Re: Documentation Needed

[Guest guest]

I don't think this is the article you're looking for Tricia? It was

at www.eurekalert.org and it's copied & pasted below for you:

Debbie Abby's mom

MI

Public release date: 8-Jul-1999

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Contact: Van

sandy@...

1-800-396-1002

Cedars-Sinai Medical Center

SIDS prevention tactic leads to epidemic of 'misshapen head' in

infants

LOS ANGELES (July 8, 1999) -- While the potentially life-saving

benefits of the " Back to Sleep " campaign -- launched nationally in

1994 to reduce the risk of Sudden Infant Death Syndrome (SIDS) -- are

indisputable, the admonition to place babies on their backs during

sleep has resulted in an epidemic of plagiocephaly, or " misshapen

head, " in infants, according to M. Graham, M.D., Sc.D., director

of Cedars-Sinai Medical Center's Craniofacial Clinic.

Over the last five years, the incidence of nonsynostotic positional

plagiocephaly has jumped fivefold: from an estimated 1 in 300 live

births to 1 in 60 births today. Though easily treatable,

plagiocephaly and accompanying torticollis, a shortened or tightened

muscle on one side of the neck, may go unrecognized by parents and

health care practitioners alike.

Misshapen heads are often secondary to the muscular torticollis,

which causes the baby to tilt his or her head toward the tight side

and turn away, resulting in a preferred resting position. As a

consequence, the infant's normal, rapid rate of head growth coupled

with a consistent resting position can lead to significant asymmetry

of the head shape.

" When infants sleep in one position, there is consistent pressure on

their soft and forming skull, which can result in deformation of the

head, " explained Dr. Graham, who estimates the clinic handles 250 to

300 visits a year for this condition. " Unfortunately, many care

providers are unaware of the symptoms and inappropriately reassure

parents that the child will grow out of it. Left untreated,

torticollis and plagiocephaly can result in permanent distortion of

the head as well as persistent facial asymmetry. "

The result is often needless worry, he added. " It's really a very

simple problem that needs to be more clearly recognized by the

medical community and public. " Muscular torticollis is usually caused

by the limited room in the uterus for the baby during late gestation,

and it is even more common with multiple gestation (twins or

triplets). Torticollis can be difficult to detect at birth or in

young infancy because the neck is relatively short. One noticeable

symptom is a persistent head turn, and parents frequently report a

preferred resting position with sleep. After age six months, the neck

begins to lengthen, and tilting of the head toward the tight side may

become more evident, suggesting the need for neck physical therapy.

Culver City residents and Athanasas know first-hand the

concern and confusion this condition can cause. For several months

the anxious new parents observed a number of troubling symptoms in

baby Niko. A lump on the side of his neck was initially diagnosed as

a swollen gland, though there was no response to treatment. Niko

wasn't turning his head either, and the right back side grew

increasingly prominent while the back left became flattened.

also recognized a noticeable tilt to Niko's bottom gum line, and that

the baby's ears seemed out of alignment.

These are some of the telltale signs of torticollis and

plagiocephaly, according to Dr. Graham, and parents are often the

first to recognize them. The condition, which does not affect normal

brain growth and function, may include the following physical

characteristics:

the back of the head is flattened on the same side that the forehead

is more prominent

the ear on the side of the occipital flattening (at the back of head)

can be larger and advanced forward, compared to the other ear

the jaw can be asymmetric, with an upward slant on the same side as

the shortened muscle

facial asymmetry, with one cheek appearing more full and one side of

the forehead appearing more prominent than on the other side

After visiting two pediatricians, the increasingly concerned

Athanasases were referred to Cedars-Sinai's Craniofacial Clinic.

" When I called the clinic, I described Niko's symptoms to the nurse,

and I immediately felt reassured that the staff could help us, " said

, who brought the then seven-month-old baby in for a

comprehensive evaluation by Dr. Graham. Niko was subsequently

diagnosed with torticollis-plagiocephaly deformation sequence and

began a prescribed regimen of neck massage and stretching. He was

also fitted with a custom-made " helmet " -- worn virtually around the

clock for four months -- to help reform his head and reposition his

features.

Treatment of the condition includes neck physical therapy to correct

the muscular torticollis along with repositioning techniques and/or

helmet therapy to correct the head shape. Complete resolution of the

shortened muscle takes four to six months of regular neck-stretching

and head turning exercises, which are performed by the parents. The

sleeping position must also be altered to train the baby not to lie

on the flattened part of the head, allowing this area to fill in

properly. This can be accomplished by using an infant positioning

device and placing favorite toys and stimulating objects on the

baby's non-preferred side to encourage him or her to remain in the

prescribed position.

If significant head asymmetry is present at six months, helmet

therapy is necessary to correct the head shape.

" The correction of head asymmetry with helmet therapy is based on

head growth -- the normal rate of growth slows at around one year of

age, so we have a window of opportunity when the baby is between six

months and one year old, " Dr. Graham stated.

