ASK THE DOCTOR: Alternate baby’s head position in sleep to reduce flat spots
By DR. JIM MITTERANDOQ My 3-month old son tends to sleep and sit with his head turned to the right, which is causing a flat spot on his head. I am quite worried. What can I do?
A Flattening of one side of the head (called positional plagiocephaly) is an increasingly common problem since the ‘‘Back to Sleep’’ program began 10 years ago.
Infants are put to sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS). Sleeping on the back, along with more time spent in car seats and bouncy seats, puts more pressure on the back of a rapidly growing head, and it can develop flat spots.
This does not mean that you should stop putting your child on his back to sleep, but you can alternate his head position to the right or left when sleeping. Many infants develop a preference for turning their head to one side, which can make treatment more challenging. In this instance, place him in the crib or changing table so that he will turn toward the underused side.
Place toys, flashcards, etc., on the side of the stroller, swing, crib or infant seat to entice the child to turn toward the opposite side of the flat spot.
Some infants actually develop a tightness of the neck muscles, called torticollis, which hinders their ability to turn their head to one side. Treatment includes neck stretching exercises, repositioning and sometimes physical therapy.
Treatment of plagiocephaly requires reducing the time the infant spends on his back while awake ( aka repositioning). ‘‘Tummy time’’ - placing an infant on his stomach while awake and supervised - helps develop neck muscles and get infants used to being off their backs.
Infants are on their backs so much these days that they are unaccustomed to lying on their bellies and often dislike this position. Initially, tummy time can be frustrating for an infant since he lacks the strength and coordination. Start with just a minute or two of tummy time and gradually increase it as your baby learns to tolerate it. Use toys or a mirror to distract the child.
The baby can also do some tummy time lying on your chest or stomach.
Other repositioning measures to keep pressure off the back of the head include:
- Decrease the time your baby spends in car seats, bouncy seats.
- Carry your baby in a sling or infant carrier (such as Baby Bjorn or Snugli).
- Use a stationary walker (such as an Exersaucer) when the child has good head control to keep him upright.
- Alternate the hip or arm with which you carry your baby.
- Place a rolled-up towel or blanket behind the shoulder of the flattened side to prevent the baby from resting on that side of the head. The Boppy Noggin Nest is a useful headrest for the stroller, car seat or bouncy seat.
- Interact with your child on the side opposite the flat spot to get him to turn his head toward you.
In most situations, an improvement from repositioning and neck exercise is seen over a two- to three-month period. If no improvement has occurred after two months, notify your doctor.
A misshapen head, naturally, alarms parents. Fortunately, this problem does not affect brain growth or intelligence. Most plagiocephaly improves as children start sitting up, crawling and spending less time on their backs.
Some infants have more severe deformities that cause misalignment of the ears and an asymmetric face that requires consultation with a specialist and possible treatment with helmets.
Rarely, plagiocephaly can result from premature closure of growth plates of the skull called craniosynostosis, which can be diagnosed by X-ray or CT scan.
Dr. Gary Rogers at the Craniofacial Center at Children’s Hospital in Boston is a good resource for consultation as well as for helmet fitting. His office number is 617-355-8509. Web sites and on-line chatrooms can provide some useful information but some can be alarmist and tend to push aggressive treatments with helmets or bands.
Infants with more severe plagiocephaly or those who do not respond to several months of repositioning may benefit from treatment with a skull-molding helmet or band that is custom designed. The helmet essentially provides a tight, round space for the head to grow into. It is worn 23 hours per day, usually for three to six months. Frequent adjustments are made every two weeks. Because of the tight fit required, the helmets can cause skin breakdown and need to be monitored closely. The helmets cost around $2,000, and the DOC band around $4,000. Half the insurance companies in this area seem to cover the helmet treatment.
The best response for helmets occurs in the age range of 4 to 12 months because of the rapid growth of the head during this time. Unfortunately, skull-molding helmets have not been extensively studied to show whether they are any better in the long-term than simple repositioning.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, September 09, 2003