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[CAPSORG] Some other info I picked up on PP

Date:

Sun, 31 Dec 2000 11:27:18 EST

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SYDNEY, AUS. - A visiting United States surgeon warned Australian

doctors at

a recent conference against performing life-threatening operations

on infants

with flattened heads.

Dr. ph Gruss, the head of craniofacial surgery at the University

of

Washington in Seattle, said that in the case of babies whose heads

were

flattened from sleeping on their backs, a simple sleep repositioning

would

allow the head to fill out without the unnecessary operations.

-- Chris

Pritchard

Pritchard, CRANIAL CHAT: Flattered heads. Vol. 36, Medical

Post,

01-11-2000.

The shape of things to come

BYLINE: ALDRIDGE Val

EDITION: 2

SECTION: FEATURES:GENERAL

Putting newborns to sleep on their backs in an effort to reduce

the incidence

of cot death has created an unexpected medical condition which

sees many of

those babies developing misshapen heads. Val Aldridge looks at

the

implications.

--------------------

NEW ZEALAND has an epidemic of babies with flat heads. Craniofacial

clinics

have been swamped by cases of young children suffering from this

condition,

caused by putting babies to sleep on their backs, a position that

has been

advocated since the early nineties to prevent cot death.

Preventing occipital deformational (or positional) plagiocephaly

(flat head)

is simple -- babies should sleep on their backs but, once asleep,

their heads

should be turned to alternate sides.

The big problem is nobody wants to water down the "back to sleep"

message

that has been credited with cutting the numbers of babies dying

as a result

of sudden infant death syndrome.

The theory is that a flat head may make you look funny, but SIDS

will kill

you. So this extra advice has either been muted or not given at

all.

Just how serious plagiocephaly is long-term, and who is responsible

for

seeing that parents and infant care-givers get and give proper

advice, has

been a hot potato bouncing around the medical world during the

past few years

since concerns were first raised about the numbers of children

with deformed

flat heads.

Meantime, the number of children developing this condition has grown.

Tristan de Chalain, craniofacial surgeon at Middlemore Hospital,

says: "We

have been absolutely swamped by these cases."

He says the hospital has three craniofacial clinics every two weeks

and the

clinics are full. During the past four or five years, there has

been an

increase of 300 to 400 per cent in children referred with flat

heads. "There

is a significant number out there, trust me. Don' t let paediatricians

kid

you that it's not an issue. It is an epidemic."

The condition, he says, has nothing to do with race, culture or

socio-

economics and New Zealand is not alone. Children in America, Britain,

France

and the Netherlands are all presenting with it. American figures

show

approximately 4 per cent of children have a deformity that needs

surgery.

"The paediatricians may argue, and perhaps correctly, that there

is no

long-term adverse consequences, apart from the fact the kids will

have

funny-shaped heads," he says, "but what parent wants that if the

condition is

preventable?

"In a lot of these kids, an anomalous head shape will persist. Optometrists

say that part of the spectrum of flat heads is that the ears are

in different

positions on the side of the head and those who fit these children

with

glasses will notice the difference between the eye and the ear.

We are now

trying to determine how many children in our community have a problem."

Mr de Chalain says that most of the children seen in the clinics

are less

than a year old because that is when parents are most concerned

and before

there is much hair growth. He is also concerned that general practitioners

and midwives may misdiagnose more serious cranial deformities,

which need

early surgery, for plagiocephaly, which a child may grow out of.

There is not

a lot of evidence to suggest any kind of long- term consequence,

but Mr de

Chalain says there is "soft evidence". A report from America published

in

Paediatrics looked at siblings and compared those who had flat

heads as a

baby and those who hadn' t. The report found a significant difference

in

terms of special education interventions in primary school . .

.. things like

hyperactivity, needing remedial reading and other help. He says

that, on the

whole, paediatricians, though agreeing that not all flat head problems

resolved completely, say that the condition doesn't have any implication

for

brain development, so therefore it isn't important.

Mr de Chalain says craniofacial specialists are inclined to agree

-- "but

dammit, the condition is preventable".

Glasson, a Wellington craniofacial surgeon, says he no longer

deals

with cranial plageocephally patients. It's not a surgical problem;

it's a

problem for paediatricians and health authorities, he says crossly.

He used

to see "hundreds, literally hundreds" of cases.

Originally it was regarded as a surgical problem and there was a

lot of

surgery done. Then reports showed it was clearly associated with

supine

sleeping and corrective helmets were used and are still used on

severe cases.

That is in itself a treatment with a great deal of hassle.

Babies don't die of crooked heads, he says. "But I know from sitting

through

hundreds of hours with families with babies with crooked heads

that they can

get very upset about it, particularly when they hear it could have

been

easily prevented.

"It's a pretty hot issue at the moment. If they educated the public

in the

same way as they have about cot death and back-sleeping, the parents

would

know all about it and know what to look for and what to do. It

is not rocket

science. I have tried very hard to get paediatricians and Plunket

interested."

He says there are only three cranio-facial specialists in New Zealand

running

clinics for highly specialised problems and they ended up basically

offering

a screening service for cranio- plagiocephaly. It is ridiculous,

he says,

when GPs could do the screening, and if they were concerned, could

then turn

to a paediatric clinic.

"This is a very easy diagnosis to make, you don't have to rely on

X-rays. I

can spot it in the supermarket -- and I am not kidding."

Kim Finlayson of Khandallah says that as a first-time mother she

didn' t know

what to do when she noticed the flattening of her son Liam' s head.

When somebody else mentioned it, she became concerned and asked

advice from

the Plunket nurse who told her to continue putting Liam to sleep

on his back.

By six months of age, the flatness was more pronounced and she

asked the

family doctor, who told her to put Liam to sleep on alternate sides,

which

she did. "The doctor told me I'd got it just in time for it to

correct. He

told me he'd seen far worse than Liam's."

RUSSELL WILLS, the national paediatrician for Plunket, says: "We

take very

seriously the question of parents worried about flat spots and

we're

certainly seeing it. We'd like to reduce the number of babies with

flat spots

but we don't want to undermine the message of babies being put

to sleep on

their backs." He says there is no way of knowing how prevalent

the condition

is because Plunket doesn't have the resources to collect the data.

"Sure, parents are worried and you can't not answer the question,"

he says,

but "the condition is a cosmetic problem, it does your baby' s

brain no

harm."

Plunket nurses have the information on how to prevent flat head

and many give

this out, but mothers have only seven 20-minute Plunket visits

a child, from

birth to five years, and there is a limit to how much information

-- relating

to a number of serious topics -- Plunket nurses can give in that

time.

Asked whether, as Plunket nurses were giving advice to mothers on

putting

babies to sleep on their backs, it wouldn't also be prudent to

give

instructions on how to prevent flat heads, Dr Wills says; "I guess

the most

important thing to say is, if this is something you are worried

about, raise

it with your Plunket nurse."

Plunket says parents who are worried about flat heads should put

babies to

sleep on their backs and when the babies are asleep, turn their

heads to one

side for one sleep and to the other for the next. Cots should be

moved to

encourage babies to look around at different aspects and closely

supervised

babies should regularly be given some "tummy time" on the floor.

Concerned

parents should talk to a Plunket nurse or a doctor.