Monday, July 28, 2014

Parent FAQs : My child/ baby has a flat / abnormal shaped head, what should I do?

This is a fairly common concern in the OPD practice of a pediatrician. 
Question: My child/ baby has a flat / abnormal shaped head, what should I do?
The answer is NOTHING. In most cases as the baby's brain develops and the skull size increases the shape of the head improves.
The reason for the abnormal shape in most normal infants is due to the posture that they adopt while they are inside the uterus, during pregnancy. 
In the west, specially designed helmets have been used, however a recent article seems to suggest that these are not likely to be of much benefit.
Here is the study as quoted on the AAP (American Academy of Pediatrics) website

Helmets no better than natural course for skull deformity

  1. Carla Kemp, Senior Editor
No differences were found in the use of helmets to treat positional skull deformation compared to allowing the condition to follow its natural course, according to a randomized, controlled trial of 84 infants with moderate to severe skull deformation.

Side effects were common among infants who wore orthotic helmets to treat plagiocephaly and brachycephaly, while changes in skull shape were similar to those who received no treatment, according to a recent study.
The incidence of plagiocephaly and brachycephaly has increased since the Back to Sleep campaign recommended putting infants to sleep in the supine position to prevent sudden infant death syndrome. Orthotic helmets may be recommended if skull deformation persists at 6 months of age. However, long-term data are lacking on the effectiveness of helmets.
This study compared changes in skull shape among infants who received helmet therapy for six months compared with those who received no treatment for positional skull deformation. Secondary outcomes included side effects of therapy, motor development and parental satisfaction.
Infants were eligible to participate if they were ages 5-6 months, born after 36 weeks’ gestation, and had no muscular torticollis, craniosynostosis or dysmorphic features. At 8, 12 and 24 months of age, pediatric physiotherapists performed anthropometric measurement of skull shape and assessed motor skills.
Results showed both the plagiocephaly and brachycephaly change scores were not significantly different between the two groups. Full recovery was comparable in both groups (26% of the helmet group and 23% of the natural course group).
No differences were seen with motor development between the two groups, and parents of both groups reported high satisfaction with their child’s skull shape at 24 months. All parents of infants in the helmet group reported at least one side effect, including problems with the baby accepting the helmet, skin irritation and pain.
The authors discourage the use of helmet therapy as standard treatment for healthy infants with moderate to severe skull deformation and recommend larger studies be conducted to confirm their results."
Source (requires subscription for full access)

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