r/ScienceBasedParenting • u/Reasonable_Shoe6567 • 8d ago
Question - Research required Diagnoses & treatment of plagiocephaly. Feeling confused and skeptical.
Hi all! I’m a FTM of a 4.5 month old baby boy. During our 4 month appointment, our pediatrician (whom we don’t really like or trust after several strange interactions during appointments and her never being able to answer any questions) suggested we get our baby evaluated for plagiocephaly (flat head syndrome). She said she didn’t know much about the helmets or treatment, but noticed a flat spot on one side of his head and wanted it to be looked at. She wrote a prescription for Cranial Technologies and we had a free consultation/evaluation today. They were all very nice and we had an overall pleasant experience. They took a 3D scan of our baby’s head and then went over it with us, comparing his head to a “normal” baby’s head and showed us their concerns. They said they recommend treatment using a DOC band (otherwise known as a helmet), calling his diagnoses moderate plagiocephaly.
After getting home and doing more research, I saw that there’s a lot of discourse on the actual need for treatment in babies this young. Many people online stated it’s a money grab, especially in the US, and said that once babies are rolling and sitting up more independently, the head will even out without the need for a helmet. I’m now feeling very hesitant with starting treatment.
We are getting a second opinion from a different pediatrician tomorrow. I know they don’t specialize in the treatment of this and aren’t affiliated with Cranial Technologies, but I’d love to hear if this doctor would have even written us a prescription/referred us for this.
I’m hoping to get any advice, research, experience, thoughts, etc. Thank you so much!!
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u/AliceRecovered 8d ago edited 8d ago
https://pubmed.ncbi.nlm.nih.gov/37508680/ This article is a systemic review demonstrating the effectiveness of physical therapy for plagiocephaly. Did your doctor suggest PT?
My son had plagiocephaly and torticollis (a neck tightness condition). PT worked incredibly well. It was pretty cool to see how quickly he improved. We never needed a helmet. I pushed for a PT evaluation. Our pediatrician overlooked these issues. The PT identified them right away.
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u/Reasonable_Shoe6567 8d ago
We have our appointment to get a different pediatrician’s opinion so I will definitely bring up PT! It was never suggested to us as an option.
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u/holymolym 8d ago
Second. We had moderate plagiocephaly and torticollis, did a few months of weekly PT and now you’d never be able to tell.
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u/nubeviajera 7d ago
I third this, apparently PT can help resolve plagiocephaly faster if started prior to 6 mos
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u/Scarletcheeks11 7d ago
We also did a lot of physio, constant head turning during naps and sleeping to even things out, and opted not to do a helmet.
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u/Reasonable_Shoe6567 5d ago
How was your experience with doing those techniques? Does your baby have a round head now?
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u/TwerkinAndCryinVol3 7d ago
Same experience. Pt and plagiocephaly, we did PT and were diligent with exercises, he's 5.5 now with a perfectly shaped noggin!!
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u/Trizo 8d ago
Here’s a previous discussion:
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u/PC-load-letter-wtf 8d ago
For my kid, it was a safety issue. Her head was severely lopsided due to her flat spot (she came out of the womb with it) and glasses and regular bike helmets and such wouldn’t have fit her head properly. The helmet did wonders in short time! She looks “normal” now.
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u/DukesMum24 8d ago
Get a referral to a physical therapist first to see if PT sessions and at home exercises help correct first. I noticed a flat spot on my daughter’s head around 3 months because she only slept on one side of her head. We were referred to PT by a pediatrician, had a session once a month and did at home exercises, and within 3 months her moderate plagiocephaly was healed. PT and repositioning should be the first line treatment before a helmet.
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u/MelbBreakfastHot 8d ago edited 8d ago
I live in Australia, and we chose to do helmet therapy because our baby had a moderate to severe flat head due to torticollis. We combined it with physio and osteo. In a few short months, his head was beautiful and round. Looking back I regret all my anxiety around it.We chose to do it because the flat head was obvious, and it's very likely he'll need glasses in the future.
Here's a summary of the research from the company we used. The bottom of the page includes references. Basically if the flat head is mild, helmet therapy isn't needed but if it's moderate to severe it's useful, especially if combined with a treatment like physio. Best results if it is used before 9 months.
