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Keeping Baby's Head Shapely

CHEO has seen a steady increase of babies with flattened heads (occipital plagiocephaly) over the last few years. While parents and caregivers rightly follow recommendations to avoid sudden infant death syndrome (SIDS) by placing infants on their backs, their soft skulls are particularly susceptible to flattening at the back. Plagiocephaly can potentially lead to long-term social and emotional consequences. It is highly preventable and treatable if identified in time.

Back sleeping has significantly reduced the rate of SIDS, however, babies, who lie in one position for long periods of time, such as with their head to one side, often develop flat areas on their heads. Plagiocephaly is seen more and more at CHEO's neurosurgery clinic. In 1994, five cases were referred. This year, the clinic has already seen over 120 babies with plagiocephaly.

"A recent study confirms that eight to 10 percent of infants prefer to keep their head in one position," says Karen Dubé, the CHEO nurse practitioner who identified the need to raise public awareness about prevention. "The prevention is easy and need not cause added stress for new parents. It involves rotating an infant's position while they sleep so that one day their head is at the head of their crib and the next day it is at the foot. Babies tend to turn to face the door or the inside of the room so by rotating in this way they are more likely to alternate which side of their head they rest on. Another key prevention strategy, which is also good for development in general, is to encourage the infant to play on their stomach and not to spend their whole play time lying on their back. This includes time in car seats, strollers, swings and bouncy seats."

Plagiocephaly can usually be picked up at the two or four month well baby checkup. If it is detected, positional therapy, including strategies to keep baby off the flattened spot, is pursued. It is important to detect this condition early, before the bones of the skull fuse and harden. In some cases, older babies may be referred to CHEO where they may be fitted for an orthotic corrective helmet to help them reshape their head to a more rounded shape. The reshaping can often be seen very quickly although the helmet may stay on for as long as six months to ensure that the best possible results are obtained. "The babies really don't appear to mind the corrective helmets once they get used to them. In fact when they are removed they often miss them," continued Karen Dubé.

In addition to spending too much time lying in one position, a number of risk factors may predispose some infants to developing plagiocephaly. Some babies start off with misshapen heads whether as a result of crowding in the womb because of twins, a larger head or low amniotic fluid. Babies with neck, back or hip problems may also be particularly prone to staying in the same position and therefore developing flattened areas.

CHEO has partnered with the Community Services Branch of the City of Ottawa to get the message out. Family physicians, pediatricians and others have been sent background information about plagiocephaly: its prevention, detection and treatment. In addition, the City will include prevention information as part of a package sent to all new mothers in the area. The Public Health Information Line, staffed by nurses, is also available, Monday to Friday from 9:00 a.m. to 4 p.m. (summer 9:00 a.m. to 3:30 p.m.) at 613-580-6744 to respond to parents' and caregivers' concerns and questions.

Prevention Tips

Change the baby's direction in the crib on a daily basis. Provide lots of supervised 'tummy time' and 'side lying' when your baby is awake. Change positions when feeding, holding or carrying your baby. Change toy and mobile positions so your baby will look in different directions. Avoid long periods of time in car seats, baby seats and swings where your baby's head could remain in the same position.

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