Plagiocephaly questions

Hi

My 4 month old daughter Grace has developed a very noticeable flat spot on her head. I brought in up to her pedi at her last visit and she didn't seem very concerned. She said it wasn't bad enough to need a helmet and just to try not to let her rest on it much. It is quite apparent to me, though, and I worry she will need correction.

I cannot figure out how to position her head so she doesn't put weight on it. Now that it's flat she always rests that way. She can turn her head the other way but doesn't. I have tried putting a towel under that shoulder but it doesn't help. I tried something under her neck but she still ended up with her weight on that side. Does anyone have other ideas that have worked? How worried should I be about it? When is it time to insist on a referral to a specialist? I don't want to have to do the helmet but I really don't want her head to end up permanently mis-shapen. Thanks!

Suzanne

 

I don't want to over-react or freak you out, but since you asked.... yes, you should see a specialist. My older DD had the same thing at that age. Our ped downplayed it saying, "Oh, it'll round out" etc. Well, it didn't and by the time we pushed for a referral we were helmet-bound. The specialist tolds us these thing can't "round out" on their own when they keep sleeping on that same spot, and to get it to round out you need to be putting pressure essentially on the opposite side, either through sleep patterns or in our case through a helmet.

It sounds like your child *may* have torticollis, which just means she has a tendency to turn her head in one direction due to a slight muscle tightening. This is probably why she does not want to turn the other way when she sleeps. That is what was the case with my DD.

If I were in your position, I would ask for a referral to both a specialist and Early Intervention. A specialist can do a couple of things: 1) measure her flat spot and head dimensions to tell you how far, if it all, it is "out of the norm", 2) can recommend and monitor with position changes, and 3) can work with you early on a helmet if need be. Also, if you get a referral now, it will probably take at least a few weeks to schedule you in to the specialist, during which you can work on any suggested position changes. That way, if the positioning does not work, you are still ready to see the specialist sooner rather than later. If it is working, you can always cancel, right? Another reason to go early: if you do need a helmet, it's wayyyyyyy better to get one early because they are in it for a shorter period of time and it bothers them less. If they get it at age 5 or 6 months, then usually they only need the helmet for a couple of months. If they get it at 10 or 12 months, they're likely to need it for a year due to the head growth slowing down so much after the first year.

I suggest Early Intervention because if she does have torticollis or even just likes to turn her neck a certain way, they can teach you all kinds of ways, via PTs an OTs, to reposition and correct it. It's a FREE service, and they come to your house! Make some use out of those tax dollars, you know? They really have helped us a lot.

Hope I haven't overwhelmed you. Feel free to PM me if you want any more info or want to see pics of my daughter's flat spot (the "before" pics) to compare. Good luck!!!!!!

Mellie

 

I agree with pp. You may also want to call the PT/OT department of a large hospital in your area and ask if they make positioning pillows for plagio. They are foam pillows with cut outs specifically for your childs needs to alleviate pressure on the flat spot and place pressure on the other side instead. These work really well for young babies especially before they can roll well. Often you can avoid the helmet or doc band if you do this early enough. There is almost always a component of torticollis with plagio so getting PT invovled would help. I definitely would not wait, there is often a delay in getting early intervention services started so outpatient or a private home company may be a good option until EI kicks in.
Good luck.

 

I disagree that it sounds like she may have tort. It is very common for a baby with a flat spot to be most comfortable on that flat spot but it doesn't mean there is an issue with the muscles. If she can turn her head like you say then I would not be as concerned about the tort as I would the plagio. Kyle had plagio, no tort, and definitely was more comfortable on his flat spot merely because he was most comfortable there. The specialist said that is completely normal.

What can you do for positioning? It sounds like you are doing alot! Some suggestions are to make sure she is sitting on the side of the car that when she looks out the window she is not on her flat spot, rotate her position continuously in her crib and move anything she may look at also so she will need to not rest on the flat spot to see it, tummy time (I know easier said than done probably but remember even time laying on your chest can be considered tummy time and most babies enjoy that!).

When is it time to see a specialist? One thing to consider is if the flatness began inutero or after birth because of positioning. If you sit her in front of you and you look straight down over the top of her head, if you draw an imaginary line from one ear to the other is it straight? If you hold her up to a mirror and look at her facial features do they look aligned properly? Are her eyes level, is her mouth straight?

The reasons I ask these questions is because it is much more common for positional cases to be corrected positionally than for inutero cases where the head never formed correctly initially, so if you have noticed this flatness since birth that would be one reason for me to seek a specialist. If any facial features are not aligned then I would call to see a specialist.

I honestly believe that anyone with this concern should see a specialist if for nothing more than peace of mind. A specialist can give you a measurement of the roundest to flattest spot which will help you to realize how severe her case is, or isn't. My insurance covered treatment for anything over an 11mm difference. 4 months is the perfect time to be honing in on this. I hope I have given you some information to think about and decide how to move forward.

 

Thank you so much for all the replies. My daughter's appears pretty severe to me so I know we'd feel better if a specialist looked at it. What type of "specialist" are you generally referred to?

It wouldn't surprise me if she also had an element of torticollis. Even if I switch where she's sitting, etc., she'll just turn her head and find something interesting to look at on the wall.

I started noticing this about a month or so ago. I really wish the pedicatrician had taken it a bit more seriously. I hope that this month or month and a half doesn't affect the outcome.

Thanks again! Twinstuff is a great resource.

Suzanne

 

We saw a Plastic Surgeon at Children's Hospital then we went to see the Orthotist who did the molding etc. I believe it is more common to be seen by a Neurosurgeon than plastic but he happened to be the best in plagio so what his title was didn't matter to me. I would call your Ped's office and ask you they recommend.

 

At 8 weeks, I noticed my sons head was always tilted to one side. He was able to rotate his head both was but it seemed like he was always tilting. I took him to his ped. and he did have torticollis. So even if he 'can' rotate, it is possible to have toricollis. With torticollis you have to look at both the tilt and rotation. There are different leves of severity. Since my son was more severe at 8 weeks, he began pt. Often times, babies have torticollis and it is mild and fixes itself within time or the baby is reevaluated around 4 months.

My son had a slightly misshapened head so I did take him to a cranial dr. to have the measurments taken. He came out mild at around 4 months so he did not need a helmet. My son was sleeping in his car seat and the cranial dr. said he HAD to sleep in his crib in order to help with both the tort and head shape. I also bought one of those boppy pillows with a whole in the center to put in his boppy when I fed him.

Personally, I think many drs. are not as aggressive with tort as they should be. I have heard of many cases when the drs. dont refer babies to pt and then the therapy begins later and it is harder and takes longer to correct.

 

One of our twins started having a flat spot. Plus - she had terrible neck control. For us the Bumbo seat really helped. She hated it. She screamed - but it really helped! Now it is only a small flat area that you really only notice when you fell her head.

Hope everything turns out well! Keep us posted!

Angel