Perils of Plagiocephaly

By Betsy Bross Roberts

“Have we talked about the molding of Bross’s head?” Dr. Michael Klemm, our pediatrician asked.  My husband Chris and I had taken Bross to the doctor for his six months’ well baby check-up.  Then Dr. Klemm showed us that the back right side of Bross’s head was flatter than the left.  He asked us to reposition Bross for the next six weeks by decreasing time spent on his back, and increasing time spent in other positions.  When we told him that Bross was upright more often now and didn’t favor his right side, Dr. Klemm recommended a CT scan.

After examining the CT report, Dr. Klemm referred Bross to Dr. Kevin J. Kelly, craniofacial specialist in the Department of Plastic Surgery at Vanderbilt University Medical Center.  At our first appointment July 9, 2008, Dr. Kelly told us that Bross had plagiocephaly.  He was concerned because the CT also showed signs of possible bridging across a suture line.  If this should fuse too soon, he explained, then cranial deformity may occur.  Dr. Kelly recommended helmet therapy.

Plagiocephaly refers to a persistent flat spot on the back or side of the head.  Treatment involves wearing a helmet in an attempt to reshape this flat area.  In 1992, the American Academy of Pediatrics started a “Back to Sleep” campaign, suggesting that infants be placed on their backs to sleep.  The incidence of sudden infant death syndrome (SIDS) has decreased by 40% but positional plagiocephaly has increased dramatically. According to Dr. Kelly, “Some form of plagiocephaly that requires repositioning or a helmet occurs in one out of 1,000 – 1,500 births in this country.” In addition to sleeping on their backs, babies also spend time on their backs in car seats, strollers, bouncy seats, and swings.

After our initial visit with Dr. Kelly, he referred us to Restorative Health Services, in Nashville where a plaster of paris impression was made of Bross’s head.  This casting procedure was the most stressful part of the whole process, but took just a few minutes.  Two weeks later Bross received his helmet, and wore it continuously for the next five months. The customized helmet was made of hard plastic with four layers of foam on the inside.  It opened like a book and was held together by a Velcro fastener on top.  Dime-sized holes provided ventilation.

Although Chris and I were concerned about how Bross would adjust to wearing his helmet 23 hours a day, Bross was resilient! After a few tears, he quickly learned how to position himself comfortably to wear it in his crib.  Three times a day, 20 minutes each, we removed the helmet for cleaning. We began to relax when we noticed Bross crying for his helmet during these times!  Sometimes strands of Bross’s beautiful, long blond hair would shoot through a ventilation hole or the helmet crack.  The hair that stuck out over his ears under his helmet reminded me of a rock hopper penguin!

When Bross first began wearing his helmet, it was difficult for our family to adjust to whispers and stares.  Since it was nearly football season, we decorated Bross’s helmet to look like the Alabama quarterback’s helmet. Then the stares were accompanied by an enthusiastic “Roll Tide!” or “Where could I get that helmet for my grandbaby?”  These comments gave us the opportunity to introduce the “elephant in the room” and discuss plagiocephaly.

Once a month we traveled to Nashville for Dr. Kelly to examine Bross’s head and his helmet.  The clinicians made changes to the inside foam layers either by shaving them or removing a layer on the side where Dr. Kelly hoped the back of Bross’s head would expand.

On January 6, 2009, Dr. Kelly released Bross, stating that he had made good progress.  Wearing the helmet for five months was a small price to pay for long term results.  We avoided surgery and now Bross’s head is well-rounded. Ask your pediatrician today what you can do to prevent plagiocephaly in your newborn.  Tummy time, anyone?

Betsy Bross Roberts is a full time mom with a Master’s degree in Mild Learning Handicaps who currently runs Blossomwood Chess Club.  She enjoys spending time with her husband, Chris, an engineer, and their three children, Christopher, 13, Riley, 10, and Bross, one.