My Baby’s Head Is Flat! Study: Expensive Helmet Likely Won’t Help

Miles, a patient at Boston Children's Hospital, wearing his corrective helmet (Photo: Katherine C. Cohen/BCH)

Miles, a patient at Boston Children’s Hospital, wearing his corrective helmet (Photo: Katherine C. Cohen/BCH)

When my son was an infant, we followed modern medical wisdom and always put him to sleep facing upward. Within a few weeks, he developed a noticeably flat plane on one side of the back of his soft, bald little head.

“Deformational plagiocephaly” is the technical term, and it’s a widespread condition that has risen sharply since public health campaigns to put babies to sleep on their backs began in the 1990s. It affects at least one-fifth of American babies and possibly closer to half. My own overwrought, sleep-deprived diagnosis sounded more like, “Oh, no, my baby’s head is going flat!”

We brought him to specialists who raised the prospect that he might need to wear a helmet virtually non-stop for a few months, to protect his flat spot from pressure and help it round back out.

A helmet? All day and night? But there was no actual danger from his moderate head-flattening, no known risk except perhaps of future ridicule. In the end, we tried a custom-carved foam “head cup” and special “positioner” pillows to help vary which side he slept on. And we consoled ourselves that he just wouldn’t be able to become a skinhead when he grew up, which was surely just as well.

It’s the kind of parental decision you can second-guess yourself about forever. (There’s no sign of any flatness nine years later beneath his full head of hair, but what happens if he goes bald?) So I found welcome reassurance in a study just out in the journal BMJ on “Helmet therapy in infants with positional skull deformation.”

The paper is small but it’s the first randomized, controlled study — the gold standard in medical research — of helmets for plagiocephaly in babies. And it found that, at least in 84 babies without other risk factors, the helmets don’t help. The babies tended to improve with or without helmets. From the press release:

There was no meaningful difference in skull shape at the age of two years between children treated with therapy helmet and those who received no active treatment. Both groups showed similar improvements although only a quarter made a full recovery to a normal head shape, according to the team of researchers based in The Netherlands.

The results are especially underwhelming when you consider that the helmets, made of firm foam in a hard plastic shell, can cost as much as several thousand dollars, even in Great Britain, where the national health system doesn’t tend to pay for them.

The findings can also seem a bit daunting when you consider that once the flat-headedness developed in babies, only about a quarter of them fully “normalized,” helmet or not.

Dr. Carolyn Rogers-Vizena, a craniofacial surgeon in the department of plastic and oral surgery at Boston Children’s Hospital, emphasizes this point: By no means should concerns about head flatness dissuade parents from putting babies to sleep on their backs, which is known to protect against Sudden Infant Death Syndrome. Back-sleeping alone should not be blamed, she added; babies who develop flat heads usually have other risk factors that lessen mobility, including neck tightness, prematurity or developmental delays.

Also, the study offers useful new knowledge but it’s only one small study, she said, “it’s certainly not the be-all and end-all.”

Because the study is the first of its kind and has not yet been reproduced by other researchers, “it won’t yet dramatically change my practice,” Dr. Rogers-Vizena said. “But it gives me something new to tell parents when we’re counseling them, and hopefully bigger, higher-powered studies will come out so we can get a sense of who’s an appropriate candidate for a helmet and who’s not.” Continue reading

Circumcision Boost: Study Cites Benefits, Notes Foreskin-Related Health Problems

New findings may offer a boost to proponents of newborn male circumcision: Researchers in the U.S. and Australia report that the health benefits of undergoing the procedure “exceed the risks by over 100 to 1,” and note that “over their lifetime, half of uncircumcised males will contract an adverse medical condition caused by their foreskin.”

The review, published online in the Mayo Clinic Proceedings, bolsters the position of mainstream physician groups, such as the American Academy of Pediatrics, which supports insurance coverage of the practice and full access for families who choose circumcision for their infants. But the new report is unlikely to silence critics of the practice, who have called it “insane” and a “disservice to American parents and children.”

Here’s some context, from the study, which shows a slight increase in circumcision among older men, but a decline among newborns:

Preparing for a circumcision

Preparing for a circumcision (Cheskel Dovid/Wikimedia Commons)

“The latest data on male circumcision in the United States show a 2.5% overall increase in prevalence in males aged 14 to 59 years between 2000 and 2010. In contrast, there has been a downward trend in neonatal circumcisions, with the present analyses finding that the true extent of this decline is 6 percentage points.”

And here’s more from the news release:

Whereas circumcision rates have risen in white men to 91%, in black men to 76%, and in Hispanic men to 44%, the study authors found an alarming decrease in infants. To get the true figures they had to correct hospital discharge data for underreporting. This showed that circumcision had declined from a high of 83% in the 1960s to 77% today.

There seemed to be two major reasons for the fall.

One is a result of demographic changes, with the rise in the Hispanic population. Hispanic families tend to be less familiar with the custom, making them less likely to circumcise their baby boys.

The other is the current absence of Medicaid coverage for the poor in 18 US states. In those states circumcision is 24% lower. Continue reading

Study: Depressed Moms Wake Sleeping Babies Unnecessarily

Worry begets worry (and sleepless infants), a new study finds. (littlemaiba/flickr)

File this under: Good Intentions, Bad Outcomes.

A new government-funded study found that depressed, worried mothers were more likely to wake up their sleeping babies (and wake them unnecessarily) than non-depressed moms. This, in violation of perhaps the most important rule of mothering: Don’t, under any circumstances, wake a sleeping baby.

This study makes me sad because this was me: The overwrought new mom hovering over the totally fine baby to the point she woke up, confirming my worst fears (that I had a baby who wouldn’t sleep) and keeping me in a constant state of sleep deprivation (and depression) until she was about 5. But I did learn, and I’m pretty sure I let go a bit with my second daughter, leaving us both in peace at night.

Here’s the news release from Penn State:

“We found that mothers with high depressive symptom levels are more likely to excessively worry about their infants at night than mothers with low symptom levels, and that such mothers were more likely to seek out their babies at night and spend more time with their infants than mothers with low symptom levels,” said Douglas M. Teti, associate director of the Social Science Research Institute and professor of human development, psychology and pediatrics. Continue reading