By Katie Scarvey
kscarvey@salisburypost.com
Keaton Sloop is playing with Shana Pearson and his parents, Jennifer and Chris Sloop.
He likes being the center of attention.
Although at 4 and a half months old he’s too young to express this, he is also probably relishing the feeling of having a bare head.
For 23 hours a day, his sweet, soft baby noggin is enclosed in a helmet ó and that’s why he’s here, playing on a blanket.
Pearson, a physical therapist, tells Jennifer and Chris what she’s noticing.
“He’s got a good range going from side to side,” she says. “He’s getting stronger.”
As she goes through a variety of different exercises with Keaton, she explains what she’s doing and why.
“I just initiate the movement for him, and he goes,” she says, gently guiding Keaton into rolling over.
The exercises are designed to give Keaton better motor control and help him gain strength, especially in his neck. Reaching, grasping: it’s all good baby fun for Keaton.
But the reason he’s here isn’t so much fun. Keaton has a condition called positional plagiocephaly, a malformation of the head that is typically characterized by a flat spot on the back or side of the head.
In Keaton’s case, it was caused by torticollis. The term (which literally means “twisted neck”) is a condition in which the head is tilted toward one side. An infant with torticollis will favor one side, which means that he or she will habitually sleep with the head in the same position ó which can cause a flat spot.
Keaton’s torticollis was discovered by Dr. Christopher Magryta at his two-month check-up at Salisbury Pediatric Associates.
Magryta says that he sees many children with torticollis, which is often caused by birth trauma. And in fact, Keaton’s torticollis was likely caused by a difficult birth; he was born with vacuum assistance, which may have torn a muscle in his neck, Jennifer speculates.
Jennifer says that Keaton always wanted to sleep in the same position, on his back with his head pointed the same way. If she tried to position him differently, he would always revert back to his preferred position.
Keaton’s initial treatment recommendation was physical therapy. Magryta says that many children will require only physical therapy to address the torticollis that causes plagiocephaly.
It can help, Magryta says, to increase a baby’s “tummy time” ó time spent on their tummies while awake. Pearson also stresses tummy time with her clients, including the Sloops. Parents can also hold their children more, Magryta says, to keep pressure off the head that might cause or worsen a flat spot.
In Keaton’s case, because physical therapy did not correct the problem, he was prescribed a custom-molded helmet, along with continued physical therapy. Keaton’s helmet ó which is more properly referred to as a cranial band ó was made by the Hanger Orthotic Group.
Keaton accepted the device fairly readily.
“The first two times we put it on, he cried for three to five minutes,” Chris says.
Then, he seemed to forget about it.
Chris and Jennifer are used to getting funny looks when they take Keaton out in public. Most people don’t know about plagiocephaly and are curious when they see a baby in a helmet.
“They think, ‘What’s wrong?'” Jennifer says. One woman told her that she thought Jennifer and Chris were using the helmet “for safety.”
Others assume that “you dropped him on the head,” Chris says.
Garrett and Jennifer Raper were also used to their son, Garrison, getting strange looks when he wore his helmet.
“You get some stares, but I think it’s something you get used to,” she says.
Although Garrison is now a year old and out of his helmet, he wore one for about three months this summer, returning to Charlotte every few weeks to have his cranial band adjusted, according to how his head had grown. (Keaton also has his band adjusted.)
Garrison had a flat spot on the back of his head, caused by favoring one side.
His pediatrician began keeping an eye on it when Garrison was about a month old. Sometimes, the condition corrects itself, but Garrison’s flat spot persisted, so when he was eight months old, he was fitted with a helmet.
Jennifer Raper says she felt guilty at first that her son had the condition, but she eventually realized it had not occurred because of anything she did or didn’t do.
If a helmet is going to be prescribed, it’s often between the ages of 4 and 6 months, when a child is growing the fastest and the skull is still soft in order to accommodate the rapid brain growth that happens during the first year. As babies get older and the head less malleable, orthotic devices are less effective in re-shaping the head.
Various factors may contribute to plagiocephaly, including premature birth, restrictive intrauterine position, or trauma at birth. It’s no secret that sometimes the constriction that occurs in the birth canal can cause the head of a newborn to be temporarily pointy or elongated. That type of plagiocephaly usually corrects on its own.
Flat spots on the back or side of a baby’s head can be caused or exacerbated by always putting a baby to sleep on his or her back ó which has been standard practice among parents since the early 1990s.
Like the Sloops, the Rapers tried unsuccessfully to get their son to change sleeping position.
“He was stubborn,” says Jennifer Raper.
A baby always sleeping on its back typically does not cause plagiocephaly, but if a baby also has torticollis ó the tightness or shortening of a muscle in the neck ó then the condition is more likely to appear.
Premature infants are more prone to the condition, since their heads are softer than full-term babies’, and they may spend more time on their backs without being moved or picked up if they are in a neo-natal unit because of their fragile condition.
The incidence of positional plagiocephaly has increased dramatically since the American Academy of Pediatrics in 1992 began recommending in its “Back to Sleep” campaign that babies should always sleep on their backs to help reduce the risk of sudden infant death syndrome.
That recommendation has been successful in reducing the incidence of SIDS by almost 40 percent, but the acceptable downside has been that the incidence of plagiocephaly has risen.
Jennifer Raper says they were happy with the results that Garrison got, but she’d rather not have to go through the experience again.
She and her husband are expecting another child.
“This one, I’m going to hold the whole time,” she says, laughing.