In 1992, the American Academy of Pediatrics (AAP) proclaimed that infants should be placed on their backs to sleep to prevent SIDS deaths. This inspired the state of Texas Minimum Standards for Licensed Childcare Facilities to require training in this for all employees. (This is why we only allow infants to sleep on their tummy after they've developed enough strength and coordination to roll from tummy to back.) Since 1992, SIDS deaths have been reduced by 40%!
Also, since 1992, there has been a major increase in a condition called plagiocephaly (some medical studies report the increase going from 1 to 400 babies.) Positional plagiocephaly is the most common type which literally means asymmetrically shaped head. However, there is another type called craniosynostosis which is the premature fusion of the cranial bones. For the rest of this post, I'll only be focusing on the positional plagiocephaly.
Infant brains grow phenomenally in the first six months after birth and the cranium expands to accommodate it. But because babies spend most of their time sleeping, the head of a baby who sleeps mostly on his back can develop a depression. Twins and multiples are more likely to get plagiocephaly because of constraint in the womb and prematurity requiring the infant to be on a ventilator, lying flat during the first days after birth.
There are some thing which can be done to prevent positional plagiocephaly.
Prevention Do's
- Increase supervised tummy time
- While the infant sleeps on his back, you could gently rotate his head to face the right or left
- While nursing, consider different angles that would be comfortable for you and your baby and also vary the infant's head position in your arms
- When changing the baby, try approaching him from different angles to vary his gaze on you
- Move mobiles around so the infant is turning his gaze in varying directions
- Move light sources occasionally
Prevention DON'TS
- Never poke, push or apply pressure on the infant's head, no matter where on the head but especially near the top
- Never prop the infant's head, the infant's body or his crib. Propping the infant or the crib is dangerous and should never be attempted no matter how small of an incline.
If the prevention strategies are not enough you will most likely notice asymmetry between 3-6 months. There is treatment which includes a specially fitted helmet prescribed for the infant to wear for about 23.5 hours per day for up to 6 months. This helmet is used to shape the infant's growing skull. How it works - the doctor will first measure and make a plastic mold of the infant's head. These will be used in creating the individual helmet. Once the helmet is ready, the idea is that it will fit firmly on pronounced areas while leaving room for the other areas to grow, letting them "catch up" to those that are more pronounced.
Correcting plagiocephaly vs. not correcting plagiocephaly
The research is more clinically based which relies on individual trial & error cases rather than an experimental and control group.
Pros - No research has shown harm from correction with a helmet
- Reduction in future emotional stress or self-consciousness
- The practice is not new as it can be seen in Asian & ancient Egyptian cultures.
- Not always paid for by health insurance as it can be considered cosmetic (For example, Aetna pays for the treatment only in moderate to severe cases)
- The infant can get used to the helmet and when it's removed it takes some time for him/her to get used to life without it
