Guest guest Posted April 8, 2010 Report Share Posted April 8, 2010 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! > > > > 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. > > > > 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. > > > > 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. > > > > 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. > > > > 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. > > > > 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. > > > > > > ----- Origi Quote Link to comment Share on other sites More sharing options...
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