Re: Does positional therapy work? When to get a helmet.

January 25, 2010

Thanks for the info and advice. We will wait for his four month well child (in

two weeks) to decide about seeing an ortho. He also has a pop in his hip and

might need to see an ortho for that as well (we had an ultrasound that showed

everthing is fine, but it still pops when he kicks. Does anyone have experience

with this? I've been told that hip problems are associated with plagio where

torticollis is a factor.). I don't know how other pt's measure for plagio, but

the way ours does seems to leave alot of room for human error. I don't have a

lot of confidence in the pt.

>

> >

> > I'm looking for advice from those of you with experience. Our story starts

> > at our sons 2 month well child visit. His doctor noticed a flat spot on the

> > back right side of his head and referred us to pediatric physical therapy.

> > There we learned there was an 8 mm difference in measurments, and that he

> > has torticollis. We were taught stretches and positional therapy. Three

> > weeks later we went back to the physical therapist and found that his

> > measurment had improved 1 mm. This was disappointing. The PT said he would

> > have liked to see more improvement and made a couple of suggestions. He is

> > now almost four months old, and we will be meeting with his PT and doctor

> > soon. I'm wondering if others on this board have had positive experiences

> > with positional therapy (any tips or advice would be welcomed) Also, do any

> > of you have advice to share about if and when to get a helmet. What kind of

> > measurements usually require a helmet? Is it better to get it at 4 months,

> > or should be wait until 6 months? I feel lost in a new world. HELP!

> >

>

January 26, 2010

My son Silas starting showing a flat spot on the right back side of his head at 5 weeks. I brought it to the attention of our Pediatrician at the 2 month check-up and we started PT immediately to treat torticollis and get repositioning therapy. After 2 months of PT I felt like there was some rounding out, but the PT recommended we go to the orthotics place (in Tampa, we go to Westcoast Brace & Limb) to have a digital cranial scan done, to have a marker to compare with in another month. That scan showed a 15mm difference between sides, which is considered severe. We did PT for another month with no change. Silas worked through the torticollis (never had any limitation in range of motion), but he ALWAYS sleeps on that right side out of preference no matter how much I reposition him. And he

started sleeping through the night at 10 weeks, so I wasn't waking up to feed and reposition him at night. Anyway, after 3 months of PT, and much deliberation (our insurance, United HealthCare, does not cover the cost of helmet), we decided to go forward with the helmet around the time Silas turned 5 months old. Our orthotist believes that 5-6 months is the best time to start. He has had the helmet on for a week and a day and has adjusted wonderfully. A little bit of fussing on the first day, but the "break-in" schedule with the Star Band allows for gradual adjusting, starting with an hour on, hour off schedule and working up to the full 23 hours by day 5. We are continuing with once per week PT while he has the helmet on. Our insurance gives us 20 visits per year, so that should get us through April. He's in the middle of a growth spurt now too, so we are already seeing a little bit more rounding even after just one week. Overall, I'm glad we

got the helmet. For us, I was ready to do the helmet until I found out that insurance would not cover, but some friends came to our rescue and made it possible for us to afford it. That was a blessing. Wardrombachb@...

January 26, 2010

I'll tell you about our experience - my son is 6 months now, and we did not wind

up getting a helmet.

When my son was born, he looked pretty much exclusively center-to-right (mostly

to the right). Early on, we did cranialsacral therapy to help some latching

issues we were having with breastfeeding - the OT was the first one to gently

point out that he had some mild asymmetries. (I definitely think the early CST

helped keep the torticollis and plagio from being much worse.) The pediatrician

we had at the time vaguely mentioned trying to encourage him to look the other

way, but was not clear that this was IMPORTANT for reducing the plagio, that he

had torticollis, etc. By the time he was 2 1/2 months old, we could see he had

a seriously flat spot in the right lower corner of his head. We switched

pediatricians, and at 3 months that pediatrician flagged the issue before I even

asked about it.