In Niko's case, his plagiocephaly was already quite pronounced so

helmet therapy began simultaneously with the neck stretching

exercises and repositioning techniques. The corrective helmet is

designed to " remold " the head to a natural, oval shape, and therapy

usually continues for four months. Babies quickly adapt to wearing

the helmet, which is ventilated with holes to allow its use in

Southern California's warm climate.

" Within the first few weeks of wearing the helmet, I called the

doctor's office and said, 'Niko's cured, he's cured!,' "

remembered. " They told me it would take longer, but I was amazed at

the progress. "

Every few weeks, Niko returned to the clinic for evaluation or to the

orthotics specialist for adjustments to his helmet. Despite 's

concern that his features might always be " a little crooked, " she

watched with excitement as his ears and gums shifted into proper

alignment, and Niko's head began to round normally. " He's great now,

and his head is gorgeous, " she said with relief. " Every parent wants

their baby to be perfect, and I was so afraid he'd be deformed. "

Tony and Avallon, also of Culver City, faced similar concerns

when twins Perris and Quinn displayed signs of the condition. At four

months, both babies had noticeable flattening behind the right ear,

while the left back sides of their heads appeared more prominent.

also noted that their right ears were larger.

" It was scary, because the problem was clearly getting worse, and no

one could explain why, " said .

A pediatrician told the anxious parents that it was " nothing to worry

about, " and a neurosurgeon wanted to fit the twins with

$7,000 " headbands. " Neither mentioned torticollis and plagiocephaly,

which first heard about at her Twins Club meeting. That chance

conversation led to a referral to Dr. Graham, who told them that

torticollis is more frequent in twins and triplets because they have

even less room in the uterus in late gestation.

" He was really so great, so thorough, " she recalled. " He went over

everything and spent hours with us. "

The twins, then five months old, embarked on neck physical therapy

and repositioning techniques as their first course of treatment.

While Quinn responded well, it was determined that Perris required

the helmet therapy to correct her degree of plagiocephaly. At six

months, she was fitted with a helmet, which she wore day and night.

Her mother explained to curious onlookers that the headwear was

like " braces on your teeth, " but designed to round the head into

shape. was impressed with the dramatic -- and speedy --

improvement she witnessed in Perris' head shape.

" I'd never heard of this condition; my pediatrician had never heard

of it, " added. " This is a dramatic example of the importance of

a second opinion. I'm really happy now, and I'm so glad I found Dr.

Graham. " Director of Clinical Genetics and Dysmorphology at Cedars-

Sinai Medical Center, Dr. Graham is also a professor of pediatrics at

the University of California-Los Angeles School of Medicine. He is a

graduate of s Hopkins University and The Medical University of

South Carolina, and also earned a Doctor of Science degree in

Communicative Disorders from s Hopkins School of Hygiene and

Public Health.

Dr. Graham, who has authored more than 200 publications on medical

genetics and birth defects, is president of the Society of

Craniofacial Genetics, and a member of the American Cleft

Palate/Craniofacial Association, American Society of Human Genetics,

Society for Pediatric Research and American Pediatric Society. In

addition to his work with plagiocephaly and torticollis, he runs a

diagnostic and treatment center for children with developmental

delays or birth defects at Cedars-Sinai Medical Center.

###

For media information and to arrange an interview, please call 1-800-

396-1002. (Thanks for not publishing this number in stories.)

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> Hi,

>

> I am looking for research paper by Dr. Graham of Cedars-Sinai

> Medical Center titled " Management of Plagiocephaly and

Torticollis " .

> Does anyone have a copy of this article? I have searched the web w/

> no luck.

>

> Thanks,

> Tricia

[Guest guest]

Tricia,

I have also been unable to locate this specific research title and

author anywhere, but I may have some information that helps.

I went to the NCBI studies search site that is in the links section,

and conducted a search for " Graham. " Although the research

article you are looking for didn't come up, there were others with

Dr. Graham from Cedars Sinai as the author.

In one of the studies, he included his email. Here it is if you

would like to email him directly to ensure that he is the same

Graham, and see if he knows where you can get a copy of that

research article:

john.graham@...

I hope this is of some help. Would you let us know what you find

out about his research article?

Take care,

Christie (Mom to Repo'd Remy)

> Hi,

>

> I am looking for research paper by Dr. Graham of Cedars-Sinai

> Medical Center titled " Management of Plagiocephaly and

Torticollis " .

> Does anyone have a copy of this article? I have searched the web

w/

> no luck.

>

> Thanks,

> Tricia

[Guest guest]

> > Hi,

> >

> > I am looking for research paper by Dr. Graham of Cedars-Sinai

> > Medical Center titled " Management of Plagiocephaly and

> Torticollis " .

> > Does anyone have a copy of this article? I have searched the web

> w/

> > no luck.

> >

> > Thanks,

> > Tricia