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Baby's First Helmet

As More Infants Get Misshapen Heads, Parents Grapple With Questions, Headgear

By James V. Grimaldi
Washington Post Staff Writer
Tuesday, March 8, 2005; Page HE01

Like all fathers, I thought we had the perfect baby. So when our son, Xavier, was a couple of months old, and my wife asked me, "Does his head look flat in the back?" I rejected the idea.

But the question was odd enough that it lingered. Within a week or so, after looking at his head from different angles, I changed my mind: There was a flat surface on his head, on the right rear part of his skull. His forehead also was protruding and his ears were not symmetrical.

Xavier Grimaldi, almost 1, wears a custom-made polymer helmet prescribed to treat plagiocephaly, literally, an oblique or misshapen head. Thousands of parents and pediatricians grapple with treatment options each year. (Family Photo)

_____Live Discussion_____
Transcript: Post Staff Writer James V. Grimaldi answered readers' questions on the rise of a condition among infants called plagiocephaly.
_____From The Post_____
Keeping Kids Better Rounded

Thus began our odyssey into a little-known but surprisingly common condition in infants: plagiocephaly -- literally, an oblique or misshapen head. We were relieved that our son's kind would not require surgery. And there was a remedy.

Still, we faced some difficult decisions. The treatment is somewhat controversial, unnecessary in many cases, not always paid for by health insurance, inconvenient for parents and annoying for the infant. A specially fitted helmet -- worn 23 1/2 hours a day for as long as six months -- is used to shape the baby's growing skull.

The seemingly extreme remedy posed a dilemma: Do we "fix" our son's head by subjecting him to a helmet for six months? Or do we let him grow up with a flattened head?

Because thousands of parents and pediatricians face such questions each year, we decided to share our story.

SIDS and Head Shape

There are two kinds of plagiocephaly. Luckily, our son did not get the rarer and much more serious form that is caused by craniosynostosis, the premature fusion of the bones in the head. The kind Xavier had -- positional, or deformational, plagiocephaly -- has skyrocketed to "almost an epidemic" level, as one Harvard medical professor put it. Since 1992, the number of infants with plagiocephaly has increased from one in 400 babies to as many as one in 10, according to numerous medical studies.

What accounts for the spike? The reason is probably the 1992 proclamation by the American Academy of Pediatrics (AAP) that infants be placed on their backs when they sleep to prevent sudden infant death syndrome (SIDS). The "Back to Sleep" program is considered a success; SIDS deaths have plummeted 40 percent in the United States. But it's not without consequences.

An infant's brain grows phenomenally in the first six months after birth; the cranium expands to accommodate it. But since babies spend most of this time sleeping, the head of a baby who sleeps mostly on his back can develop a depression. Picture a balloon filled with water sitting on a table: That's how a child's head can look.

Xavier's large size -- he was a half-ounce short of 12 pounds at birth -- placed him at greater risk for certain postpartum problems, including plagiocephaly. He ended up with left torticollis, a shortening of the neck muscle on his left side. A tight neck muscle meant he had trouble turning his head. When he slept, his head naturally rotated to the right, pressing the right side of the back of his head flat.

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© 2005 The Washington Post Company


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