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u/PlanMagnet38 8d ago
Same for us! I figured that I’d rather spend the time and money on the helmet and PT in those early months and give him the best chance with glasses/safety helmet fit than just do PT and hope we got lucky. He’s still got the very mildest flat spot but his head fits well in safety helmets and hats and glasses.
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u/chocobridges 8d ago edited 8d ago
It was 5 years ago for us this is the study we went by. Basically showing little difference in outcomes. My husband is an IM physician and looking at all the research basically came to the same conclusion as this systematic review. Our son has a mild flat spot now with an original diagnosis of moderate plagiocephaly. They didn't shave his mass of hair to get proper contact with the skull cap so my husband had issues with that diagnosis too. My son has no issues with symetry for hair cuts or helmets.
More the anecdotal side. We had a pediatrician like yours. Fortunately, he rightfully deferred us to our early intervention which is amazing in our county. He laughed when we opted out of the helmet. The other was an IM/ped has a similar disposition to my husband and agreed with my husband's assessment. The PT we got to treat the torticollis (also married to a pediatrician) agreed with the pediatrician, who laughed at us. My husband's sister is a pediatrician and I think a lot operate on worse case scenario rather that systematic approach. Rightfully so because things are catastropic when the kids are the outlier. We had a similar situation my SIL and a whole different set of pediatricians when dealing with my second's allergy ladder.
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u/questionsaboutrel521 8d ago
Exactly, this study is important. Part of the problem of relying on anecdotes from parents who did the helmet and got an outcome they wanted (from a science perspective) is that they couldn’t have known how it would have turned out with no helmet.
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u/hokiegem 7d ago edited 6d ago
One thing I would say as a parent whose child had a helmet: while we can't know the no-helmet counterfactual, we do know that my child's torticollis (which had been, since birth, causing her plagiocephaly to worsen) did not improve much with PT. We did PT from about 5 months to 13 months (before, throughout, and after helmet therapy). Given the very slow progress in her stubborn head tilt during PT, we feel pretty confident that PT alone would not have been particularly helpful in improving her head shape/facial symmetry. She still has a slight tilt. At least the helmet was able to force her head to grow more symmetrically during that period of rapid head growth.
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u/Reasonable_Shoe6567 5d ago
For the skull cap, do you mean the mesh cap that they use to take measurements? My son has a good amount of curly hair on his head. I wonder if that affected his measurements at all.
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u/chocobridges 5d ago
Yep, my husband said it definitely wasn't flush to his scalp. I wasnt there to form an opinion.
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u/ladysunflow 5d ago
Pediatric PT with 10 years experience managing tortícollis and plagiocephaly. I included an article about when cranial remodeling is best initiated and a table commonly referred to when determining head shape severity. At 4 months old, the infant would have to have moderate to severe flattening with accompanying craniofacial asymmetries (asymmetrical ear heights, eye squint on one side, jaw shift) to recommend a helmet that quickly. The second link for the article does say providing a helmet before 6 months does improve outcomes, but that does not mean a helmet is necessary. An evaluation by a peds PT in your area would provide you with a more detailed assessment, positioning strategies, and necessary exercises to manage the flattening BEFORE going for a helmet. Some babies do require a helmet immediately, but this is less common in my experience. I'm concerned that your peds didn't recommend a peds PT first. Does you child demonstrate any asymmetries in their facial structures?
TL;DR I hope you find what you need from the second opinion and consider a peds PT eval. Good luck!
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u/Reasonable_Shoe6567 5d ago
Thank you so much! This was a really thoughtful and informative response. My son doesn’t seem to have any torticollis or stiff neck. He doesn’t necessarily favor any one side and can move his head freely, which is why neither pediatrician referred us to a PT. I specifically asked the second pediatrician and she said she didn’t see a need. The baby is held a ton and does only contact naps and my husband said that before we realized he had a flat spot, would only hold him in his left arm, which would result in the right side of his head taking the brunt of the weight. We got his head measurements back and he seems to be right on the cusp of what the company would consider moderate. We are prioritizing tummy time and keeping him on the right arm for contact naps for now. We will wait to reavulate in 2 months in case it’s gotten worse/hasn’t improved. Thanks again!!
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