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Comment| Wednesday, July 30th, 2008 | Emily Halevy | CWK Producer |
“In the hospital, they said make sure you keep her on her back. … Everything I read said that. So that was where she was going to be, and about eight or nine weeks [later], that’s when I started noticing [that the back of her head was starting to flatten].”
– Jill Ramos, mother of Samantha
“How do you think her head is looking?” asks Laura Plank, cranial orthotist at Children’s Healthcare of Atlanta.
“I think it looks good,” Jill Ramos says.
Jill’s daughter, Samantha, was only 2 months old when her parents noticed something odd.
“In the hospital, they said make sure you keep her on her back,” Ramos said. “… Everything I read said that. So that was where she was going to be, and about eight or nine weeks [later], that’s when I started noticing [that the back of her head was starting to flatten].”
The condition that leads to the flattening of babies’ heads is caused when babies spend most of their time lying on their back. It’s harmless, and usually the solution is simple.
“Let them play on their tummies and a vast majority will get better,” explains Dr. Andrew Reisner. “But, for those few cases that do not respond to repositioning, if they are severe, and particularly, if they worsen, only then would I consider a cranio-orthosis.”
A cranio-orthosis is typically a helmet that applies gentle pressure to correct the shape of the skull. Samantha was fitted with one at seven months, which mostly she ignores.
“Occasionally she’ll reach up and feel it or she’ll feel her head, but she doesn’t mind it at all,” her mom says.
She says the only ones that do mind are strangers.
“Lots of looks, lots of comments, lots of people running up saying what’s wrong with the baby,” Jill says. “I just say we’re rounding out her head, she has a flat spot.”
Doctors urge parents to keep sleeping children on their backs, but Plank also urges the importance of babies spending time on their stomachs.
“My biggest advice to parents is tummy time,” says Laura Plank. “If they are awake and they are being supervised, it is okay for them to be on their tummy.”
Tips for Parents
According to the American Academy of Pediatrics, sudden infant death syndrome (SIDS) is the leading cause of death in babies from 1 month to 1 year of age. SIDS is the diagnosis given for the sudden death of an infant under 1 year of age that remains unexplained after an autopsy, thorough on-scene case investigation and review of the clinical history. After 30 years of research, scientists still cannot find one definite cause or causes for SIDS, also known as crib death.
In recent years, multiple important studies have linked SIDS to an infant’s sleeping position. In 1994, the Back to Sleep campaign, sponsored by the National Institute of Child Health & Human Development and the AAP, was established to promote awareness of putting infants to sleep on their backs. Since that time, hundreds of lives have been saved in the United States as more children are sleeping in this recommended position. The AAP points out the following facts linked to the Back to Sleep campaign:
- Putting children on their backs when going to sleep has been documented to reduce the numbers of kids dying of SIDS in every country where it has been instituted. The most important step parents can take is to put their infants on their backs when letting them go to sleep.
- Some adults worry that babies sleeping on their backs may choke or vomit during sleep. No evidence that sleeping on the back causes choking exists. Millions of infants around the world now sleep on their backs, and doctors have not found an increase in choking or other problems.
- Some babies at first may not like sleeping on their backs, but most get used to it. If necessary, an infant can be placed on his side. The side sleep position does not provide as much protection against SIDS as back sleeping, but it is much better than placing the baby on his or her stomach. If you choose to use the side sleep position, make sure your baby’s lower arm is forward to stop him or her from rolling over onto his or her stomach.
The Centers for Disease Control and Prevention (CDC) cites these additional issues related to the causes of SIDS:
- Babies who sleep on their stomachs may get their faces caught in bedding, which causes them to breathe too much carbon dioxide and too little oxygen.
- In many SIDS babies, abnormalities are found in parts of the brainstem that use serotonin as a neurotransmitter, and are thought to be involved in the control of breathing during sleep, sensing carbon dioxide and oxygen and the ability to wake up. A baby with this abnormality may lack a protective brain mechanism that senses abnormal respiration or cardiovascular function and normally leads babies to wake up and take a breath.
- A larger number of babies who died from SIDS apparently had respiratory or gastrointestinal infections prior to their deaths. This fact may explain why more SIDS cases occur during the colder months of the year.
- Researchers indicate that some SIDS babies had higher-than-normal numbers of cells and proteins generated by the immune system. Some of these proteins interact with the brain to alter heart rate, slow breathing during sleep or put the baby into a deep sleep, which may be strong enough to cause death, particularly if the baby has an underlying brain abnormality.
The National Institute of Child Health & Human Development and the National SIDS Resource Center offer these additional statistics about SIDS:
- Approximately 2,643 children died of SIDS in 1999.
- Most SIDS deaths occur between 2 and 4 months of age.
- African-American babies are twice as likely to die of SIDS as white babies.
- Boys are at greater risk for SIDS than girls.
- SIDS cannot be caught. It is not contagious, and no symptoms exist before death.
- SIDS is not caused by the diphtheria, pertussis, tetanus (DPT) vaccines or any other immunizations.
Who is at risk for SIDS? The CDC cites the following risk factors associated with SIDS deaths:
- Babies who sleep on their stomachs
- Babies born to mothers who smoke during pregnancy and babies who are exposed to passive smoke after birth
- Babies born to mothers who are less than 20 years old at the time of their first pregnancy
- Babies born to mothers who had no or late prenatal care
- Babies who are premature or low birth weight
In 1999, the AAP released new guidelines new guidelines relating to the prevention of SIDS. Doctors and nurses now believe that fewer babies will die of SIDS if most infants are placed on their backs during sleep. However, if your baby was born with a birth defect, often spits up after eating or has a breathing, lung or heart problem, contact your pediatrician about which sleep position to use with your infant.
Besides monitoring sleep position, parents can take other measures to reduce the risk of SIDS. The AAP offers these suggestions:
- Bedding: Make sure that your baby sleeps on a firm mattress or other firm surface. Don’t use fluffy blankets or comforters under your baby. Don’t let your baby sleep on a waterbed, sheepskin, a pillow or other soft materials. When your baby is very young, don’t place stuffed toys or pillows in the crib with him or her. Some babies have smothered with these soft materials in the crib.
- Temperature: Babies should be kept warm, but they should not be allowed to get too warm. Keep the temperature in your baby’s room so that it feels comfortable to you.
- Smoke-free: Create a smoke-free zone around your baby. No one should smoke around your baby. Babies and young children exposed to smoke have more colds and other diseases, as well as an increased risk of SIDS.
- Doctor or clinic visits: If your baby seems sick, call your doctor or clinic right away. Make sure your baby receives his or her shots on schedule.
- Prenatal care: Early and regular prenatal care can also help reduce the risk of SIDS. The risk of SIDS is higher for babies whose mothers smoked during pregnancy. For your baby’s well-being, you should not use alcohol or drugs during pregnancy unless prescribed by a doctor.
- Breastfeeding: If possible, you should consider breastfeeding your baby. Breast milk helps to keep your baby healthy.
References
- National Institute of Child Health and Human Development
- American SIDS Institute
- Craniosynostosis And Positional Plagiocephaly Support, Inc.
- American Academy of Pediatrics
