Transcription:
How to Prevent and Treat Your Babies Flat Head or Twisted Neck

Melanie Cole (Host): Flat Head Syndrome can happen when a baby sleeps in the same position for long periods of time. There are some simple things a parent can do like changing your baby’s sleep position and providing tummy time. My guest today is Brandy Escamilla. She’s a physical therapist at Bryan Health. Welcome to the show, Brandy. So, how does a child get flat head and/or twisted neck? What are those?

Brandy Escamilla (Guest): Well, a flat head, which is also known as plagiocephaly, can result from various, different causes. Sometimes it occurs because of the child’s position in the womb. There has not been a whole lot of room in there for the child and, especially if there’s more than one baby, so the head can be flat from just being kind of stuck in a certain position. Other times, it occurs just because of the child’s environment after they have been born. Everybody has a tendency to look to one side or the other and if it’s predominately always to one side by the parent always carrying them in the left arm or always placing them the same way in the crib or in the sleeping apparatus, then just because the head is so malleable or so soft to be able to get through the birth canal, laying on the same side all the time can make the head flat from there.

Melanie: So, Brandy, the American Academy of Pediatrics recommends that infants sleep on their backs to reduce the risk of Sudden Infant Death Syndrome and other sleep-related deaths. So, if a parent is doing what the AAP says and putting their children on their backs to sleep, that can cause that back of the head to get flat. What’s a parent supposed to do about that?

Brandy: That’s a very good question because, yes, we definitely want kiddos sleeping on their backs. What the parents can do, though, is sometimes maybe just kind of keep an eye on their head and notice if they’re getting a flat spot. Most children, at some point, will try to move a little bit in their sleep, so just be aware of are they always looking to the one side? Are their heads always to the left? And it’s just as simple as when you put them down, turn their head a little bit towards the right or to the other side. The other thing they can do to make it a little bit better is a lot of tummy time throughout the day. It’s very important for babies to be on their tummy at least an hour a day at a minimum so that they can build those neck muscles and those back muscles, and even those muscles in the upper extremities, in their hands and in their fingers, so that they are able to meet their developmental milestones later on a lot easier.

Melanie: So, parents can do a lot of these things that you just mentioned, but when do they worry that it could affect baby’s brain development?

Brandy: Usually, if you have a noticeable difference and you’ve kind of tried some of those other techniques, turning the baby’s head in their sleep, and if you notice any of the facial features being affected. So, you look at their forehead, if you look at the baby when they’re sitting in front of you and they look straight down and you can see that their forehead on one side is kind of coming out a little bit more, or maybe look at their ears and their ears seem to be shifted--one’s a little bit further forward than the other --those would be some signs that you would need to contact the pediatrician or family doctor, and they could refer to physical therapy from that point. The other thing is those regular well-child checks that the infants attend. Usually, the doctors are looking at that, too, at their head shape. The other thing with that would also be make sure your baby can turn their head to both sides equally, that they’re not always just looking to one side or the other. That’s something I feel like a lot of parents have said to me afterwards, “Oh, I look at all the pictures and they’re looking always to the left,” but as a parent you’ve got a lot of other things to think about and so you’re not always thinking about that. So, that’s something that would be important for parents to just keep in the back of their head, how they’re carrying them, which way they’re positioning the child, and if the child is always looking to one side or the other and they can’t go to the other side, that would be a problem.

Melanie: If a pediatrician recommends physical therapy, what do you do with babies to help get this twisted neck or flat head from becoming a serious condition?

Brandy: It depends on the severity of it, but a lot of the times there’s just some stretching that goes along with it, where you’re just turning the child’s head to the opposite side--the side that they can’t go to. And then, there’s a lot of the positioning things that we kind of already mentioned. Just when the kiddo’s sleeping, you try to turn their head to the opposite side. You try carrying them in the opposite arm so that they’re looking to the direction that they’re not always likely to do on their own. Then, we also do a lot of kind of screening and making sure that they’re meeting those developmental milestones. If a child is unable to look over to their right side or left side, whatever it may be, they start compensating. When they start rolling, sometimes they only roll in one direction because those muscle asymmetries in the neck have then started to kind of go down throughout the body, to that other left side or that right side. So, sometimes they crawl and they don’t crawl on their hands and knees; they crawl with one leg up. Or other times, too, there can be kind of the risk for scoliosis where if a child is unable to rotate their head to the left, then what would they do? They would end up kind of compensating with their back and rotating their trunk instead to look to the left, instead of their neck. So, physical therapists, we do a lot of the positioning with the kiddos. We’ll do some stretching with the kids, and all of those techniques are then taught to the parents so that they do that on a regular basis. And then, we’re making sure that they’re able to meet those developmental milestones appropriately and help them with facilitation of rolling or helping them to roll to the side that maybe they’re not comfortable doing it to, or they’re not strong enough to do it yet.

Melanie: Is this something that requires x-rays when you bring them to the doctor?

Brandy: It can, yes, just to rule out any other sort of orthopedic conditions or things that may be the reason for the torticollis or the twisted neck, because the twisted neck kind of arises sometimes from the head being flat. So, if they can’t move to the other side, that neck muscle gets tight. But then, the twisted neck can also come from that position in the womb that I had talked about before; whereas, they weren’t able to move so they were tight before they even came out. Then, we’re addressing the torticollis or the twisted neck from that aspect, first, and then the head gets flat because the child can’t move the head to the other side.

Melanie: So, wrap it up for us, Brandy, what do you want parents at home to, first of all, notice as far as red flags for flat head or twisted neck? And then, what would you like to tell them about things that they can do at home to help keep their child from developing this in the long term?

Brandy: I would say the things to look for is just make sure that you are always being aware of your child’s ability to look to both sides, and equally. Make sure that you’re aware of how you’re feeding the child and look at their head position there. Are they always looking to the one side? And if they are, can they get over toward that other side? If they can’t, then that would be something you need to contact the doctor about. And then, the things that they can do at home is doing lots of tummy time. Since they’re spending a good majority of their time sleeping on their backs, when they’re up and awake and alert, they need to be doing at least that 60 minutes of tummy time throughout the day, and that can include having the child just on their stomach on the floor. You can use Boppy pillows or kind of prop them up chest to chest so they’re on you in kind of a reclined position so that it’s a little bit easier for them to tolerate that tummy time, because a lot of babies don’t because it’s hard. So, that makes it a little bit easy for them. So, doing a lot of tummy time and then, again, just making sure you’re not always carrying your child in the left hand or in the right hand. The other thing that goes along with that is just giving the babies a lot of the floor time and not being cooped up in those containers like car seats and bouncers and stuff like that. Those are okay for short periods of time, but the child needs to be out moving around, too, on the floor, so that they are strengthening those neck muscles and moving their head back and forth, where sometimes other devices don’t always allow that.

Melanie: Thank you so much, Brandy, for being with us. It’s such important information for parents to hear. You're listening to Bryan Health Radio, and for more information, you can go to bryanhealth.org. That's bryanhealth.org. This is Melanie Cole. Thanks so much for listening.