Orthotic Helmets

Some babies may require a customized orthotic helmet to correct their plagiocephaly.

A few things to keep in mind when considering a helmet: ⁣

• The optimal time to use helmet is between 5 and 7 months of age, when the baby's head is rapidly growing. That being said, helmet therapy can be initiated as late as 12 months old.

• Having an assessment by an orthotist at 4 months of age is ideal, to allow time to monitor for change and make a decision prior to 5 months of age.

• Torticollis (tight neck muscle) or a delay in motor skills can make strategies like counter positioning more difficult and less effective.

• Given that plagiocephaly does not impact brain growth or development, correction is often considered “cosmetic only”. However, severe asymmetries can affect things like wearing glasses or sporting helmets⁣

• You do not need a referral to have an assessment by an orthotist or a physiotherapist. ⁣

If you are at all concerned about the shape of your baby’s head, speak to your health care provider.⁣

Torticollis

Does your baby prefer to look in one direction?

The problem may actually be coming from a muscle on the opposite side of the neck! The sternocleidomastoid (SCM) is a muscle in the neck that’s function is to rotate to neck to the opposite side and tilt the neck to the same side.

𝐓𝐨𝐫𝐭𝐢𝐜𝐨𝐥𝐥𝐢𝐬 occurs when the SCM is shortened or contracted, resulting in a preference to look in one direction and/or tilt in the opposite direction.

Commonly, we see a shortened left SCM which leads to right rotation and a left tilt. ⁣

What causes torticollis?⁣

Torticollis may be a result of positioning in the womb, stretching of the muscle during birth, or the muscle may become tight because the baby has a preference to look to one side only.⁣

Why do we want to treat torticollis? ⁣

• A baby who has decreased neck range of motion (ROM) and a preference to look in one direction can develop a positional plagiocephaly, commonly known as infant “flat head” (See our last blog post!)

• Finding midline (the middle) is an important developmental skill and can be delayed in babies who have torticollis ⁣

• Integration of certain reflexes (e.g. ATNR) can be delayed with a persistent head preference ⁣

Treatment for torticollis involves gentle stretching and strengthening of baby’s neck muscles and positioning strategies to reduce a preference for one side. ⁣

If you notice that your baby has a tendency to look more towards one direction, speak to your healthcare provider for advice. 

Positional Plagiocephaly

Positional Plagiocephaly, commonly referred to as “infant flat head” is a condition in which a baby’s skull develops a flat spot, often on one side. 

What causes plagiocephaly?⁣

• Often, plagiocephaly is the result of positioning. Babies’ skulls are very soft and easy to mold. As a result, if a baby spends too much time lying on their back or in a piece of equipment, such as a car seat, they can develop a flat spot on the back of their head (called brachycephaly). If a baby has a preference to look in one direction only, they can develop a flat spot on the same side as the preference⁣

• Torticollis (tight neck muscle) can play a role as well.  If a baby has reduced range of motion, the back of the skull becomes flat on the same side the baby prefers to rotate towards. ⁣

In more severe cases, you may also see changes in the appearance of the baby’s face. The ear may shift forward, the cheek appears larger, and the eye may appear smaller on the same side as the skull fattening. ⁣

It is important to note that plagiocephaly does not impact brain development. However, a positional preference or torticollis can impact acquisition of motor skills. ⁣

Treatment for plagiocephaly often involves: ⁣

• Counter-positioning exercises to address a preference and prevent continued pressure on the affected side. Back to sleep is recommended as it is safest for baby, making tummy time so important when baby is awake. Scroll a few posts back for some hints on making tummy time more enjoyable! ⁣

• Stretching and strengthening of the neck muscles if torticollis is a contributing factor. ⁣

• An orthotic helmet may be considered. More information on orthotic helmets for plagiocephaly coming later this week!⁣

If you have a concern about your baby’s head shape, or notice that they prefer to look in one direction, speak to your doctor or physiotherapist for an assessment (you don’t need a referral). The earlier a positional preference or plagiocephaly is identified, the easier it is to treat. ⁣ 

Swaddling

Swaddling your newborn is a common practice that may provide comfort to your infant. It is important to remember that care must be taken to ensure healthy hip development.

Your baby’s legs should be able to bend up and out at the hips. They should not be tightly wrapped straight down and pressed together.

This position places the hip joints in a vulnerable positioning and may lead to damage of the soft cartilage of the socket.

If you choose to use a sleepsack specifically designed for swaddling, please ensure it has a loose pouch/sack for your baby’s legs and feet.