Re: Questions for the orthotists

[Guest guest]

You should want to know the answers, too, and unfortunately, this

medicine is largely craft, not science. But, here are the FAQ's I'd

write if *I* were an orthotist...

Q: Is this going to hurt my baby's skin?

A: There is often a mild rash in the first couple weeks. If that

happens, we'll extend the break-in schedule and work with you and

your pediatrician to manage the condition. Hydrocortisone cream is

often effective. We would want to avoid shaving foam out of the

forehead area of the helmet just to manage a heat rash, /miliaria

rubra/, as that could severely diminish the therapeutic effect, at

least for a certain amount of time.

On the other hand, if we somehow fail to catch a more localized

pressure sore, that's a different matter. We are available on short

notice to shave down excessively tight areas of the helmet interior.

We may rely on your help to monitor the pink spots, or " reactive

hyperemia, " under the holding points to make sure they fade away

within an hour when the helmet is removed.

Q: So, if we see pink spots, we should call you?

A: No. Provided the pink areas are located where they should be,

centered on the prominent skull areas, reactive hyperemia simply

indicates that the helmet is working. I like to see them right after

an adjustment, then have them fade away over the next few days as the

cranium changes shape. They might persist longer, though. The

problem would be when they don't disappear within an hour when the

helmet is taken off daily. The skin needs at least that much rest in

order to stay healthy.

And if you ever feel the helmet getting tight at the closure when you

put it back on baby's head, *don't* wait for pink spots to tell you

when to call for an adjustment. They could re-appear in the wrong

places, which might not be good for your baby's head.

--

Thad Launderville

Montpelier, Vt

Clara age 2, STARband '10

On May 2, 2010, at 1:03 AM, vk263 wrote:

> Hello,

>

> I have an appointment with three different helmet providers the

> coming week and i was wondering if u all could help me out with

> some questions that i should ask them. I have prepared some but am

> wondering if i will forget to ask something important!

>

> Thank you

[Guest guest]

The following is almost pure fantasy, based on *one* story read here

of a clinician who recognized a fit problem and sought to correct it

without major prodding. Call it a bonus question, but nonetheless, I

feel I should pursue my line of questioning to its logical conclusion...

Q: Have you ever made a helmet that doesn't fit? How would we know?

What would you be willing to do in order to make things right?

A: It has happened. The initial helmet shape is a human-modified

form of the image we capture here (cast or scan), and subsequent

adjustments are also subject to human error. Sometimes it comes back

too small, so there isn't enough foam to complete a full course of

treatment. You can trust me to be on the lookout for that and get

you a new helmet within two weeks if necessary. Expect a treatment

period of at least four months, or else a perfect head before that

time is done. (I can't guarantee results -- it does depend on your

baby's head somewhat.)

Sometimes the helmet fails to make positive contact with the

prominent points of the head, often seen as rotation when the

prominences slip into the void spaces. A little bit of that is

normal at the beginning, but if I can't show you a snug, properly

aligned fit within three weeks at the latest, I'll make you a new

helmet for free. Expect to see pink spots on the prominent points of

the head.

--

Thad Launderville

Montpelier, VT

Clara age 2, STARband '10