positional plagiocephaly (flat head) with facial asymmetry

Hi, one of my 3 month old boys has a flat spot on the right side which is causing facial asymmetry. Our ped thinks its a mild case of torticollis, we go for our PT evaluation today. The ped wants to do PT for 3 months before we talk about getting a helmet, but I want to be more aggressive.

Has anyone else had to deal with not just positional plagiocephaly, but facial asymmetry?

From what I understand, if we intervene earlier he would have to wear the helmet for a shorter time and we'd get better results. I'm worried if we wait, it will affect his eye sight, eating and even talking (his right half of the face is larger, squishing his left eye and cheek). i posted posted a pix to show you what I mean...

http://i564.photobucket.com/albums/ss85/ny...michaelface.jpg

 

How did the PT eval go? I do see what you mean about the facial asymmetry. Most cases that I have seen on these forums with the asymmetry usually have helmets. If you are unsure at all with your peds course of action, I would definitely go and get a 2nd opinion.

 

If you do get the helmet make sure its before one year=our DD should of gotten it very early on but we wanted to see if it could be fixed with no intervention=her head is still flat on one side and her ears stick out more then her sister-at this age its not going to help much-i was on the fence for a long time.

 

We had to deal with torticollis, flat head and facial asymmetry. We started PT at 4 months of age and from my POV my son's flatness was very noticable. Our ped. didn't think so and the PT said it was noticeable but he shouldn't need a helmet. We still went to a specialist but that wasn't until 6 months. The specialist didn't recommend a helmet for our son and said that by 18 months his head/symmetry would be good. He was right. My son was in PT until 11 months and his tort. is completely gone. :good: His head is still not perfectly round but I think we've inspected it so much that we see everything. No one else notices, but they did when he was younger. And his face is no longer flatter on one side. Good luck and keep us posted on what they said at the evaluation. :hug:

 

Mine both go for the eval for a helmet due to Plagio on July 28th, DD also needs an eval for PT due to developmental delays. DD's head is flat on the back and DS is flat on the right side. I have no experience and worry too. Our pedi had us wait till 6 months hoping it would correct by positioning them certain ways. Obviously didn't work and has gotten worse. Pedi hasn't mentioned asymmetry but DS right ear is further back than his left

GL you son is adorable! He can hold his head well for only 3 months!

 

we started doing PT for torticollis when the boys were 4 months old. their flat spot was on the back of their heads so i can't help you with the facial asymmetry part. but i can say that doing PT did help them get up off of the flat spot and we've seen lots of progress with it rounding back out on its own since it started. since you've got an asymmetry situation you should definitely seek a second opinion and don't be afraid to insist that you pursue the more aggressive route to get things back in order.

you're little guy is cute as a bug, by the way.

 

Hi, Hope everyone (Moms and Kids) is doing well. At our son's 2 month check up our pedi referred us to PT for torticollis and positional plagiocephaly. At 5 months we have "dumped" our physical therapist and re-evaluated his treatment. Here's our story:

2months : 1st visit to PT. Shown how to position to correct head shape and given strengthening exercises for neck. Told to return in 1 mo. She didn't prescribe any stretching.
3months: 2nd visit to PT Improvement seen. Referred for x-ray to rule out fused plates (she couldn't feel the back soft spot). Told to do the same positioning/exercises and return in a month. If x-ray normal and shape correction seen at same amount PT would be over. X ray was normal.
4months: 3rd visit to PT We were told that the improvement in head shape was as much as the previous month but not enough. Told we should have him evaluated by orthotist for helmet. When I asked whether the head shape was a cosmetic issue or something that could affect development she said it was cosmetic. She also said that his neck muscle was still tight and that she's like to "monitor" him monthly through walking. No additional treatments for tort offered.

