Re: Cephalic Index Question Answered by CT's Tim Littlefield

[Guest guest]

I want to first thank for writing a thoughtful response about all this.

She makes a couple of great points, including one about the difference between

" normal " and healthy.

I also want to clarify my point about weight/obesity, because I do think it's a

good analogy. Whether someone looks overweight to our eyes probably has a lot

to do with what's normal now; Unfortunately, since so many people are

overweight now, it is unwise to judge someone's weight that way. (Nevertheless

a lot of people do judge this way and that is making the problem worse.)

Fortunately, though, enough research has been done so that we have an absolute

measure, BMI. One of 's points is that more study should be done on head

proportions to get an analogous objective measure of what range of CI is

healthy.

With body weight, it turns out that about 30-40 years ago people, children

anyway, were by and large not overweight. Thus we use growth charts from that

era to judge our children's weight. Many of you probably know that this chart

is a bit misleading for the first year or two because it is based on formula-fed

babies, but otherwise I think it is pretty good. In other words, what was

typical then pretty much correlates with what is actually healthy. (I am not

sure exactly how good a match it is, and I'd be interested to hear if anyone

does know.)

Now, the study that Littlewood cites was also done a few decades ago, when very

few children were left on their backs so much. If we knew that the range of CI's

back then correlated well with the range of what is healthy, then we could be

confident in using these charts to judge head proportions today. However, we do

not, because no study has been done. Thus we can only take the numbers from the

study to give the natural distribution of C.I.s in a population that has had no

external force on the backs of their developing heads: meaningful, definitely,

but not conclusive.

There are many forms of body modification that do not have ill effects on the

health if done in moderation---weightlifting comes to mind. Does the amount of

external force on the back of the head necessary to result in a CI of, say, 90%

actually harm health? We don't know.

Does anyone know why most orthotists recommend banding only above 90%? Is that

cutoff based purely on cosmetics?

, by the way, thanks for mentioning that your daughter has no trouble

with safety helmets. Our little guy hasn't had a need for one yet, but that's

something I've been fretting about having just bought big brother his first

bike. (I haven't had the nerve to try the helmet on yet.)

This was meant to be a short post....Thanks for reading if you did!

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> One thing that occurred to me is that he didn't address Molly's classification

of moderate and severe. I never saw anything on that insurance link that

classified the percentages into these categories. It only presented the average

and standard deviations. And Molly's categories leave out the mild

classification. So, even if we accept the numbers as valid, this doesn't answer

the question of severity. I still make the argument that one standard deviation

is not considerate moderate in any field that I know of.

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> I agree with that some of his statements are clearly opinion. Yes, the

study he quotes is definitely a fact. Insurance companies using it seems to be a

fact as well. However, his opinion is that the standards should not be adjusted.

Given the discussions that I've had with my ortho, PT,  and my cranial doctor,

I'm thinking that there are disagreements within the field. Anyone in a

professional field knows that this is not unusual. You will get differing

opinions on lots of things. This is not a ba d thing, it's what keeps people

thinking and research going.

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> In addition, his discussion of norms does not make sense. Norms are a

statistical concept - they have to be adjusted when they do not represent the

normal population. Now, a norm can be considered problematic, but it is still a

norm. Obesity is not a good example because we do not use norms to define it. It

is defined by a criterion (BMI). Based upon this standard, we know that obesity

is going up.

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> If Tim is correct that having wider heads is a problem, then the field ought

to move to a criterion based standard rather than a standard that is u s ing

norms. What that would require is some sort of research that determines at what

point the width of the head becomes problematic. I can tell you that 's

head (at somewhere in the low 90s) fits into hats and helmets. Her gross

motors skills were tested to be above average in the study that she

participates in (I believe 6 months ahead). Visual perception was judged to be

48 months (at 29 months of age). Language was also a few months ahead.  The

only area that was not above average was fine motor skills, but this was

average. She's been invited to move up to the next gymnastics class 2 months

early and will likely start in an " invitation only " preschool gymnastics class

in the fall when she turns 3 . And, she is learning to read . The dentist says

that her jaw is fine and she has not had an ear infection since she graduated

from her helmet. So, what are the negative effects of a cranial index in the low

90s. I don't see it. Now, is this true of all kids with her level of cranial

index - I can't say for sure and we will never know unless more research is

done. may be an exception to the rule. I guess what I'm saying is that

I'm not sure at what point a wider head becomes a problem and I question whether

he knows as well . Wider heads are traditionally common in some ethnicities and

it seems culturally biased to make this kind of generic statement. Would an

index of 100 percent be a problem - maybe due to things like the angle of the

ear tubes and fitting into helmets. But a number of 90 does fit into helmets

from our experience so far . But then, a number of 100 is not normal in any

cultural group. And, I think that 's starting number of 95 would have

also been a problem. The controversy comes with the numbers in the high 80s to

low 90s.

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> My big question is why there is not going to be more research looking at this.

It's just wrong not to do it. In the meantime, we are worrying parents for

reasons that may not be valid. Using norms that are old to tell parents that

they're child's head is severe is just unethical, in my opinion. Like I've said

previously, if a psychologist were to use old norms for things, half of the

child population would be diagnosed with some sort of behavior disorder since

the standards for behavior have changed since our parents were young.  Now,

using some other standard to decide this, even if it isn't the current norms,

would be a more acceptable practice. This is why both my cranial doctor, PT, and

ortho all told me the average, but then cautioned me that this average was old

and probably no longer represented the average head. Then, they told me that

's head was definitely flatter and wider than recommended. I guess what

I'm saying is that if measurements are shared, the full information ought to be

shared. Very simply put, the norms are old and are no longer representative, but

they still like to use them because they are the best that are available. Plus,

they believe that the current average head is too wide. At least the parent

would be informed.

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> Can Tim answer what the field can do to bring things up to what would be an

acceptable standard in most other fields. What needs to happen so that a study

is completed? I guess I expect more from a scientific field that what we are

getting and am disappointed that it won't be occurring. I am in the " soft "

sciences and we are often criticized for not being scientific enough, but this

standard would be unacceptable in my field.

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> ----- Origi