This is a topic about which I am so passionate, I thought, " it has to be my first posting." So, I spent days researching different aspects of it and its association to SIDS (Sudden Infant Death Syndrome) so I could present a well rounded and argued perspective. Then I realised that most parents interested in this topic are just going to want practical ways to avoid it or, if already apparent in their baby/child, what to do next.
Most parents now lay their babies flat on their backs to go to sleep. Since the Back To Sleep campaign, there has been a sharp increase in the number of babies appearing with 'wonky head shapes' or plagiocephaly. (PEDIATRICS Vol. 97 No. 6 June 1, 1996 pp. 877 -885.) This can sometimes be avoided and here are the things to do to minimize it occurring in your baby.
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Tummy time : Because babies are now spending a reduced amount of time prone (on their tummy), it is prudent to, now, think about allowing for tummy time in your day. Many babies don't like to be in this position anymore but I think that is only because it is a new experience for them. I tell my parents to give baby a few moments of tummy time with EVERY nappy change. Baby will usually only tolerate it for a few moments anyway so it won't take too much more of your time. It also helps you to remember to do it. It is also very exciting to see a newborn start lifting his/her head and the reflex to crawl will also kick in as they try to pull their knees up underneath their body. As the days go by, you will see them trying to lift their head. This is also an important aspect of tummy time which will help symmetrical development of the neck muscles. They will try to turn their head from one side to the other.
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Car Seats : What a grand thing to have! These car seats are so versatile that you can shift baby from the car to the pushchair frame to the house without ever waking baby!! That's great! EXCEPT that you need to be mindful about just how long baby is spending in ONE position in this seat. If you feel you must leave baby in, check which side they favour and gently persuade baby to adjust their head to face the less favoured side. Another option is to leave the car seat in the car and remove baby. They love being held most of all. You won't spoil them and it keeps their lovely growing cranium free from pressure to grow round and symmetrical! Those car seats are heavy!! You might just find the added benefit of saving your own back by just carrying baby rather than the heavy seat plus baby.
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Feeding Time : If you are bottle feeding, swap sides. I know it feels so weird! But try it anyway. That way you are not holding baby in the same position for every feed. The perfect combo is one parent who is left-handed and one who is right-handed and then they can share feeding! But I know! For most of you, it will feel odd at first. You will get used to it.
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Playtime : If baby is left underneath a playgym, move the brightly coloured toys and objects to baby's least favoured side. When you play with baby, play and attract his/her attention also to the side that baby least likes to turn. They are amazing at adapting to situations and you will find that it won't take them long.
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Nappy Change : Along with tummy time during nappy changes, if you always change baby from one side, swap sides or change baby by positioning yourself at baby's feet.
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Cot :Orient baby in his cot/crib so that he will move his head to the less favoured side in order to see toys or the room etc.
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Also, mothers frequently ask me about whether to use a pillow or not as it seems to be against SIDS guidelines. It appears the guidelines were addressing the use of soft pillows, duvets and furnishings that may interfere with baby's breathing should they fall across the face, or be so soft that baby cannot move his/her head away. Infant pillows today appear to be more sophisticated, singly addressing the prevention of plagiocephaly. Several on the market are uniquely designed to maintain a supine position whilst minimising unilateral pressure to baby's head.
If there is a dramatic sweeping to one side of your baby's head, despite all your preventive measures - you can view this best by looking at your baby's head from above - and you are worried, please seek advice. There are a few clinics around that will assess your baby's head free of charge and explain to you the use of orthotic helmets to encourage the bones to adopt a more natural shape.
I have had, over the years, many mothers come in to say that they had been told that plagiocephaly is simply a cosmetic problem and not to worry. This may be the case although there is recent research that may link plagiocephaly with temporary developmental delay. Collett BR et al., Arch Pediatr Adolesc Med 2011 Jul; 165:653.
However, just take a little time out to ponder the cosmetic problem: if a unilateral headshape persists, sometimes it involves the displacement of one ear so that they are out of alignment. This also means that the jaw is probably misaligned as well as the orbits that contain the eyes. This becomes problematic, just on a purely cosmetic point of view, if you wear glasses or sunglasses, if your teeth don't align because your jaw doesn't fit in your head squarely and, as for sport, finding a cycling helmet or any other sort of head gear might end up being a real headache!!