Head deformity is not uncommon among infants. Though not serious, treating it on time is important as it may lead to visual, auditory and neural problems that may hamper the normal development of child. While surgery is the last option if the condition becomes severe, it can be treated using cranial helmets when diagnosed early.
Uneven head shape in infants is a common sight, often resulting from sleeping in just one position. As the flattened skull shape is an outcome of lying in the same position in infants, the condition is thus also known as ‘positional head deformity’ or deformational plagiocephaly/brachiocephaly.
Plagiocephaly is abnormal flattening on one side accompanied by bulging from other side of the head and giving the head an uneven shape rather than normal round appearance. Brachiocephaly on the other hand is even flattening of the back of the head which happens from the constant supine position of infant. Both the conditions happen in children when they keep lying on their back for long hours without any movement. With even doctors suggesting parents to keep their babies in supine position when they are sleeping in order to avoid SIDS (sudden infant death syndrome), and they are rightly doing so, the prevalence of head deformity in infants has risen. The need of the hour is just to be cautious to prevent it from happening while sticking to the advice of doctors.
Though not unheard of, head deformity is not taken very seriously by parents, particularly in India, who ignore it considering it non-hazardous to health. Oblivious of the ill effects of deformed head, such ignorance is obvious in parents.
Traditional method of using special pillows to keep infant’s head in a proper shape is quite popular in India. However, even after taking all precautions if the skull of the infant gets deformed or flattened on one side it is ignored as a minor issue that does not warrant any medical intervention.
Parents are, however, unaware of the fact that head deformity can lead to major health problems as the age of the infant progresses.
Health worries arising out of head deformation
There have been a number of cases wherein deformational plagiocephaly has led to visual, auditory and neural impairment, restricting the child’s normal development. Though results usually are not extreme in every case, staying cautious is very pertinent for almost every parent to avoid any kind of eventuality.
In case of abnormality in the head’s shape, the most common issue is excessive pressure on the brain. This increased pressure can potentially damage the normal neural development, leading to many problems, including visual and auditory disorders. Chances are also there that a child may have hampered learning abilities and may not be able to show the same progress as others who do not have any head deformation. On a severe side, loss of vision, mental retardation and speech problems are the worst outcomes of skull deformity.
Measures to prevent head deformity
Parents, especially those, who have been blessed with a child for the first time should be given counselling by the doctors at the hospital itself. They should be made aware about how to handle a child and what precautions to take. It is equally imperative for parents to ask as many questions from their gynaecologist as it involves the health of their child. A lot of information is available on internet too these days and parents should make the most of it. Being inquisitive is essential for the well being of child.
Continuously changing the sleeping position of the infant by parents is very important as they are unable to do so on their own in the very initial months. The infant should be moved from side to side when sleeping so that pressure shifts from one side to another. At the same time, the baby should also be kept in supine as well as prone positions while sleeping and when awake. These changes in sleeping positions is the best way to keep head deformation in the child at bay. Mothers should also be careful to change positions during breastfeeding and not leave the child in supine positions for long.
Surgery
Positional skull deformities are usually mild. However, in severe cases that can be corrected through reconstructive surgery when the child is 12-18 months. When surgery involves a child, it makes parents panicky. The head area is sensitive portion where the brain is also located. So surgery is not welcomed easily by parents. Though in some cases, surgery is the last option, cranial helmets is best suited when the condition is diagnosed early.
Cranial helmets
In cases where surgery can be avoided, cranial helmets are the best alternative to treat infant’s head deformation. These helmets correct the asymmetrical head shape of the infant as he/she grows and helps correct the flattened areas of the skull to round out, besides preventing the bulged out portion from further bulging. Without putting pressure on the baby’s head, cranial helmets improve skull shape by pushing healthy and corrective growth of deformed area.
The helmets have to be worn by the child for 23 hours a day, providing enough time for head growth. They are custom-made and can be removed at the time of bathing and clothing. When the cranial therapy is started, a tab should be kept by parents for any redness or irritation on the child’s head or neck. If any discomfort is detected, changes are made accordingly for easy fit. Parents should be cautious if the helmets cause any redness after its removal for a short period and immediately bring it to the orthotist’s notice, who can initiate corrective measures.
The babies are not made to wear the helmet for continuous 23 hours since beginning of the treatment, as they take time to get adapted to it. The helmet is introduced slowly so that the infant becomes used to it. During the initial phases, the infant is made to wear the helmet for a few hours and then removed for a break. This process is repeated several times as advised by the orthoptist. The number of breaks is cut down as the baby gets accustomed to it. Also, the infants are not made to sleep with it until they are comfortable wearing it for continuous 6-8 hours when awake.
Things to keep in mind when going for helmet therapy
- When parents notice any abnormal skull shape after birth or during the initial months of birth, they should consult a doctor and start the treatment early on as the growth of head slows down after one year.
- The helmets have to be worn for very long hours to achieve desired outcome. As they become an integral part of the infant, cleanliness of the device is very important so that the infant does not acquire any infection from it. The helmets are made up of high-end plastic material which can be easily washed and cleaned every day.
(Author is clinical director, Comprehensive Prosthetics & Orthotics)