Infant head shape problems and helmet therapy: What parents should know

Slight imperfections in a baby’s head are normal after birth, but as babies grow, a misshapen head could be a sign of something else.

Sometimes, helmet therapy can help correct a baby’s misshapen head. We spoke with Dr. Suresh Magge, medical director of neurosurgery at CHOC, to answer some of parents’ most common questions about whether helmet therapy is right for their child.

Dr. Suresh Magge CHOC neurosurgeon

“In the vast majority of infant head shape issues, the baby has what’s known as positional plagiocephaly, also known as deformational molding of the skull. In these cases, we first try conservative measures, such as supervised tummy time while the child is awake. If the head flattening is still significant, a cranial molding helmet is an option to help the cosmetic correction,” Dr. Magge says.

Head flatness due to positional plagiocephaly can occur when a baby spends a significant amount of time lying on one particular side of the head.

“I want to reassure parents that the vast majority of the time, a flat area on their baby’s head is simply a sign of positional plagiocephaly, a condition that can often be corrected with conservative measures, and sometimes helmet therapy as well,” Dr. Magge says.

Of all babies with head shape problems, Dr. Magge adds, a small percentage have a condition called craniosynostosis. In this condition, a child’s skull fuses too early, causing problems with head growth. Learn more about craniosynostosis. In these cases, surgery is necessary to correct the deformity, and a helmet may be used after surgery.

What can parents do to prevent flat spots on their baby’s head?

You should always put your baby to sleep on his or her back. Follow your pediatrician’s advice on supervised tummy time while the baby is awake, which can help your baby strengthen his or her neck muscles and reduce the time spent on their back.

I am concerned about my baby’s head shape. What should I do now?

If you have specific questions about your baby’s head shape, speak to your pediatrician. Your child’s pediatrician will check your baby’s head regularly. If you or your doctor notices any problems with the shape, the doctor will feel your child’s head and take measurements. They can also refer you to a pediatric neurosurgeon for further examination and continued monitoring.

Why is my child being referred to a pediatric neurosurgeon for their head shape?

It can be daunting to hear your pediatrician say they’re referring you to a pediatric neurosurgeon, but it doesn’t have to be. Being referred to a pediatric neurosurgeon doesn’t mean your baby needs brain surgery. Pediatric neurosurgeons are experts in diagnosing, treating and managing conditions related to the heads and spines of babies, kids and teens.

At CHOC, we can assess your baby’s head using different tools, including a special laser scanner, which is eye-safe and radiation-free. You can see a pediatric neurosurgeon and — if needed — a cranial helmet specialist in a single appointment, and we will form a treatment plan with you.

What will my baby’s doctor do about the head shape?

When babies have some flatness on their head, if diagnosed early, doctors will likely try to treat it with conservative measures including supervised tummy time and/or physical therapy. If those measures fail to correct the head shape, it may be time to think about helmet therapy.

Babies 1 to 4 months old are too young for helmets. If a baby 4 to 6 months of age still has flatness after conservative measures have been attempted, helmet therapy may be considered. The older a baby gets, the more their skull has grown and formed, making a helmet slower to work.

Is helmet therapy required?

Helmet therapy for plagiocephaly is always a choice; it’s never mandatory. It can be helpful in the right situation, but it’s not always needed. The head shape does often get better, with or without the use of a helmet.

Helmet therapy is a choice some parents make, along with their child’s doctor, to try to cosmetically improve the shape of a child’s head.

With your pediatrician, or a pediatric neurosurgeon, you can discuss your baby’s specific case and the pros and cons of helmet therapy.

How is torticollis related to plagiocephaly?

Sometimes, babies with develop torticollis, or a stiff neck which causes a head turning preference. This can lead to the baby spending more time on one side of the head, which can cause positional plagiocephaly. Supervised tummy time also helps to strengthen the muscles in a baby’s neck. Your child’s doctor may prescribe physical therapy to help to relax the baby’s neck muscles.

