing our baby in the wee hours of the morning then waking in a panic afraid we have smothered him or her.  Co-sleeping is especially dangerous if an infant shares a sleeping environment with other children.  The Center for Disease Control released some statistics in 2003 then updated them in 2008 stating that infants who died of "SIDS" were 5.4 times more likely to have shared a bed with other children*.  I put SIDS in quotes because I believe a more appropriate diagnosis would be smothering or entrapment in the case of co-sleeping since the cause is known.  Dr. Andrea Minyard,  Medical Examiner in Florida explained that 2/3 of the 41 infant deaths she examined were accidental asphyxiations.  She determined "These infants die because they are accidentally smothered by their parents or other children who sleep with them or because they are placed on dangerous overstuffed sofas or heavily blanketed beds."**

More recently, I attended a seminar to hear Lisa Carter, RN speak.  Lisa is the Regional Perinatal Director in Alabama who is undergoing an investigation with the other regional directors in Alabama reviewing the infant deaths in our state from 2010 to 2011.  She stated that 50-75% of cases were sleep related deaths.  1) Co-sleeping in an adult bed 2) Co-sleeping on a sofa or recliner 3) Infants sleeping in swings unattended 4) Lying on the stomach on an adult bed 5) Sleeping on U-shaped pillows (like a Boppy) She was very specific when she stressed, "These were all preventable deaths!

The bottom line is, an infant is safest in a his or her own sleeping environment on a firm mattress.  To answer the question, "Is co-sleeping safe?"  No, it is not.  And for all of you mothers who nurse your baby throughout the night, I recommend nursing the baby in a place other than your bed so you are less likely to fall into a deep sleep in the comfort of your own mattress.  Personally, I had a firm twin bed in the nursery where I would nurse with a lamp on to remind me I was nursing and not safe to fall into a deep sleep. 


*NIH/NICHD "Bed Sharing with Siblings, Soft Bedding, Increased SIDS risk and Frequently Asked Questions about Bed Sharing" NIH/NICHD News Release, May 5, 2003. Updated September 16, 2008.
**Hargrove, T., Bowman, L. Many Babies Die from Suffocation, not SIDS, Study Shows. Scripps Howard News Service, December 16, 2007. 

SIDS Shift in Thinking....Finally!

It is very refreshing to read the latest study that now has swept through the medical community regarding SIDS and sleeping environments. 568 SIDS deaths in the San Diego SIDS/Sudden Unexplained Death in Childhood Research Project from 1991 through 2008 were reviewed concluding that multiple risk factors are responsible for the remaining ~2,500 SIDS death each year, not just back sleeping. FINALLY!

The article explains that a safe sleeping environment is paramount. Just to review, a safe sleeping environment is one in which a baby sleeps alone in a crib with a properly fitted, firm crib mattress devoid of soft, plush items such as stuffed animals or thick, heavy blankets. Included in the term "safe sleeping environment" includes not smoking around the baby or in the room where the baby sleeps.

It goes on to pinpoint prematurely as a risk factor for "SIDS" as well. Prematurely is on the rise with an increase in 9% since 2000. A baby born premature is at risk for complications. This makes prematurity/low birth weight the second leading cause of infant mortality in the United States.  It is perplexing why a premature infant with complications leading to mortality is sometimes labeled as "SIDS". Shouldn't this be labeled "complications with prematurely" since the cause of death is known? Remember that by definition, SIDS is an "unknown" cause of death. Just FYI, the number one cause of infant mortality is congenital defects with heart defects leading the pack. Sudden Infant Death Syndrome is the third.

It is not in my professional repertoire to say, "I told you so!" so instead, I will refer you to the book The Truth About Tummy Time: A Parent's Guide to SIDS, the Back to Sleep program, Car Seats and more. I am just thrilled that we are heading in the right direction in protecting our youngest and most precious members. 

SIDS, Daycares and Back to Sleep

With two thirds of children younger than 12 months old being cared for in a child care setting in the United States, it is important to be aware of what position your child is spending most of the day in.  Does he spend hours a day on his back in a bouncer, swing or car seat?  Or is he given the opportunity to move around and play in the safety of a crib or play yard?  These are the questions I encourage you to ask every day when you drop your infant off and pick him up from a secondary caregiver. 

One retrospective study done in 2000, not only gained a lot of media attention, but started its own widespread panic surrounding daycares.  Unfortunately, law suits were cast resulting in some daycares fearful of positioning infants in their care.  The study consisted of 11 states reporting with 1916 SIDS cases analyzed.  It found that 20.4% of what was diagnosed as SIDS occurred in a daycare setting citing an “unaccustomed” sleeping position as the culprit.  Rather than encourage everyone to get infants accustomed to different positions from birth, the AAP decided it was best to further discourage any position but on the back.  Of course, the AAP is referring to the sleeping baby, but what people hear most is “only place your baby on the back” translating to “never put your baby on his side or stomach”.  The whole “while sleeping” part is often left out of the equation. 

If babies are given the opportunity to explore side lying, lying on the stomach and lying on the back equally from the beginning (birth) during waking hours, there should be no “unaccustomed” position.  Unfortunately, I hear from the parents of my patients that the only position their baby is in for long hours a day is on the back, especially if he isn’t the only infant being cared for at the daycare.  One could only assume it is easier to keep all the infants contained if there are multiple babies in one room. 

If you are not the primary caregiver of your child, I encourage you to have this conversation with the one who cares for you infant during the day.   Think variety of positions.  If the caregiver needs to put your child in a contained situation to care for the other infants, ask them to place him or her in a crib or play yard so they are not confined and can easily move around an explore in an safe situation.  Cribs and play yards are so much better for development, exploration and movement because the baby is given the opportunity to use his muscles, build his skills and mature his brain.  Car seats, swings and bouncers restrict movement and discourage muscle movement and exploration.  They also encourage a favored head position and propagate flat spots on the head.  Substituting the crib or play yard is a very reasonable request that even the busiest day care worker should be able to comply with.  Even if they are not comfortable placing your child in any position but on the back, at least your child can move around during the day and explore the positions he is capable of on his own. 

Good luck out there!