Flat Head Syndrome

Other Causes

Plagiocephaly is on the rise, according to studies. In 1992, the American Academy of Pediatrics initiated a "Back to Sleep" campaign to fight the number of SIDS cases. The campaign has been incredibly successful, with some estimates putting the decrease in SIDS at 50 percent a year. However, there has been a six-fold increase in the incidence of positional plagiocephaly. Most pediatricians feel that, given the excellent prognosis of plagiocephaly, the benefit of preventing SIDS by putting babies on their backs to sleep far outweighs the risk of a temporary flat head.

But plagiocephaly isn't always due to sleeping positions or torticollis. Debbie Joneses daughter, Abigail, was born with it. "Abby's plagio began in utero as many babies do," says Jones. "We noticed her head was stuck in one position for the last several weeks of my pregnancy on our weekly ultrasounds. We are very fortunate to have a great pediatrician who was alert and noticed this so young."

The Jones attempted repositioning but found it to be too difficult with their daughter. They used the side sleeper method, but within 30 minutes Abby would have already rolled back over to her flat side. "We often compare plagiocephaly heads to a deflated ball," says Jones. "Once they are flat, the head just instinctively rolls back to the flat side."

The Jones' pediatrician recommended that her daughter wear a band, but she and her husband were skeptical and decided to try further repositioning. When they began getting comments from others about her flat head they finally decided to give it a try. "If adults were rude enough to make such cruel comments to us today, imagine what it would be like for Abby in school with kids picking on her 'flat head' day in and day out," says Jones.

The first band the Joneses tried on Abby was not successful, so they tried a band from Cranial Technologies, which she wore from age 11 1/2 months to 15 1/2 months. The second band was more successful with approximately 50 to 60 percent correction of her plagiocephaly. "It's so very important to get fast and early diagnosis," says Jones. "I feel too many pediatricians are not educated nearly enough regarding plagio, considering the number of cases today. I would like to see first-time parents educated on plagio at child birth classes or while in their hospital stay after the baby is born. This could help prevent countless plagio cases."

Studies Look Promising

Because of the increase in the number of plagiocephaly cases, more studies are being done on causes and treatment of the condition. According to Dr. Andrew Reisner, a pediatric neurosurgeon for Children's Healthcare of Atlanta, the Craniofacial Team and the Orthotics and Prosthetic Department at Children's Healthcare of Atlanta at Scottish Rite are working on a number of studies.

"These studies include two exciting projects," says Dr. Reisner. "First, there is an ongoing study assessing how quickly children with mild to moderate plagiocephaly improve spontaneously with repositioning only. Second, there is a study assessing the value of a new device [that] assesses and measures the individual shape and deformity of the child's head using a laser scanner." The information from the laser scanner can be entered into a computer, which will generate a three-dimensional image of the patient's skull from which a helmet or band can be made, according to Dr. Reisner.

"This technique is very sensitive, accurate and allows the treatment to be highly individualized for that particular patient," he says. The best part about this particular method of obtaining a mold of the patient's head is that it is painless and well tolerated by the children.

Both Manias and Jones say neither of their children minded wearing the band, and both families are very pleased with the results."Dane actually missed the band when he graduated," says Manias. "We were thrilled with the progress he made. Banding him was the best decision we made as parents. We saw improvement within the first week of treatment, so we had high expectations. All those expectations were realized after three months in the DOC band."