Fighting flat head: Long-term problems can plague babies if left untreated
The "back to sleep, tummy to play" campaign began 20 years ago by the American Academy of Pediatrics in an effort to reduce deaths caused by sudden infant death syndrome, a diagnosis given when a child less than 1 year old passes away without any other explanation. And since then, parents have listened. Between 1980 and 2005, SIDS cases dropped by two-thirds, from 1.53 per 1,000 live births to .51 per 1,000 live births, according to the Centers for Disease Control and National Center for Health Statistics.
But the campaign has had an unexpected side effect -- an increase of plagiocephaly, or flat head syndrome. And along with that came torticollis, or tightening of the neck on one side.
"There is new research out that 50 percent of 2-month-old children have a flat spot already," said Katie Schlosser, PT, DPT, a pediatric physical therapist with RehabVisions in Dickinson. "Some may grow out of it just by exploring their environment and having adequate tummy time, but this is a huge growing problem. There has been a 600 percent increase since 1993."
At first plagiocephaly was thought to be a strictly cosmetic issue, but having an unusually shaped head can cause issues when buying safety helmets, increasing a risk of injury from an improper fit and it can cause torticollis.
"With torticollis, if that's not resolved you can have a constant tilt of your head that you're unable to correct," Schlosser said. "You also would have inability to rotate your head equally to both directions."
This can affect the way babies interact with their environment; favoring one direction to the other, Schlosser said. If left untreated, it could cause pain in the neck that may need to be treated with surgery.
Plagiocephaly can cause issues with eye orbits, altering depth perception. It can cause ear issues, increasing a rate of ear infections, Schlosser said.
It is very rare that plagiocephaly will cause brain issues, said Dr. Marc Ricks, a pediatrician with the Sanford Health Dickinson Clinic.
"Most of the time, no, there is no significant neurologic impact," Ricks said. "In some severe cases, yes there can be."
It's not just sleeping that places pressure on babies' heads. Safety seats, strollers and other baby restraints often support the neck and head, which can also create pressure points.
"The child's head is about the consistency of a pumpkin," Schlosser said. "If the child is always laying in the same spot with the pressure on the same spot of their head, then their head is going to continue to grow with that flat spot on it. Just like when we buy pumpkins, there's flat spots where the pumpkin was laying on the ground."
Getting a child into physical therapy around the 2- to 3-month-old mark once the condition is realized shows the greatest improvement with the most conservative amount of treatment, Schlosser said. Once an infant hits 6 months, a cranial remolding helmet may be necessary.
Observing the "tummy to play" part of the rule can prevent a flat spot from forming, Schlosser said.
"There is evidence that shows that at least 15 minutes of tummy time a day is preventative," Schlosser said.
Because of the risk of suffocation, babies should be awake and parents should be awake for tummy time, Ricks said.
"That's supervised time on a hard surface like a floor with a blanket over it where the infant is on their stomach and is being supervised and awake," Ricks said. "Additionally, we recommend that babies, if they are bottle fed, not always be held in the same arm."
If parents and pediatricians notice plagiocephaly starting, there are several courses of action that can be taken, Ricks said.
"We refer them to physical therapy for neck stretching exercises," Ricks said. "They go to physical therapy a couple of times to learn the exercises and then parents do those exercises at home."
Doing the exercises combined with the tummy time and switching the sides will often improve the shape of the skull, Ricks said.
"However, it may not always be fully sufficient," Ricks said. "Even with molding it's not always corrected entirely and it is pretty much a long-term cosmetic issues."
Surgery may correct the issue, but if it's strictly cosmetic the risk do not outweigh the benefits, Ricks said.
"Once it's stuck and final, it's kind of one of those deals where that's the way their head is," Ricks said.