STORY BYAs a newborn, Matthew Resendez was the picture of perfection, but within a few months, photographs began to reveal a significant flaw.
His mother, Sandy Resendez, was thumbing through snapshots she had taken of her youngest child at a pumpkin patch when she realized how severe it was. Matthew’s head looked just like the pumpkins.
“He had a little pumpkin head,” she says. “The front of his face was getting so wide, and the back of his head was flat. It got to the point where it was hard to get a shirt over his head.”
Resendez, a registered nurse, had seen this same condition in thousands of children who are treated in the pediatric surgery clinic at The University of Texas Health Science Center at Houston Professional Building. It was positional plagiocephaly, and unless Matthew received therapy, his mother knew the asymmetry in his face and head was likely to get worse.
In 1997 the American Academy of Pediatrics started its “Back to Sleep” campaign in an effort to lower babies’ risk of sudden infant death syndrome (SIDS). Since then the incidence of positional plagiocephaly has increased.
Pediatricians began recommending that parents keep their babies on their backs. This kept them safer in their sleep, but put them at risk for developing flat spots on their heads since they were always resting in the same position.
John Teichgraeber, M.D., professor of plastic surgery at The University of Texas Medical School at Houston, says roughly 1 in 300 infants now develop this condition. The head becomes askew as a flat spot on the back or side develops, causing other parts of the head and face to protrude.
Surgery was once thought to be the best course of treatment for babies with positional plagiocephaly, but doctors now know that a tailor-made helmet is all it takes to reshape the head in 99 percent of cases.
“We can reposition the head using a helmet, which is designed to put pressure on the parts of the head that stick out and be loose on the flat spots,” Teichgraeber explains. “We’re trying to get the head to grow into the flat spots.”
At the first sign of a flat spot or lopsidedness, Teichgraeber recommends that parents take their child to a pediatric specialist for an evaluation and to rule out other craniofacial deformities.
If it is positional plagiocephaly and the deformity is severe, Teichgraeber then refers the parents to an experienced orthotist who can make a mold of the infant’s head and design the helmet, which is cushioned with a polyurethane cast.
Teichgraeber says the optimal time to give “helmet therapy” is when the child is between 6-12 months. “The helmet works because the baby’s head is growing so quickly, that with frequent adjustments, we can train the head to grow properly,” he says.
Helmet therapy is a commitment for both parents and the child. The infant must wear the helmet 23 hours a day, usually for about three months, and parents must take the child to the orthotist once every other week to get the helmet adjusted. Also, not all insurance companies cover the cost of the helmet and adjustments, so parents may have to pay as much as $3,500 for the treatment.
“It’s a lot of work, but it’s worth it,” Resendez says. “It was amazing. I saw a difference within three or four weeks. The flat spot rounded itself out, and now my son has a nice, little round head.”
Teichgraeber said that once children are out of the helmet, they are usually more active and the bones in their skull are beginning to harden, so it is unlikely the deformity will occur again. However, children with disabilities who aren’t as mobile may be at risk for a recurrence, so it is important to take some preventative measures.
He recommends that parents increase “tummy time” for their children when they are awake. He also suggests alternating the baby’s position during each feeding. Don’t always feed them on the same side, Teichgraeber says. Key signs to look for are any flattening on the head and neck tightening.
“If that doesn’t work, we can get great correction with the helmet,” he says.
UPDATED: 10-25-2005
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Dr. John Teichgraeber is a professor of plastic surgery at the UT Medical School.
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