In 1992, the American Academy of Pediatrics took a 180-degree turn (and never better) in recommendations about the position to put babies to sleep and went from recommending that parents put them upside down, belly , to what put them on their backs, with their backs to the mattress, with their heads tilted.
Thanks to this recommendation, an incidence of sudden death of 1.2 per 1,000 born to live in 1992 was passed to 0.56 per 1,000 live births in 2001, proving that sleeping on your stomach is much more dangerous for babies.
The problem is that putting babies to sleep on their backs is causing many babies to have head deformities, known as plagiocephaly, Until almost half of the two-month-old babies have plagiocephaly to a greater or lesser degree.
Why plagiocephaly occurs
The so-called postural plagiocephaly occurs if babies spend a lot of time with their heads resting on a flat surface, which can be either the crib or the bed, such as the stroller or the hammock.
In most cases (practically 80% of cases of plagiocephaly), what is observed are flat points on the head that only pose an aesthetic problem because they are mild cases, and the recommendations do not vary: keep putting the baby on his back, vary the position of the head to both sides, and try to reduce the time the baby is lying in that position. This is achieved by avoiding as much as possible the use of hammocks and the use of the stroller.
How to prevent plagiocephaly
Just the way we just mentioned: the plagiocephaly It can be prevented and treated, in case it is mild to moderate, acting so that the pressures on the head act giving the shape of the head a normal appearance.
Thus, to prevent it we can do the following:
- Sleep face up with head tilted, varying both sides in the same proportion. More or less spend the same time looking to one side than the other.
- Alternate the arm with which we take the baby, so that the pressure of the head on the arm does not always come from the left arm (usually we take them with that arm to have the right free).
- Do not abuse the hammock or have it lying when you are awake, or the stroller, using other "transport" methods like backpacks or scarves, or even the arms of their parents.
- Assess the possibility of making use of a preventive cushion, especially if the baby is one of those who cry a little, sleep a lot, just ask for arms and spend a lot of time lying down for this reason, and also end up looking at the ceiling. In addition to the above measures, it may be a good idea to make use of this type of cushions, since studies begin to appear that show that they can be useful (look below on the distribution of the weight of the head on a much larger surface with the cushion, compared to the baby who falls asleep looking up without him).
How plagiocephaly is treated
The plagiocephaly It happens, above all, because the different bones that make up the baby's skull are not yet fused and different pressures can cause one form or another in the head. Some babies, in fact, are already born with plagiocephaly (my middle-aged son was born with plagiocephaly more than evident, having been in the same position for a few weeks).
As the days and weeks pass, if the child alternates the pressure on the head when sleeping, the flat points change and the plagiocephaly disappears, if it is mild to moderate.
To explain it in some way, if the baby has something flat on the right side of the head, it is necessary to place more emphasis on sleeping on the left side (get, for example, that 60-70% of the time spent asleep is on the left and the remaining 30-40% on the right).
In addition, for the day, we can put the toys, the crib mobiles and everything that is fun, including dad and mom talking and singing, to the left side of the baby, so that side attracts more attention. In any case, as I have explained, everything is to get that the head has no pressure on the affected side is positive (arms, baby carrier, etc.).
In addition, it can be very useful to go to a professional physiotherapist who values the possibility of performing manual therapy as a complement to everything discussed.
If plagiocephaly is severe
In the event that plagiocephaly is very pronounced, it can be very difficult to treat it properly through the posture, because the baby will be very uncomfortable in the position that would solve it, and it is likely that it ends up in the position that worsens. In such cases, it is advisable to go to a specialist to evaluate the case individually and decide if the use of a corrective orthopedic helmet.
To date, there are many doctors who insist that it is gradually being solved and that it is really nothing more than an aesthetic problem; but that it is only aesthetic does not mean that it is not a problem, since there are cases in which the malformation is so obvious that it can affect the child in case of growing up and continuing with it (no child will like to be looked at strangely by the shape of his head or by not being able to wear a bicycle helmet).
Now, although the data is not yet clear, some studies seem to show that children with severe plagiocephaly may have a worse psychomotor development that children who do not have it, or that those who suffer from it in a mild way. The last ones that I have read about it also speak of a possible malocclusion in the bite, as well as a possible alteration of the balance in children between 3 and 5 years.
By this I mean that whether it is an aesthetic issue only, as if it could be something else, the logical thing is try to fix the deformity. To date, removing surgery, which would always be the last solution, the best option is the aforementioned helmets, and better if it is not too late.
A study conducted in 2015 compared the effectiveness of conservative treatment (all the measures that we have mentioned above - cushion, control the posture, avoid spending a lot of time lying down, etc.-) with the effectiveness of an orthopedic helmet in cases of severe plagiocephaly. They saw that 77.1% of the cases were corrected with conservative treatment, while with the helmet 94.4 percent was completely solved. In addition, in cases where conservative treatment had not been effective, 96.1% of those wearing helmets were also solved.
That is, it seems clear that conservative treatment can be useful, but much clearer than The best treatment in case of severe plagiocephaly is to use orthopedics. In this sense, the later it starts, the worse the resolution rate because the stiffer the joints begin to be and the more united the bones are. That is why it is recommended to start early (from 5-6 months) instead of waiting at 12-13 months onwards, as is done many times.
But this is only an ideal that cannot always be fulfilled (let's not forget that it is a treatment that is not subsidized by social security), so that each child must be evaluated individually to establish possible solutions and follow up if it is considered that it can be expected. And it is not the same a baby with severe plagiocephaly that does accept corrective postural measures, one that does not and always ends up with the head positioned in the worst possible way. In this case the improvement will be very little, or zero.
Photos | iStock, TechnologyinMotion, Wikipedia, Infocephaly, London Orthotics
In Babies and more | Increased cases of babies with plagiocephaly (flat head), How to prevent plagiocephaly (deformity of the baby's head), Is the orthopedic helmet recommended in children with mild or moderate plagiocephaly?
