Tuesday, August 26, 2014

Plagio - what?


Every mom thinks that their little boy is perfect. So when the pediatrician points out that your little boy's head isn't quite shaped right, it can be a bit of a hit. At Evan's 2 month appointment, we were told that he had developed a bit of a flat spot on the left side, but that we should just keep an eye on it. The next two months, we worked hard to keep him off his back and to get better at tummy time. We held him when we could, and repositioned his head when he was flat. And every time I saw his flat spot, I felt anxious. 

So, at his 4 month appointment, we brought it up, and the pediatrician confirmed that it was still there, and severe enough to warrant a referral to an orthotist. He has what's called plagiocephaly, which means that he has a flat spot on his head. 
This has become much more common now that babies sleep on their backs. We had these photos taken by a cranial orthotic company to evaluate him.

Have you ever seen a cuter little stocking capped baby?

From the sides, I don't think you can really notice too much, though you can see the left is a bit flatter than the right. You can also see from the front that his head slopes a bit more on his left. However, the real issue is best seen from the top and the bottom. 
                                     from the top                                                 from the bottom

Evan's plagiocephaly falls right on the border of moderate and severe, with a 12 millimeter difference between the sides. You can also see that his forehead sticks out just a little. The woman we spoke with said that this was likely because, since he was such a big baby, he was probably very compressed in utero. This probably caused some initial misshaping and could have also cause his neck muscles to be abnormally tight on one side, and condition called torticollis. We always wondered why he favored his left so much, and this is probably why.

Looking back at pictures from when he was very young show a definite tendency towards that left side

So, that begs the question - what do we do about this? We have three general options. Option one is just wait and see - keep repositioning and hope he grows out of it. Option two is physical therapy to treat the side favoring and hope that as his head grows and he learns to put less pressure on his favored side the flat spot will be less noticeable. Option three is to get Evan a "band", or helmet as most people call them, that he would wear for 2 - 4+ months. They look something like this:
(plain on the right and decorated on the left)

Right now we're just trying to gather information and figure out our next steps, which will probably be a combination of the second and third options. We have an appointment with a physical therapist who specializes in plagiocephaly later this week, and we are hoping she can give us guidance in terms of whether or not to do the band/helmet, and if so, when and where. From what we here, the "golden age" to start the band is between 4 and 6 months, so we probably will want to start soon. However, they are incredibly expensive (the place we visited yesterday's costs $3,800) and insurance usually doesn't cover them. Plus, some babies will need two bands, and Evan is a probably candidate for that. So, we definitely can't rush into this until we are positive it's necessary. There are also a few more orthotist companies to check out that are a bit less expensive so we'll be making evaluations with those soon, too.

Overall, even though we feel badly that our little boy has this problem, we are so thankful that it's treatable and that the treatment is painless and non-invasive. He'll get to remain our happy, healthy little boy :). 


  1. Thanks for sharing what's going on with Evan. The photos do help to visualize the problem. I know you and Ed will make the right decision for Evan. Your positive attitude is admirable. :)

  2. Those picture of him with the cap on are so cute, that will be fun to show him when he's old enough. What's important is that y'all are on top of it and it's a relatively minor issue. One of my close work friends' son last year had the same thing and did the "band" with excellent results. When I see him next week I'll ask him about it.