On the drive home from our last "evil PT" session we decided that our initial gut feeling about her was right and to dump her and find a new PT. What we have learned since then via own research and interviewing new physical therapists:
1. Stretching is a key component of treating torticollis.
2. Monthly monitoring appointments aren't enough. Kids with tort should be getting weekly hands on PT in addition to what is prescribed for home.
3. Head shape is not just a cosmetic issue and can cause medical issue later.
4. Most PT/pedi will try positioning first for plagio. This works best on younger babies - before they turn into little wiggle worms. If you have a wiggle worm advocate for earlier eval for helmet (especially since it may take several weeks to get the referral and appointment). Make sure you call your insurance company to find out what they'll cover (it's a cranial re/molding helmet/orthosis and is usually considered durable medical equipment or DME). Also find out which companies that do the helmets are on their approved list. The best time for the helmet is while they're still growing quickly.
5. If you have any concerns about tort / head shape start as early as possible and if your gut doesn't agree with what a pedi / pt says then get a second opinion.
6. Tort treatment may need to continue even if head shape returns to normal. Solving one part of this equation doesn't necessarily mean the other part is solved.

Here's a link to a book that I found helpful in understanding torticollis better. It's for a PT but helped me at least ask better questions regarding eval and treatment.
http://books.google.com/books?id=uft8mpH4-2kC&printsec=frontcover&dq=torticollis

We met with a new PT yesterday that has many years treating tort. She passed our "test"- she did a thorough eval based on the book I read and gave us the stretching exercises we'd been longing for. She has many years working with babies and tort (a key thing to find out). Hopefully she'll help our family. Our daughter has also been having tort symptoms and needs PT. Son is being evaluated for helmet on 7/29. We're frustrated but we finally feel like we're on the right track! And shew... it sure feels good to get some of these thoughts off my chest~!

Best wishes to all families going through similar issues...

 

I'm glad you posted this topic because we are going through this too. Both twins have plagiocephaly, torticollis, and facial asymmetry. It is good to hear others stories and advice. I will be following some of it soon...like calling my insurance company. Great tip!

First I want to say your son is adorable! I did a search on photobucket for "michaelface" and I can see what you mean about his eyes. My dds eyes are slightly asymmetrical, she has a prominent cheek, and both have ears that are misaligned and have forehead asymmetry.

When I took them to the dr. at 3 months for this, he suggested repositioning and said they didn't have torticollis. I asked about PT. He said he wasn't going to bring it up, but gave me a referral anyway.

I took them to PT for the first time last week. She has a lot of experience with plagiocephaly/torticollis and diagnosed them both with this. She advised me to call and set up an appt. for a helmet eval. She also gave me stretching exercises to do at home and said they will require weekly PT visits. This Thursday I go in and they are going to fit their carseats with foam to improve posture and head position. Also, she wants to make sure I feel comfortable with the stretching exercises after trying it for a week.

I wasn't sure if I should wait on the helmet eval either. Ultimately, timing is critical with this whole thing so I've decided to go ahead and make an appointment (that is, if I can get the referral from my pedi). I don't think it could hurt. Plus, there might be a waiting list so I better call now. What does your PT say about this? Maybe if your PT advises it, your pedi might be more willing to give you the referral.

I don't know about you, but I really worry about this. I'm constantly wondering if I'm doing enough. It is heartbreaking for me to see my babies with these problems but am hopeful it will get resolved with time and lots of work. Hang in there and if you ever want to PM me to talk to someone going through it too, feel free! :hug:

Good Luck, and keep us posted!

 

My baby A had positional plagiocephaly from positioning in the womb. The fact he was vacuumed out didn't help his little head at all! He did not have torticollis, so luckily there was no PT for that. We did start him at 2 weeks old with cranial manipulations - think of it like a chiropractor for the head. It was very gentle and was performed by an MD. We did that until he was about 4 months old and then we got him a helmet. He wore the helmet for only 2 months (we continued the cranial manipulation treatment during that time). His head looked good when he stopped wearing the helmet and continues to improve with age. I'm glad we got the helmet at such a young age, his flat spot was so prominent I do not think it would have worked itself out. I also believe that the combination of treatments allowed him to wear the helmet a shorter amount of time.

Continue to trust your instincts!