Perspective....

For the many years I have cared for infants with plagiocephaly and other forms of cranial flattening, I have seen parents faced with this diagnosis exhibit every emotion ranging from fear and extreme anxiety to annoyance and disbelief that they were even asked to seek a consultation. I have seen parents cry uncontrollably during the consultation because they blame themselves for their child's appearance- that they did something wrong, such as failed to reposition hourly or do consistent tummy time. Regardless of their perspective, I explain the truth- that it will improve, although not completely resolve, with growth and that the flattening is a cosmetic issue with no adverse health consequences. For those unconcerned from outset, this explanation affirms what they already assumed or were told- that their child will be fine and it is nothing serious. Some parents, however, are devastated by this diagnosis and my reassurances are met with skepticism or are unwelcome. Many have been told or have read that their infant will permanently disfigured, delayed, have dental or TMJ issues, hearing loss, chronic "spinal malalignment", ear infections, and a myriad of other medical issues. I assure them that I have read every study on this condition and that there is no credible evidence that flattening causes any of these problems. Sure, kids with delays can become flat due to poor mobility early in life. That is not the same as inferring that the flattening causes delays, a statement that is patently untrue and unfounded. Often these parents bounce from pediatrician to various specialists looking to validate their fears. They will often seek out a provider who says what they want to hear- that plagiocephaly is a serious medical issue with potential long term problems if not treated. Of course, aggressive treatment usually follows. I have been an expert witness for such a case where a patient sued a pediatrician for failing to refer them for timely treatment. They bounce around and found a craniofacial surgeon who did helmeting, repeated Botox injections, and neck muscle release all before one year- none of which was warranted.

In the end, their child had multiple surgeries, a neck scar, and a helmet for six months. I will add that my review of the medical records showed nothing that required any treatment- a head asymmetry in the normal range (8mm), minimal neck rotation discrepancy, and a minor head tilt BEFORE any treatment was rendered. They blamed the pediatrician for all of the problems but in fact the pediatrician was correct in recommending observation for what was self-resolving torticollis (which is the norm) and a minor head asymmetry. Unfortunately this family's misconceptions coupled, fueled by an overzealous and unscrupulous surgeon, resulted in an avalanche of unnecessary treatment and pain for their daughter. I will caution parents- what I have outlined above is a common scenario often promulgated by those who are at best completely ignorant on this subject, and at worst are shameless profiteers willing to play on your fears and desire to do what is best for your child to make a buck. Do not buy into the narrative. Head flattening is common throughout the world and is at worst an aesthetic issue. Ask yourself- how many adults do you see with major head or facial asymmetry? Did the incidence of TMJ dysfunction, ear infection, or developmental delay skyrocket after the Back to Sleep Campaign? No they did not and that is all the empirical evidence you should need.....

I will close by mentioning that over the last two days I have done two operations for craniosynostosis, or premature fusion of the cranial sutures. This is a major procedure under general anesthetic that involves peeling down the scalp, removing segments of the cranium, molding or contouring them on the back table, and then rearranging/repositioning and stabilizing them with small dissolvable plates. It is terrifying news for parents to hear that their infant or young child must undergo such an ordeal and then to face the impending day of surgery, not to mention the many concerns about the child’s future (implications of the diagnosis, of the surgery, need for more procedures, possible social stigma, cognitive development, etc.). Both families and both patients did extremely well during and after the 4 hour surgery, and I could not help but stand in awe of how graceful each set of parents were in this time of extreme duress. We see this every day in our hospital. Parents, faced with life-changing diagnoses in their children, standing strong for their kids. As I finished the last procedure today, I walked to the adjacent room to tell my neurosurgery colleague that we were done. He was in the middle of resecting a malignant tumor deep in the brain of a young patient. I walked out and stood in the hallway to compose myself and to consider how fortunate most of my patients were in that their conditions are usually treatable or have only minor long-term implications. Against this backdrop, I would encourage every parent who finds themselves heartbroken over a bit of head flattening to view the diagnosis with a more thoughtful perspective.