We were told to be much, much more aggressive on tummy time, upright time

(holding him upright with the back and side of his head not resting on

anything), etc. We flipped around how we were putting him in the crib and on

the changing table. We also learned stretches to do with him.

My son has a bit of an atypical case of torticollis. By the time we started

chiropractic work at 4 1/2 months, he would tend to have his head tilted to the

left but turned to the right. So he tends to have muscle tightness on both

sides, as well as his top two vertebrae out of place in opposite directions.

Thus, his plagio is in a bit of an odd spot, and was not easily measured by the

traditional calipers (we went to Hanger for an evaluation since they are in

network for us). But the pediatricians, chiropractor, OT, etc. all saw the

plagio, it just wasn't easily measurable since it's further down on his head

than where the calipers measure.

All that said, we were thus in a tough place on this. Had his flatness been

able to be measured in any meaningful way, I'm sure we would have qualified for

a helmet. But because it couldn't be, we would have had no insurance coverage

for the helmet (and our coverage stinks as it is on practically everything, so

we're paying for a lot out of network on all fronts on top of the premiums).

So, we aggressively repositioned, did a lot of upright time, the stretches, lots

of tummy time, chiropractic, etc. Luckily, his head has rounded out a lot, and

the torticollis has gotten gradually better with chiropractic work. Since the

chiro we've been going to is very expensive, now that the most critical part of

the treatment is done, I'm going to start taking him to the chiro I go to (who

is $30 cheaper per visit). I also absolutely believe the chiro helped get him

onto a normal schedule for physical milestones. After the very first chiro

appointment, he turned over stomach to back for the first time the next day.

After we were able to bring him twice weekly for a couple of weeks, he turned

back to stomach for the first time. Thus, he had turned both ways before 6

months - I truly don't think that would have happened without the chiro.

The pediatrician said last week at his 6 month appointment that he still had

some flattening, and said to have him on a lot of tummy time. I kind of

laughed, and said he's only on tummy time as much as he wants to be - when he

doesn't want to be, he flips over, and has even started rolling! We still do

try to put him on his tummy pretty much whenever we put him down on his activity

mat. We put him on his back to sleep, but he rarely stays there for more than a

half hour or so - he generally doesn't spend a lot of time lying on that part of

his head at this point. Doing tons of tummy time really did make a huge

difference in his upper body strength and ability to push up, which obviously

helps reduce the amount of contact on the flat spot and reduce the amount of

turning to the one side.

My thought is to very, VERY aggressively work on the stretches, repositioning,

tons of tummy time, etc. for the next month, and get your baby re-evaluated at

that time. If you can, look into CST and chiropractic, especially the

chiropractic. If there hasn't been more significant progress by 5 months and

the measurements aren't really improving, I would probably go for the helmet.

I hope our story is helpful to you. Good luck -

--

>

> I'm looking for advice from those of you with experience. Our story starts at

our sons 2 month well child visit. His doctor noticed a flat spot on the back

right side of his head and referred us to pediatric physical therapy. There we

learned there was an 8 mm difference in measurments, and that he has

torticollis. We were taught stretches and positional therapy. Three weeks

later we went back to the physical therapist and found that his measurment had

improved 1 mm. This was disappointing. The PT said he would have liked to see

more improvement and made a couple of suggestions. He is now almost four months

old, and we will be meeting with his PT and doctor soon. I'm wondering if

others on this board have had positive experiences with positional therapy (any

tips or advice would be welcomed) Also, do any of you have advice to share

about if and when to get a helmet. What kind of measurements usually require a

helmet? Is it better to get it at 4 months, or should be wait until 6 months? I

feel lost in a new world. HELP!

>

February 11, 2010

I just wanted to thank everyone who responded to this post. I really just

needed some encouragement and hope. We have seen the PT and Pediatrician and

have recieved great news. Torticollis is corrected, and plagio down to 4 from 8

(in 7 weeks of repositioning)! I actually had to remind the pedi what side the

plagio was on. Thanks again! I really really appreciate it!