| Today,
deformational plagiocephaly is seen in up to 1 in every 50 newborns.
It has developed as a result of the recommendations of the American
Academy of Pediatrics for children to sleep on their back as part of
the "Back to Sleep" campaign. The Back to Sleep campaign is,
of course, endorsed by ourselves and all pediatricians because it has
been shown that by sleeping on a child's back, there can be a decrease
in the risk of sudden infant death syndrome or SIDS. However, the
fallout is that many children are developing flatness on the back of
their head which is causing severe deformity of not only the skull
shape but also the position of the ear, the position of the eye, and
the position of the temporomandibular joint. Of long-term concern is
how abnormal positioning of the eye and the temporomandibular joints
may effect problems with reading, vision, astigmatism, and
temporomandibular joint position and pain as this abnormal positioning
of the joint may place abnormal forces on the TMJ and result in
long-term pain and clicking in these children.
The correction of deformational
plagiocephaly has also undergone an evolution over the past several
years. Fifteen years ago, when a few cases were seen, it was deemed to
be a neurosurgical problem. Neurosurgeons and plastic surgeons around
the world were performing a skull reconstruction for this condition
similar to that being performed in classic craniosynostosis. This is
no longer the case.
Doctors now realize that this condition
can be treated by nonsurgical methods that are as effective as
traditional surgical therapies. The two treatments for deformational
plagiocephaly are: 1) Positioning of the child. 2) Use of an orthotic
remolding helmet. Positioning of the child can be
effective if the abnormal skull shape is caught very early. The child
can be positioned instead of constantly on the back, in rotating
positions from back to side. This is within the guidelines for
decreasing the risk of crib death and at the same time, the rotating
position of pressure on the skull prevents or decreases the risk of
flattening.
If your child has flattening, you
should position your child on the opposite side away from the
flattening as much as possible. In the car seat and in the stroller, a
bump or blanket, which in no way would cover the child's face and
cause suffocation, should be placed behind the flattened part of the
head to actually force the head over toward the opposite direction. In
addition, the child's position should be rotated nightly and wedges
and positioners should be used in the bed to try and decrease the
continual pressure in the flat spot.
It is essential to also rule out
torticollis as a cause of a contributing factor to the flatness. Many
children will have stiffness in the neck which is felt to be related
to intrauterine positioning that keeps them from turning their head to
one side or the other. Most children with this problem can be treated
with physical therapy alone. However, the flattening of the head will
persist until the torticollis has been treated. If you feel that there
is any restriction in the motion of your child's head, then your child
should be seen by a craniofacial specialist to rule out torticollis
immediately. Physical therapy regimen will then be assigned that will
augment any attempt at positioning or treatment with an orthotic band
or helmet.
Dr. Stelnicki has recently patented a new device that attempts to
correct positioned Plagiocephaly without the need for a molding
helmet. This same device can also be used to prevent
Deformational Plagiocephaly in newborn infants. If you are
interested in this device please contact our office for more details.
Dr. Stelnicki has successfully used cranial remodeling devices in order to treat
deformational plagiocephaly that has not been
responsive to positioning. Cranial remodeling devices can be used effectively up to
a year and a half of age, and in rare patients even beyond that. There are several FDA approved devices which have now been
used on
thousands of children across the world for treatment of deformational
plagiocephaly. Cranial remodeling devices work in several ways. They
provide a
rounded surface that prevents the child from rolling into the flat
spot on the back of the head. It is also a passive process that is
adjusted weekly to control head growth. The head is held in areas
where it is already pushed too far forward and there is space made in
the areas of the flattening so that as the brain and skull grow, the
flattening resolves. These cranial devices must be adjusted weekly or
bi-weekly in order to work effectively.
With the use of the helmets, we expect a
90-95% correction in head shape. All human beings have some asymmetry
in their skull and it is unrealistic and unnatural to expect perfect,
rounded symmetry following any treatment of head shape. The typical
length of a cranial remodeling treatment is directly dependent on the
age at which the child begins this therapy. It is also possible that
more than one helmet may be needed to complete corrections. When the child outgrows
his or her helmets, a new helmet could be reapplied after updated measurements
are taken to fit the child with new proper fitting device.
It is essential that after you have
been diagnosed with deformational plagiocephaly that you contact the
provider of your helmet therapy as soon as possible. Some insurance companies
will try and fight you on authorizing this band and call this a
cosmetic concern. This is not a cosmetic problem! It is a deformity of
the skull, which is abnormal and is a result of a medical
recommendation. There are theoretical concerns about long-term
problems with temporomandibular joint placement and long-term
astigmatism in the eyes and should be corrected by an FDA approved device. You may have to fight your insurance
company. Try to get your pediatrician to write you a letter of
support, this will help in most cases. Dr. Stelnicki, of course, will
help you and support you in every way.
Cranial remodeling devices are developed as a conservative treatment and is most
effective early in life. The correction of this does not in any way
effect the development of the brain, in fact, the brain will develop
the same regardless of treatment. However, the remodeling of the head needs to be done early in order to be
effective. Most cranial devices are fabricated from a plaster of Paris
impression, or a digitalized image of the child's head shape using a semi-rigid outer shell, which is bonded to a foam
inner lining. The lightweight cranial headband applies dynamic
pressure to the elevated areas, leaving spaces for growth and
remodeling of the flattened areas. For effectivness, cranial devices
need to be worn 23
hours a day with 1 hour taken off for skin care, hygiene and cleaning
of the helmet. Dr. Stelnicki will decide with you when the treatment
has been optimized. Careful measurements of your child's head
shape will be taken to evaluate the results of the treatment.
Dr. Stelnicki also uses cranial remodeling
devices in
conjunction with his endoscopic surgical repair for craniosynostosis.
This helmet will be worn for 6-8 months postoperatively depending on the
age of the child at the time of craniosynostosis repair. It must be
worn at all times with the exception of being taken off once a day for
cleaning. The endoscopic repair success relies heavily on the use of
the helmet and families who cannot commit to the postoperative helmet and
the need for constant adjustments for 6-8 months should not undergo
endoscopic cranial vault repair. With the helmet, however, the
correction of craniosynostosis can be minimized to a much faster
operation with much less blood loss, with much less time in the
hospital and much less morbidity. There is also no need for placement plates and screws around the skull, as the
cranial remodeling devices offers post
surgical splints for molding the healing and regenerating skull bone. |
