Big heads, tilted heads, flat spots, oh my!

Hello there. If you haven't seen my previous posts, this may seem like I'm ragging on innocent little babies... no no no :)

I'm just sharing my experience and observations during an early intervention internship. (week 6! Halfway through!)

Crazy Head Shapes

But really, can I just tell you how many odd-shaped heads I see in a day? These peanuts are so cute, but their heads are sometimes so strange.. flat spots, bulging spots, asymmetrical, odd shapes... 

and I check out adults more closely now, to try and see what things stay with people and what things kind of even out at the end of the day. Try it: Next time you're in line at the store, check out the person's head in front of you. Or in the aisle, look at the way someone is walking. Is it symmetrical? Do their arms swing evenly? Are their steps even, smooth, and the same distance apart?.. I digress...

So there's really only been a few instances in my life I can think of where I remember thinking someone's head seemed too large or small for their body. This gives me hope for our little guys because I'm sure I've bumped into many grownups who had early intervention as a baby, specifically for issues related to their head, neck, and movement patterns, and didn't blink an eye.. Covered up with hair or a hat.. all good

Heads are like teeth, they don't really make sense to me. Teeth are so weird! Like we see a 9-month old with 2 teeth and another that age with none and another with eight! And that is just normal. So some kids just have huge heads, that eventually they'll grow into I guess, and some have proportional heads.. But it's no wonder they are having trouble holding their head up or getting on all 4s or crawling! I mean some of our kids had hydrocephalus or macrocephaly and shunts put in, or different operations..  

Quite a few heads we see are tilted. Instead of holding their heads up tall in the middle when sitting, or even lying down, their relaxed or "normal" state is tilted to the right or left, with their ear closer to their shoulder on one side. This is called torticollis. It's kind of this mysterious thing that tends to work itself out with the right attention. We only have one walker who still has it pretty bad. 

Torticollis

It's a muscle thing. Your sternocleidomastoid muscle (SCM). You have two - one on either side of your neck, from the bottom of your skull behind your ear, to the front of your collar bone. So one of these gets tighter/shorter and one gets stretched/lengthened, which creates the tilt. 

This can be because of the way the baby was positioned in utero or it can develop in infancy, simply out of habit of preferring to look to one side. Maybe mom tends to hold baby in one arm, and baby gets used to turning her head one way to look up at mom. Maybe baby prefers to sleep with the head to one side. Maybe baby is on her back quite a bit and all the action in the room, or the window, or the tv is on one side. And this is where the flat spots come into play. Our babies with torticollis typically have a flat spot on one side of their head in the spot they prefer to lay. Overtime, the muscles adapt to this preference by shortening on one side, lengthening on the other. 

As OTs we come in and stretch these babies necks, through legit stretches and through play, depending how old they are and what they'll tolerate. Reaching for toys overhead on the leaning side puts those muscles on stretch. We encourage tummy time and wearing your baby on your body rather than in a hard carrier whenever possible (movement is key!). We can make referrals to a neurosurgeon who decides if a baby's head shape could be corrected by a molded helmet. The bones in the skull fuse around the first year, and the process of getting the helmet takes some time, so our window of rounding out these heads is small. The earlier the parent notices the better. 

We teach parents different ways of holding their child, and encourage changing their positions often. We teach the parents how to do all the stretches we do, because without their follow-through, our hour session once a week won't make a dent. We discourage putting the baby in "containers" i.e. the swing, the stroller, the supported seat, lying in the playpen.. for extended periods of time. Leaning against all these devices feeds into the flattened head and the weak muscles because they don't have to use their muscles to keep their heads up when they can just lean back. 

Some babies do NOT like when someone stretches their neck. The cries are heartbreaking. It was so much easier to handle when I was watching my supervisor stretch the kiddos. Now that I'm hands on, it's emotionally exhausting. :( 

Why do we care?

So what if a baby's head is slightly tilted? Or even very tilted? Let them be their own person, have their own flavor, be unique.. well...

1. Their point of reference impacts how they interpret what they see. If they continue viewing the world side-ways, their "normal", go-to position to interpret their visual input will be sideways. Straight up and down will become "side-ways" to them. This impacts the nervous system eventually in making sense of the world. We don't want these kiddos brains becoming wired this way.

2. It impacts the use of their hands and feet. Typically developing babies will bring their hands together when lying on their backs, and play with their feet. Put all hands/feet in their mouth. We want them to explore both sides of the body. If they're lying facing one side, they start favoring one hand and motor milestones become lopsided. We don't want to see kids having a hand preference until at least 3 years. Kids with torticollis can also develop a dominant foot, when they learn to walk and kick a ball. Each skill they learn (rolling, pivoting, crawling, changing positions, walking) can be lopsided or favor one side. We want symmetry to help kids reach their greatest potential in whatever they take an interest in someday down the road.

3. The flat spot/head shape issue can impact facial features. If it's uneven on the back, we always look to see if they're uneven on the front. Where we see this the most is with ears! Weird, I know. But ears can actually shift forward (like one is closer to the face than the other), which impacts the ear height and the way glasses/sunglasses fit. 

4. I've heard different things on this one, but it's worth mentioning... brain development! Does the skull impact the way the brain grows or will the brain figure itself out regardless? I've heard different views.. I really don't know..  

(All pics are copyright free from pixabay.com unless otherwise noted. I couldn't find pics of kids with torticollis, so these are just kids with their heads to one side.)

Some resources on torticollis:
http://blog.dinopt.com/torticollis-treatment/
http://blog.dinopt.com/torticollis/
http://www.babybegin.com/baby-begin-blog/prevention-torticollis-exercises-for-baby/