Baby with an abnormal head
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7609 (Published 10 January 2014) Cite this as: BMJ 2014;348:f7609
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The 10-Minute Consultation on a Baby with an abnormal head was good (Gatrad et al, BMJ2014; 348: f7609). Unfortunately it completely failed to mention anywhere, or within the "What you should do" paragraphs, the importance of spending (less than) one of those 10 minutes observing or examining the eyes. In any suspected craniosynostosis this is essential, and the eyes can sometimes be the presenting complaint. Strabismus (squint), pseudostrabismus, and abnormal eye movements, are all frequently seen. In many cases of plagiocephaly the asymmetry of the skull base will cause an obvious vertical misalignment of the orbits.
Reference: Gupta et al. J Craniofac Surg 2003 Jul; 14(4): 529-32
Competing interests: No competing interests
As part of the history, would it not be relevant to know how much time the baby spends in car seats and other baby contraptions that may restrict baby's free movements?
Long periods strapped in buggies, car seats might also be contributing to mechanically restricting the normal movements where baby would turn his/her head side to side which would prevent flattening.
Babies allowed free floor time with no tummy time do not get flattened heads. They can get 'bald' spots for a while till they roll onto tummy but no flattening.
Competing interests: No competing interests
Re: Baby with an abnormal head
This article by no means gives a comprehensive or well rounded look at Positional Plagiocephaly or the true outcomes of using Cranial Remodel Bands. There are cases of children who were overlooked or undiagnosed who have since gone on to need corrective surgery. This article leads readers to believe that ALL CASES will self correct by age five, when in fact, as someone who works within this community, I can say that this is not the case. While I see that the article mentions mild to moderate cases, clinicians will typically only recommend banding (helmets) for cases that are moderate to severe. We take issue with stating that the benefits of helmet therapy are weak and disputed is not accurate. Also stating that parents are sometimes not willing to accept conservative management - we believe to be incorrect. Parents will accept conservative management during the appropriate time frame and depending on the severity but when all else fails, we do recommend that parents seek a specialist's opinion and by specialist we refer to a neurosurgeon and or Craniofacial Surgeon.
Competing interests: www.cappskids.org