Centers of Excellence

	Custom molded helmet created at Great Plains Rehabilitation Services, Bismarck helped Chloe with Plagiocephaly.

Candy Wormsbecker began to notice that her four month old daughter, Chloe Heinze, was developing a flat spot on the right side of the back of her head. Chloe also had the habit of always tilting her head to the right.
“A lot of people said to me, ‘Don’t worry, babies get flat spots.’ It just kept getting worse. By the time she was 6 months old, it hadn’t gotten any better,” Wormsbecker said.

At the time, Wormsbecker tried everything she could think of to keep the flat spot at bay. Chloe rarely sat in a seat or a baby swing, and had a lot of time on her tummy. Her bedroom was rearranged in an attempt to get her to look to her left, but she continued to sleep on her right side.
Wormsbecker started looking for information on “flat spots on babies’ heads” online, and mentioned her concerns to Chloe’s pediatrician at her 6-month well baby check up. Chloe was referred to a specialist in Bismarck, where she was diagnosed with plagiocephaly — a flat spot on her head — and torticollis, which refers to tightened neck muscles. Due to her tightened neck muscles, Chloe was tilting her head to the right side and always laying on her right side, which was causing the flat spot.

Common Issue
Plagiocephaly is more common than many parents may think. It happens in approximately one in every 300 live births, according to the American Academy of Pediatrics. Peter R. Davidson, registered nurse and certified prosthetist orthotist of Great Plains Rehabilitation Services in Bismarck said there has been an increased incidence of plagiocephaly in recent years.

“Starting in 1992, we noticed an increased incidence of plagiocephaly,” Davidson said. “We don’t exactly know what’s causing it, but we think it may be due in part to the ‘Back to Sleep’ program where they had the children laying on their backs a lot. Because a baby’s head is soft to come through the uterus, the gravitational pull on the head sort of flattened it out.”

Once Chloe was diagnosed with plagiocephaly and torticollis, her parents took her to physical therapy sessions to help improve the range of motion in her neck muscles. As a fix for plagiocephaly, her parents also made the decision to fit her with a helmet designed to mold her head. The decision to put Chloe in a helmet was reached after carefully weighing their options.
Helmeting isn’t done for purely cosmetic reasons, Davidson said. Children with flat spots on their heads can develop misaligned jaws, ears, or eyes due to the problem.

“If you can imagine your car being hit, if you bent the frame, and the lights were out of alignment or the doors were out of alignment, it wouldn’t work very well,” Davidson said. “It’s the same with the human skull. It can cause the jaw to be out of alignment, and the jaw wouldn’t work very well. It can cause the eyes to be out of alignment, and your vision would be off.”
“If you don’t helmet, the misshaped skull does not influence intelligence or neurological issues, but most feel the misalignment of the skull, jaw, and eyes has a negative outcome for the child long term,” he added.
In mild or moderate cases, parents may opt not to helmet.

“Some may say they’re happy with it the way it is, and other parents choose to do the helmeting, once we show them what the regimen’s going to be,” Davidson said. “We make sure the parent understands what their responsibility is going to be,” Davidson said. “The child needs to wear the helmet pretty much full time. It’s quite a bit of work on their part.”

Full-time
Chloe began wearing her helmet for shorter time periods at first, and then worked up to wearing it 23 hours a day, seven days a week.
“It doesn’t seem to bother her, but she doesn’t like taking it on or off,” Wormsbecker said. “She’s gotten a little brave, she knows she can bonk her head and it’s not going to hurt. The only bad thing is, the helmet stinks.”

The helmet works by rounding out the flat spots on a baby’s head, Davidson said, by putting gentle pressure on areas that are protruding. Helmeting is ideally done when an infant is between 4 and 8 months old, because once the sutures in their skull have knit, it’s too late to helmet. When the sutures fuse, the shape of the head is no longer influenced by a helmet.

The idea of molding an infant’s head shape isn’t a new one.
“Molding helmets shaping children’s heads have been around since the beginning of time,” Davidson said. “The Egyptians used to do it: Their royalty would shape their heads sort of like a cone head. They would wrap the childrens’ heads to give them that shape. In today’s culture, we aren’t going for the cone shape, and we’re not just doing it for cosmetic reasons.”

Parents may worry that their children won’t be as readily accepted if they’re in a helmet. They’ll likely find that they were more concerned About St. Alexius the unusual appearance than children are.

“Psychosocially, I think it’s harder on adults,” Davidson said. “In some cases, the child actually starts to bond with the helmet, like a teddy bear. They’ll actually ask for their helmet once it’s taken off. Children are so open-minded, it’s easier for them than it is for us.” Wormsbecker has noticed that some people will stare at Chloe in her helmet, especially children, but she isn’t concerned.

“People really just want to know what it is,” Wormsbecker said. “We explain to them About St. Alexius why her head is flat. People will say to their kids, ‘Don’t stare’, but we tell them it’s OK. The kids are just curious.”
Wormsbecker just hopes to let other parents know that the condition is out there, and that there are options.

“We want people to know About St. Alexius it. We want the doctors to examine for it, and give us the options,” she said.

by Katina Tengesdal, Minot Daily News

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