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Helmets gently reshape head of Somerset baby

By Carla Destefano
Monday, March 3, 2008
 

In July, Justin and Jennifer Shull of Somerset welcomed a new son, Oliver, into their lives.

His big blue eyes and chubby cheeks melted the hearts of those around him. But before long a flat spot on the back of Oliver's head became so noticeable that his parents were alarmed.

"Oliver was three weeks early, but he was still a healthy, full-term baby. His head was fine when he was born," said Jennifer Shull. "But he favored his left side ever since he was a tiny baby. When we would lay him down, he immediately turned his head to the left. It created this huge flat spot."

Now nearly 8 months old, Oliver has spent the last few weeks wearing a little plastic helmet -- technically a "cranial remolding orthosis" -- for 23 hours a day.

His parents hope it will recontour his head, which was so misshapen that his ear and cheek were being pushed forward.

Because a newborn's skull is soft to allow for rapid brain growth during the first few months of life, the bones can be easily molded, sometimes leading to an abnormally shaped head. Flattening of the skull, or plagiocephaly, is a malformation that occurs when an infant frequently lies in the same position in a crib, stroller, bouncy seat or car seat.

The helmet can help to reshape the head, if it's worn early enough.

"Ideally, (treatment) should start no later than 4 12 to 5 months, but it's not unusual to have them come in at 8 or 9 months," said Jan Lewandowski, a certified orthotist with Union Orthotics and Prosthetics Co. near Greensburg. "Once you get to around 10 months, your window of correction begins to close."

Around a child's first birthday, the fontanelles, or soft spots between the skull bones, begin to close.

"Basically the head shape has taken, and you can't change it," he said.

Orthotists make leg braces, shoe inserts and other supportive devices. Lewandowski also works with Orthomerica, based in Florida, to fit patients like Oliver with the STARband helmet.

Weak muscles

Some infants are born with plagiocephaly, but often the condition is a result of torticollis, when the neck muscle is shorter or weaker on one side. That causes the baby's head to rest in the same position most of the time.

At each of Oliver's checkups, the Shulls questioned their pediatrician, who told them to monitor the flat spot. When Oliver was about 6 months old, his parents contacted Children's Hospital of Pittsburgh, where their son was diagnosed with plagiocephaly and torticollis.

A few weeks later, a personalized helmet was designed to gently mold Oliver's skull back to a normal shape.

The helmet consists of a copolymer shell and polyethylene foam liner, held on with a Velcro strap.

Babies like Oliver are introduced to the helmet gradually, and after a week they wear it day and night. Most parents see results after only a few weeks, Lewandowski said.

The baby is monitored regularly, and Lewandowski adjusts the helmet as the infant's head grows and gradually changes shape.

Oliver's helmet already has needed adjustment, and Jennifer Shull said she's amazed at the changes she's seen in just a short time.

Lewandowski said there's a growing demand for the treatment.

Plagiocephaly cases have increased dramatically since 1992, when the American Academy of Pediatrics recommended that infants be put to sleep on their backs to help prevent sudden infant death syndrome.

The "Back to Sleep" program resulted in a 40 percent decline in SIDS in the United States -- but plagiocephaly cases increased sixfold between 1992 and 1994, occurring in 33 of every 10,000 newborns.

Parents and physicians agree it's a small price to pay for saving lives -- especially when helmets can help.

Intensive care

Chad and Christy Dubovsky of West Newton noticed a flat spot on their son Gannon's head when he was about 2 months old. Gannon was born four weeks prematurely, and he spent 10 days in a neonatal intensive care unit while his tiny lungs developed.

It's common for babies to develop plagiocephaly in the NICU, where tubes and monitoring devices prevent them from moving around.

"We asked the pediatricians every time we would go, but they said it was nothing to be concerned about and told us he would grow out of it," Christy Dubovsky said.

Once Gannon came home, doctors suggested repositioning him often while he was sleeping, so his head would rest in different spots. It didn't help, his mother said.

When Gannon was 6 months old, the family was referred to Children's Hospital. An exam revealed that Gannon had plagiocephaly and torticollis, and a physical therapist suggested trying a helmet.

Two months later, Gannon was fitted with a STARband helmet in Lewandowski's office. He was already 8 months old, beyond the optimal age for cranial correction.

But his parents began noticing a difference in Gannon's head after only three weeks.

Christy Dubovsky also noticed a change in attitude toward her son when they were out in public.

"Before the helmet, people would come up and comment about Gannon all the time. But when he had the helmet on, they stopped coming up so much," she said.

"It was sort of a funny reaction. Either they would say 'How's the flat spot?' or 'What's wrong with your kid?' Either they get it or they don't."

That was sometimes difficult, the new mom admits, but it was important to get Gannon the help he needed.

"I would rather him go through this now than later on have him asking why I didn't fix his head when I could have," Christy Dubovsky said.

After five months in the helmet, Gannon no longer needed it. His head isn't completely symmetrical, but his mom says you can't tell a flat spot was there.

3-D image

Lewandowski said constructing the personalized helmets has become easier in recent years. When he first began making them, he had to create a plaster cast of each baby's head. Now, a state-of-the-art laser scanner in Union's Pittsburgh office takes a three-dimensional image that is sent to the company in Florida. The helmet is constructed there and sent back to Lewandowski, who makes the final adjustments.

He said he finds the work rewarding.

"I've been doing this for 20 years, and I work with a lot of children with cerebral palsy and other conditions. So a lot of my kids wear braces for the rest of their lives," Lewandowski said. "But one of the nice things about these helmets is that there is light at the end of the tunnel for these families.

"Being new parents can be hectic enough, without something like this. It's rewarding because this window of treatment is short."

 

 
 


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