Boston Othotics and Prosthetics

Truth vs Myth: Expert Answers to Common Parent Questions About Plagiocephaly

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Plagiocephaly, or “flat-head syndrome,” is a relatively common condition characterized by a flat spot on the back or side of a baby’s head. Plagiocephaly can be caused when the baby’s head frequently rests in the same position on everyday surfaces such as a mattress or car seat, or it can even happen in the womb. It can develop in as little as one week and is present to some degree in nearly half of infants.

When your baby has been diagnosed with plagiocephaly, it’s natural to have questions or concerns. At Boston Orthotics & Prosthetics, we treat hundreds of infants for plagiocephaly every year, often with the Boston Band. The Boston Band is a lightweight helmet developed by Boston O&P that has been proven as a simple and effective solution to the problem of positional plagiocephaly and brachycephaly.

There is a lot of misinformation about flat-head syndrome, and a lot of plagiocephaly myths that have been propagated by people who don't have all the facts. We want to get the truth out there, so we compiled this list of the most common plagiocephaly questions we hear from parents, with answers provided by one of our lead cranial experts, Steve Slawinski, CO.

How long would the Boston Band need to be worn?

The Boston Band must be worn for 23 hours per day, and the length of treatment depends on the baby's age, head circumference, and amount of growth needed. Typical treatment ranges from 2-5 months. In general, longer treatment times are needed with small heads, older babies, and large asymmetries. Shorter treatment times are needed with bigger heads, younger babies, and smaller asymmetries. For more information, see Boston O&P’s plagiocephaly outcomes chart.

Can they wear the Boston Band only at night; does it have to be 23 hours per day?

The Boston Band works to re-direct growth; we don’t know exactly when the child will grow so the more it is on, the better opportunity we have to capture growth. If a child only wears the Boston Band at night, we may miss out on growth that occurs during the day. If significant growth is missed, it can lead to a poor fit, and follow-up may be needed sooner and overall treatment time may increase.

What are the side effects from wearing the Boston Band?

The most common side effect is skin irritation, most often caused by sweating. Most babies sweat in the Boston Band; some acclimate but others continue to sweat for extended periods of time. Cornstarch-based baby powder can be used to help absorb the moisture and lessen irritation. Parents can also dress the baby in lighter clothes and keep the climate control a little lower.

Are there any concerns if we don't move forward with treatment?

There is no clear evidence that head shape asymmetry directly affects development, although there are studies that have shown links between head shape asymmetry and developmental delays. More practical concerns are how well helmets and hats will fit; this is usually an issue for heads with more substantial asymmetries.

What would you do if it was your child?

We try to remain as objective as possible and use objective scales that have been validated and used in published literature to determine our recommendation. We try to keep our subjective opinions out of the decision.

What do I do if the Boston Band smells?

There is a standard cleaning process described in the Boston Band Wear and-Care Guide that every parent receives. With exceptional odors, clean the Boston Band thoroughly with rubbing alcohol and allow for it to dry. Repeat this process at least once daily. Cornstarch-based baby powder can be used to keep the baby’s skin dry and help with the smell.

Does the Boston Band hurt babies?

The Boston Band should not be applying any pressure, just contact to redirect growth. The baby may be uncomfortable at first until they adapt, but there should not be any pain. When weaning into the Boston Band, it is important to follow the schedule to allow the skin to adjust, and be aware of any potential areas of redness due to excessive pressure that does not resolve in 30 minutes.

Will my baby’s hair fall out from wearing a helmet?

Sometimes if the Boston Band moves slightly on the baby’s head it will rub on the hair and weaken the follicles, however this is only temporary and does not happen very often. This is similar to what occurs when a baby rubs their head on the mattress.

What if my baby does not like the Boston Band?

Most of the time, it is more of an adjustment for the caregivers than it is for the baby. Babies usually adapt very quickly to wearing it and often forget that it’s there. Any discomfort that they feel usually stems from skin irritation, so it is important to follow the cleaning instructions and perform skin checks whenever the Boston Band is removed.

Can the Boston Band be safely worn in the car seat and stroller?

Yes, it will not affect the safety of the car seat or function of the stroller. If there is built-in head protection, ensure there is proper clearance.

How much does the Boston Band weigh? Will it be heavy for my baby?

The average weight of the Boston Band is 9 ounces, so it is not a substantial amount of weight that would interfere with head control development. Sample Boston Bands are available for reference in the office.

Is the scanner safe to go over my baby's face?

The scanning process is safe for your baby. The clinician will take all necessary precautions to ensure the process is performed in the safest manner possible.

How often do we need to come in to the office with the Boston Band?

Initial follow-up should be 1-2 weeks, then additional follow-ups will take place every 2-4 weeks, depending upon age and growth.

Does insurance cover the Boston Band?

Insurance coverage varies, but our billing specialists will confirm coverage prior to your baby being fit.

Does the Boston Band restrict head growth?

Head growth is not restricted, it is redirected. The goal is to prevent further growth in certain areas, while promoting it in others. Head growth is how cranial remolding works; the more growth, the more improvement.

Will the Boston Band affect how my baby sleeps?

Initially, there may be a brief period of adjustment, but if fitted properly the Boston Band should not affect their sleep and should not lead to any discomfort. They can sleep in any position that they normally would.

Will my baby’s head round out on its own?

Repositioning and Tummy Time is recommended prior to 6 months, depending on sleeping preference and level of asymmetry. Conservative methods can be effective at improving asymmetry while the head is still growing very fast and the baby is still sleeping in a fairly still position. For these reasons, we utilize the CHOA Plagiocephaly scale and the Hutchinson Brachycephaly scale, which recommend conservative treatment whenever possible.


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