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The Long Standing Effects of "Flat Head Syndrome"

This research article is something disconcerting to me as a therapist.


https://www.dailymail.co.uk/news/article-2358511/Flat-head-syndrome-affects-47-percent-babies-guidelines-prevent-sudden-infant-death-syndrome-blame.html


In 1994, the Back to Sleep program was implemented and pediatricians around the US began recommending that babies sleep only on their backs, in order to decrease the risk of Sudden Infant Death Syndrome (SIDS). Although since its implementation, the rate of SIDS has decreased, there is cause for concern about the long term implications of an infant constantly being on their back, especially in the first 12-months of life.


In the first year of its implementation, the incidence of flat head syndrome in infants increased by 400%. 400%. Within this research article, they are now estimating that an average of 47% of infants will be diagnosed with flat head syndrome before a year, and that half of those cases will occur within the first 3 months.


The alarming factor to me as a therapist, is that pediatricians and the large corporations doing research are telling parents that the presence of a flat head or asymmetrical head, if mild, is not going to affect their child's development. These mild cases are often overlooked and children's cranial sutures fuse in these inappropriate positions before any intervention can be done. As a therapist that works with children of all ages, the most common factor I am seeing in all of the children I treat that present with delayed motor milestone development, self regulation deficits and/or academic delays, is the presence of asymmetry or flattening of the cranial bones with coinciding fascial line tightening throughout the body. The whole body structural changes are easily seen in these children's infant pictures, and often time parents report to me that they had mentioned it to a pediatrician and been brushed off, or that other delays were mentioned in the first year to their pediatrician and that were met with the response of "they will grow out of it."


The research that has been done over the years would say that these mild cases of flattening or asymmetry do not pose risks long term, although in the clinic setting I am clearly seeing something very different. I am seeing children with flattening at the back of their head with long standing visual deficits and persisting anxiety and/or depression disorders. I am seeing children  with asymmetry at the sides of their head with long standing motor development delays and academic challenges. And I am seeing children with tightening of temporal and coronal suture lines with language, feeding, and attention difficulties. These children range in age from 2-11 years old. If there is no long term effects of just a mild case of head flattening / asymmetry, then why do the majority of the children on may case load demonstrate delays as a result of these "Mild" cases. It appears that the research is not looking deep enough or those researching do not hold the credentials needed to make appropriate conclusions about the ever present delays resulting from the flattening of cranial bones in infancy. 


What increases my concern is that those children with the more severe cases are having a helmet recommended without a subsequent referral or recommendation for them to also receive body work ie: Chiropractic, myofascial unwinding, craniosacral therapy, reflex integration, infant massage etc. When the cranial bones are shifted, it creates a butterfly effect of tension throughout the body that does NOT remediate with the reshaping of the head. For instance, if a child experiences a moderate to severe case of flattening at the back of their head, it will tighten the muscles all along the spine and prevent full integration of flexion and extension reflexes. In turn, spiral reflex that allow for rolling do not emerge fully. If a child does not roll, they will not Bauer crawl appropriately. If they do not Bauer crawl with symmetry, they will skip full integration of the right and left brain, and will most likely walk early. If they walk early, they are not integrating their cerebellum appropriately, which in turn leads to poor attention, poor motor development, and academic challenges later on. As you can see, "fixing" the head is only part of the treatment needed, and without full body intervention, delays can persist throughout life. 


Explaining away mild cases of head flattening / asymmetry and only treating the visible symptom in moderate to severe cases, is just not enough. The Back to Sleep program is not going to go away, nor will the recommendation for it stop. With that in consideration, it is even more important that early detection and treatment occur to help our youngest generation thrive in all areas of development. I believe that if your child is demonstrating any signs of flattening or asymmetry in their head appearance, it is important to seek an evaluation and treatment in those first 18 months. Treatment can be started after the cranial bones have fused, although delays may already be present and remediation often takes longer than in children 0-18 months. 


Below is a check list of symptoms to look for during infancy, toddler, and childhood ages that would indicate need for an evaluation and subsequent treatment:



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Infancy

  • C-section birth
  • Stuck in the birth canal OR required manual manipulation through the birth canal
  • Difficulty latching OR preference for one side during feeding
  • Thumbs that are fisted into the palms consistently
  • Colicky OR Restless
  • Delayed, advanced, or skipped motor milestones (no rolling, no crawling, walked early)
  • Excessive shivering with positional changes 
  • Reflux that does not improve with medication
  • Neglect of one side (No use of right hand OR left hand / No use of one leg during crawling)
  • Constant open mouth posture 
  • Tight rib appearance with "Buddha Belly"
  • Constipation 
  • Feeding difficulties / Difficulty with transition to solids
  • Asymmetry in body in first 3 months ie: constantly twisted to one side, arms are not positioned in the same pattern frequently, turning head consistently to one side but not the other.
  • Flattening of head either at the back or to one side.
  • Diagnosis of flat head, plagiocephaly or torticollis
  • Tight coronal suture, which is seen as a rubber band across the soft spot area of the head
  • Ridge line on the forehead
  • Using frequent V-Up posture when placed on back
  • Difficulty with diapering or hair washing 

Toddler-hood

  • Increasing aggression or tantrumming lasting longer than 10-15 minutes. 
  • Low frustration tolerance / easily stressed OR overwhelmed
  • Difficulty settling to and remaining asleep
  • Feeding difficulties (Difficulty with textures OR oral motor)
  • Motor delays (jumping, climbing, hesitation to explore playground or sensory gym equipment)
  • Confused handedness 
  • Tilting head to look at objects or learning material
  • Hyperactivity
  • Increasing anxiety with daily activities novel and familiar
  • Constant open mouth posture 
  • Delayed fine motor skill development (stacking blocks, doing shape / letter puzzles, lacing, buttoning, zipping, dressing)
  • Frequent sensitivities or meltdowns with bathing, grooming, and dressing activities 
  • W-sitting 

School-Aged Children 

  • Increasing aggression or tantrumming lasting longer than 10-15 minutes.
  • Low frustration tolerance / easily stressed OR overwhelmed
  • Difficulty settling to and remaining asleep
  • Feeding difficulties (Difficulty with textures OR oral motor)
  • Motor delays
  • Confused handedness
  • Tilting head to look at objects or learning material
  • Hyperactivity OR poor attention
  • Emotional regulation difficulties 
  • Increasing anxiety with daily activities novel and familiar
  • Constant open mouth posture (Resting OR seeking to stick tongue out frequently)
  • Delayed fine motor skill development (buttons, zippers, shoes, writing, utensils)
  • Delayed visual tracking skills 
  • Delayed reading 
  • Frequent sensitivities or meltdowns with bathing, grooming, and dressing activities 
  • W-sitting