Helmet therapy for positional plagiocephaly and brachycephaly
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2906 (Published 01 May 2014) Cite this as: BMJ 2014;348:g2906All rapid responses
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We didn’t evolve to spend the nights on our backs in infancy. We evolved to spend the nights next to our mothers, falling asleep facing first one breast and then the other.
This unintended consequence of the “back to sleep” campaigns is yet another reason medical authorities should rethink their opposition to the family bed. Doctors have done a real disservice to parents by discouraging parents from establishing the bed-sharing habit from birth. There has not yet been a study establishing an increased rate of SIDS among babies whose primary sleep location is in a bed with sober, unimpaired, non-smoking parents. In fact it remains a distinct possibility that that is the safest sleep arrangement of them all. For many families it also affords the parents the most sleep since they don’t have to get out of bed to tend to the baby.
Studies claiming to show an increased risk of SIDS among “routine” co-sleepers have suffered from methodological problems so profound that that a single study has in some cases given rise to completely opposite interpretations. Take, for example, a 2013 meta-analysis combining data-sets from five earlier studies. (1) The authors concluded that bed-sharing was a risk even for breastfed infants with sober, non-smoking parents. In correspondence published in BMJ, they further claimed that the evidence showed this to be the case even for “routine” co-sleepers. (2) Yet one of the same authors had participated in a meta-analysis published a year earlier, using overlapping data-sets, which reached exactly the opposite conclusion. (3)
The reason for the discrepancy can be seen in the inconsistent coding used in the underlying studies with respect to “routine” co-sleeping. In the 2009 German Sudden Infant Death Syndrome Study underlying both meta-analyses (4), only 26 of 333 SIDS cases were reported to have “usually” slept in the parental bed during the last four weeks. Yet one table later there are 146 cases classified as “bed sharing usual.” These turn out to be cases in which the parents took the infant into the parental bed “sometimes” or “every night,” as opposed to “never.”
There was no increased association with SIDS seen among the smaller group of infants for whom the parental bed was the primary sleep location, but only among the occasional co-sleepers. The point here is not that occasional co-sleeping in risky. It is that among occasional co-sleepers there is good reason to doubt the direction of any causality. In a family with flexible sleeping arrangements, the odds of the infant being taken into the parental bed almost surely increase when something is “wrong,” whether the parents are consciously aware of it or not. The infant may be unusually fussy or difficult to settle. Even a small number of cases in which the presence of the infant in the parental bed and the occurrence of SIDS are both influenced by some underlying pathology would explain the results seen with respect to occasional co-sleepers. The statistical association may say nothing at all about risks of co-sleeping.
Given the current state of the research and consequences of back-sleeping including plagiocephaly and brachycephaly, it is a shame that the medical establishment seems so determined to frighten parents away from bed-sharing.
Elizabeth S. Bernstein
Bisbee, Arizona, United States
eberns@post.harvard.edu
(1)Carpenter R, McGarvey C, Mitchell EA et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. BMJ Open2013;3:e002299. doi:10.1136/bmjopen-2012-002299
(2)http://bmjopen.bmj.com/content/3/5/e002299.abstract/reply
(3)Vennemann MM, Hense H-W, Bajanowski T, et al. Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate? J Pediatr 2012;160: 44-8
(4)Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics 2009;123:1162-70.
Competing interests: No competing interests
Re: Helmet therapy for positional plagiocephaly and brachycephaly
My son had a helmet for positional plagiocephaly. We are few families in France in this case. This article talk about every plagiocephaly, obviously for slight case, it doesn't work , but usually any doctor will not motivate family to an helmet treatment if skull deformation is less than 9 mm. After 9 mm of skull deformities, helmet will be a solution. My Son and I went to 4 different doctors, 2 physiotherapist , and 5 "osthéopate" none knew about plagiocephaly and said " keep calm and every thing will be right in few week". After 6 months the "flat" grow. I was lucky because I found on the web a mother's website case. This website explain each case, consequences (neurological, physical...). My son had a first skull deformitie at 9 mm then 18 mm, after the helmet he had only 3 mm. We are 9 families around me in this case. So please, before writing such information, please think and verify in the true life in order to not panic some families in the same case
Competing interests: My son have a helmet for positional plagiocephaly