Brachycephaly, and other news

Fig. 1. Bath time - from this angle you can see the flat side of Alex's head.

If you saw the photos from my last post about our trip up to Moab, you probably noticed that Alex is wearing a funky helmet in most of them. As you may or may not know, the helmet is a cranial remolding orthosis used for treatment of plagiocephaly and brachycephaly.

In other words, our little dude has a flat head and the helmet is supposed to fix that.

Of course, no one’s head is geometrically perfect. A lot of us, myself included, may have a flat spot or two that is concealed by hair (to some extent, at least). So, like braces for your teeth, the helmet is mostly for cosmetic purposes, except in some extreme cases.

In infants between 7 to 12 weeks of age, it is estimated that 47% have heads that are somewhat misshapen. There seems to be an upward trend in flat head syndrome in recent years. There is at least one explanation.

Back in 1992, the American Academy of Pediatrics (AAP) began recommending to parents that they rest their infants on their backs, or in the ‘supine position’ to use their words. The intention of this practice was to reduce the incidence of SIDS, which indeed was cut by 50% in the years that followed. Back-sleeping was reiterated again among other things in the most recent AAP recommendations for reducing the risk of SIDS, released last year.

It seems that all this sleeping swaddled up in the supine position is having some unintended consequences for the cranium. But at least one company believes they have a solution.

A few years after the AAP came out with their sleeping recommendations, Cranial Technologies sought and gained FDA approval for the DOC Band, which is the name for their custom-made helmet that is designed to shape the infant’s head before the bone structure is set. The ancient Maya had a similar idea with the head vices they used on their children, although I believe it was for a different purpose.

Anyway, there is some skepticism within the medical community regarding the use of the helmets to treat flat-headedness. Some doctors may be more inclined to recommend it than others. A lot of this stems from a 2014 study in which 42 infants with flat heads wore a helmet device for about 6 months, and 42 infants with similarly flat heads did not. At the end of the 6-month period, a blind evaluation did not produce any evidence that those infants with the helmet had any more significant improvement than those who did not wear the helmet. The implication of this is that it is a condition that will self-correct, which is probably true in some cases.

But to be fair, the professional community that is associated with Cranial Technologies and their ilk have studies to back up their work, and several criticisms of how the aforementioned 2014 study was carried out (see here and here). For instance, they claim that the chin-strap helmets used in the study are ineffective compared to the 3D-molded foam-plastic space-age devices they use.

With that said, I had my reservations about putting a helmet on our baby’s head to treat what he may grow out of anyways, for all I know.

Like everything else about our baby, we love Alex’s cute little flat head that he's had since birth. But we realize that it may not be so cute if it stays that way forever. And so after a couple doctors made note of it and it appeared not to be rounding out after 4-5 months in spite of tummy-time and what not, we decided to schedule an appointment with our local Cranial Technologies for an evaluation.

This involves a whole process of wrapping the baby's head in a sheet to generate a 3D computer model of the contour from which a custom hand-made helmet is sculpted. From all of this, Alex was diagnosed with "moderate to severe brachycephaly including increased width to length ratio, head height, occipital flattening, squamoid bulging, and asymmetry." Since a picture is worth at least five or six of those words, they also gave us this image to show what they mean:

Fig. 2. The right frames show the contour of a 'normal' baby's head. Alex's measurements are on the right.

We were fortunate that his flat head was severe enough that our health insurance was willing to cover the $2000 expense for the recommended helmet (thanks in part to Becky's persistence with the billing department). Otherwise, I may have had a difficult time convincing myself to shell out that much lettuce for a procedure that I was not completely sold on.

Fig. 3. Alex enjoying some story time in his walker.

Alex has been wearing the helmet for about a month now. We’ve become used to seeing him wear it now to the point where I think his head looks small when it is not on. I don’t think he notices it so much when he is awake and sitting up, but it does make it hard for him to turn his head when he is lying down. Incidentally, he wakes up more in the night than he used to.

We have follow up appointments at Cranial Technologies every week, and they are seeing some improvement already. Honestly, I think I can see it too. I may be converted from my skeptical state because the change has happened so quickly. I guess it helps that he got started on it earlier than most kids do, so he may only need to wear it for another month or so.  We’ll see, and keep you updated.

In the meantime, other news: 

We are starting him on solid foods now. Here is a video of him experiencing that for the first time. And he has a new walker that he is learning to scoot, and he’s pretty excited about it. Here’s a video of that. Enjoy!