Thursday, August 25, 2011

I'm a Flat-vocate


I am not claiming to be smarter than your Pediatrician.
I am not claiming to be smarter than you.
I know flathead (not combined with torticollis) usually doesn't become a problem for a couple months, therefore, a lot of my advise and opinions about when to get a second opinion and start cranial sacral therapy won't apply if you're just dealing with flathead.

I'm not an expert on flathead (Plagiocephaly), torticollis, cranial sacral therapy, pediatric physical therapy, or DOC bands. However, I know a whole lot more about all of it now than I did 11 months ago. In the past 2 days I've had 2 concerned moms approach me and ask if they could ask me a few questions about the helmet. Both had kids that are past the age where being treated for flathead (with a helmet) is an option. One child is over 2 years, and one will be 2 in a couple weeks. People seem to be asking more and more about it these days. That's why I'm writing this. If your children are older and/or have perfectly beautiful round heads and symmetrical ears and faces, you'll be bored. But if you have questions, are still having babies, or have a baby you've worried a bit about, I may say something that will help. Seriously though, I'm not an expert, this is just going to be the post that I wish I could have read before Garrett was born.

I'm learning that most pediatricians don't know a whole lot about flathead. I mean, they know what it is, and they know what causes it, and they know it's common, (10% of babies have it) but based on the 2 peds we've had, and a lot of conversations I've had with strangers, and other doc band moms at cranial tech, flathead is kind of one of those non-life threatening things that peds will discuss, but ultimately leave up to the parents to decide. Our Utah ped didn't talk much about it because Garrett was still too young when we were there, and his flathead wasn't very bad, (torticollis babies are very likely to develop flathead because the neck literally pulls the head to one position when the baby sleeps or is on their backs) but when we talked about the head tilt and asymmetry of his face, she suggested we just wait it out and see if he grows out of it when he learns to roll/sit up, etc. Because he was only a couple months old when we moved, I didn't expect much more than that, and at that age, that's probably the advice I'd give too. (I would however find a good massage therapist or physical therapist who does cranial sacral therapy, AND STUDIED PEDIATRICS DURING THEIR SCHOOLING AND CAN PROVE IT...don't let your baby be an experiment for someone who wants to start working on babies. Anyway, I'd start that at about 1-2 weeks old) When we got to California, our ped here noticed the tilt and asymmetry. He talked to us about stretches to do, about physical therapy, and told us what pillow we could order to help with the flathead. Even with all that info, he still talked like Garrett should outgrow it, nothing was too urgent, it was up to us to decide, and that maybe in a few months if we didn't see improvement he'd refer us to a cranio-facial doctor. Garrett was 4 months old when that conversation took place, and had I known then what I know now, I would have asked that day for the referral and we would have started the doc band and physical therapy 4 months earlier.

Our ped had us come in at 5 months to look at G's head, and we had almost the exact same conversation as at 4 months. Then at 6 months it was a repeat again, except that he seemed to think the flathead had improved a bit. We went in at 7 months for one last check and he told us things looked really good and anything we wanted to do at that point was up to us. I asked him for the referral because as Garrett's mom, and being with him everyday, I could see things that I wanted a second opinion on. That's something we need to remember as parents, your ped sees your baby for 10 minutes every couple of months. They don't see how they sleep, how much they favor one side, how their range of motion is throughout the day. And also, I think one of the biggest things with G was his thick, long, voluminous hair. It did a great job at hiding the imperfections, but when it was slicked down (in the bath) the issues were so obvious. Peds don't see that stuff.

Pediatricians don't know how to treat or even diagnose everything that might be wrong with a baby. If they did then there would be no need for specialists. You're not going to offend your ped if you tell them you'd like a second opinion about something. And if they do get offended, ask for the referral anyway and also get a new pediatrician.