How long will my baby need to wear a helmet?

Your child’s doctor and helmet orthotist will make a recommendation based on your child’s unique case. Most babies who undergo helmet therapy do so for a few months.

Migranes: Not Just an Adult Ailment

Think only grown-ups get migraines? Think again. This painful neurological condition is also common among children.

In fact, one in 20 children – or about 8 million children nationwide – experience migraine headaches. While migraines may be very painful, the good news is that kids can take steps to help prevent the ache.

Dr. Sharief Taraman, a CHOC Children’s neurologist, explains a migraine’s symptoms and causes, treatment methods, and what patients and their families can do to minimize migraines.

Head pain, other symptoms
Migraines are a specific type of headache, Dr. Taraman says. Sufferers endure throbbing, pulsating or pounding pain, either on one side of the head or both. Migraines may also impose a host of other symptom:

• Abdominal discomfort
• Nausea and/or vomiting
• Light sensitivity
• Noise sensitivity
• Dizziness or lightheadedness

But even with these symptoms, it might not always be clear that a child is suffering from a migraine because symptoms are often disconnected in children, Dr. Taraman says. For example, a child might have a stomachache but no headache, or perhaps light sensitivity but no nausea.

Children also might have difficulty expressing what exactly is bothering them, he explains. Parents should work with children to help them describe their symptoms and keep a close eye on behaviors. For example, a child might seek out a dark, quiet room but not specifically complain that lights or noises are bothering them.

The trigger factor

Migraines start when blood vessels in the brain constrict. This limits the amount of blood and oxygen flowing into the brain, which causes other blood vessels to expand. These dilating blood vessels become inflamed and result in a pounding headache or the other associated symptoms.

Certain environmental factors can often trigger migraines and the causes can differ among sufferers.

Triggers vary, but they can be linked to diet, hormones or even too much screen time, Dr. Taraman says. Common edible migraine culprits include chocolate, cheeses, and foods treated with nitrates, like lunch meat and pepperoni.

Dr. Taraman recommends that children keep a diary to help uncover migraine triggers. Document when migraines occur and what the child ate, did or experienced in the days prior. Be sure to build in some extra time: Often a certain food or behavior might lead to a migraine the next day.

Migraine diagnosis, treatment
There’s no blood test that can diagnose migraines and imaging is seldom needed, Dr. Taraman says. Instead, physicians rely on a physical examination and family history.

“Family history is huge,” he says. “Migraines run in families.”

Once a child knows he or she is experiencing migraines, over-the-counter pain relievers can help dull the ache. However, Dr. Taraman reminds parents to follow directions and avoid overuse.

Overusing over-the-counter pain relievers, more than twice a month, can result in “rebound headaches,” or head pain that develops even more intensely after medication wears off.

Finding a dark, quiet place to rest can help a child battle a migraine, as can warm or cold compresses, Dr. Taraman says. However, each person responds to temperature differently, so families can experiment with warmth or cold to see what method works best for their child, he advises.

Parents of chronic migraine sufferers should alert their child’s teacher and school nurse to the condition. The school, parents and child can work together to ensure that the student can leave class if necessary and find a quiet place to rest until the pain subsides.

Finally, if a headache is ever accompanied by weakness or numbness in one side of the body or slurred speech, parents should take the child to the emergency department immediately, Dr. Taraman cautions. This could be a symptom of stroke, which do occur in children.

‘Headache hygiene’ aids prevention
Because environmental factors can trigger migraines, kids can take measures to help keep migraines at bay, Dr. Taraman says. After keeping a diary and determining trigger foods or behaviors, avoiding these red flags can help tremendously.

In addition, general healthy habits can also stave off migraines. These steps are part of good “headache hygiene.”

• Get enough sleep
• Eat a balanced diet
• Stay properly hydrated
• Cope with stress
• Get plenty of exercise

Learn more about CHOC Neuroscience Institute.

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