Do I think Garrett could have avoided the need for a helmet at the age he was when you started it? No. I knew that too many of his problems developed in utero, therefore him outgrowing the problems would be somewhat unlikely, but I think now that I've worked so closely with a PT and she shares so much with me about what she's doing, the body, the head, and how everything works and connects, etc. (Seriously, I feel like I'm taking a class twice a week, I'm learning a lot.) I do feel now that with our situation, we could have dealt with the torticollis more aggressively and possibly avoided it. But, I'm impressed with Cranial Tech and I see positive changes there too. Because we got the helmet and we started PT so late, I really can't say for sure. Do I think the time he's spent and will spend in the helmet could have been shorter? Yes. The sooner you treat, the easier it is to correct because the head gets harder and harder the older they get. Do I think the need for a helmet can be avoided when torticollis causes flathead? Yes, if physical therapy is started early enough. (This one, as well as most of my thoughts and opinions are for sure a case by case basis.) At what age would I take my baby to a pediatric cranio-facial doctor for a second opinion? 3 months. When are you still in the window of time to be treated? If you have questions or concerns I would always keep asking. But typically at 18 months, not much will change about your child's head shape, and treatments would need to begin 6-8 months before the 18 month mark.

The lady I spoke to a couple days ago was devastated about her son. She asked her ped what she should do for his flat spot every time she took him in. She adopted him when he was 1 month old and he already had the flat spot when she got him. Her ped told her at every appointment for over a year that they'd keep watching for it to improve. She finally took him to a neurologist when he was 20 months old, and ultimately she was told that he's just too old to do anything to correct it. Knowledge is Power. As cheesy as it sounds, this really is true.

Like I mentioned, 10% of babies have flathead. Probably not all of those babies need reshaping helmets, and a lot of them can outgrow it when they roll, sit up, start tummy sleeping, etc, but if you think your child might fall into that 10%, its worth asking about. The good news about the increase in flathead babies is that the SIDS rate is at an all time low. Since 1983, the rate of SIDS has fallen by over 50 percent.

Am I worried that 2.0 might have some of the same issues Garrett has? Sure, having to do all of this again crosses my mind from time to time. (Although babies who are born with torticollis are almost always the first born.) Do I feel more confident in the decisions I'd make and how we'd go about getting treated? Absolutely. Not that money is the main issue, but I know for a lot of families it is. If Garrett needs a second helmet, we will have spent over $10,000 out of pocket in one year for him. If we would have started 4 or 5 months earlier, I'm confident it would have been about half of that. Remember, the younger you begin, the quicker and easier everything fixes. Is there anything I'll do differently when she's born? It all depends on if she's posterior, how long labor lasts, etc. But no matter how that all goes, she will be treated by Garrett's physical therapist a few times, and have a couple appointments with my chiropractor in the first 2 months or so of her life. Being born is one of the most traumatic experiences the human body goes through. A little massage and a good adjustment or two is beneficial for any baby. And even if she has a perfectly round beautiful head, she'll sleep on an infant pillow for the first 6 months or so of her life.

If your baby has a little flat head, or even a head so perfectly round it would make a bowling ball jealous, here are a couple pillows I'd recommend for your infant from CLEVAMAMA and APPI. The one I have for 2.0 is almost just like the appi, I'm also thinking of getting a clevamama baby pillow or positioner too.

If you have any other questions or you'd like the name of our doc band clinician, physical therapist or chiropractor here in southern California, or if you have a baby that favors one side or has torticollis and you'd like some simple exercises you can do to strengthen the neck and improve the range of motion, feel free to leave a comment with your info and I won't publish the comment.


And on a somewhat related note, a sad story that brought me to tears. A 31 year old women (my age) from La Habra, California (one town over, where my in-laws live) had a baby boy just a couple months younger than Garrett. When he was an infant the mother was diagnosed with postpartum depression. When the baby was a few months old he was diagnosed with Torticollis, and because of that he also developed flathead, and began wearing a reshaping helmet. Are you catching all the similarities? A couple of days ago, the mother was at CHOC (Children's Hospital of Orange County) with her baby boy. She took him to the 4th story of the parking structure, took his helmet off, and dropped him over the side. He lived for 39 hours after the fall. They interviewed her husband who talked a lot about her depression. He also said that when the baby was diagnosed with torticollis the mother stopped thinking of him as her child because he wasn't a normal baby. The reporter on the news said she claimed to be too overwhelmed with his medical issues. As much as I can relate to this women, and say that I know EXACTLY what she was going through, I can't even begin to imagine getting to the point she got to. It breaks my heart.

Babies are born with so many different issues. Some life threatening, some not. Some time consuming, some not. Some expensive, some sad, some scary, some confusing. I wouldn't even know how to define a 'normal' baby. Even if you're overwhelmed, you'll get through it. Ask a lot of questions, take it one step at a time, and do what you think is best. Your baby needs you to get them through it!

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