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Tim,

I just wanted to welcome you to the board!

Folks, we are truly lucky to have Tim here!

Sincerely,

Jaya Dong

www.caps2000.org

> > what makes some kids prone to plagio and not others. It's not

like

> > Genna spent the first months of her life laying on her back 24/7

> > (although she has always hated being on her tummy for some

reason,

> > she was held alot and I even had her nap in a sling on my hip

lots

> of

> > times so she could be upright). I'm sure there are babies that

> spent

> > far more time on their backs that have round heads.

> >

> > My sister's kids pretty much lived in their carriers and their

> heads

> > were always nice and round.

> >

> > Could it be because she was born at 36w and her skull was more

> > malleable?

>

> Today many people will cite back sleeping as the cause of

positional

> plagiocephaly, yet in reality there are a number of different

> factors. Many of the children we treat have a combination of these

> risk factors, including:

>

> Back Sleeping: The bedding we use today is much firmer, and we are

> advised not to place soft items such as pillows or toys in the crib

> with the child. Until recently, very little information was

provided

> to parents about the importance of supervised tummy time, so even

> when the children were awake, they often spent much of their time

on

> their back on the floor, or in a swing, car seat, or infant

carrier.

> Although little attention has been paid to car seats and swings,

the

> surfaces are quite hard and we have treated many children whose

> deformities have been traced to spending extended periods of time,

> including sleeping in them, for several months. Back sleeping can

> also allow a very mild torticollis (see below) to deform the head

as

> it will pull the head into the same position against the mattress

> every night.

>

> Torticollis: Often referred to as wry-neck, in essence it means

that

> the child has a stiff neck that causes them to have a very

noticeable

> head tilt and favor turning to one direction. Once a proper

> diagnosis is made, neck stretching exercises often resolve the

> problem, however " tough-love " on the parent's part is required - in

> most cases the child will not like the exercises, but they need to

be

> done.

>

> In Utero Constraint - This was often felt to be the number 1 risk

> factor for plagiocephaly prior to 1992 (When the 'Back to Sleep'

> campaign began). An infant's head can become deformed in utero by

> becoming engaged in pelvis, or if the child is in a breech

> orientation, by becoming wedged under the ribs. In the later case,

> the head will take on a long and narrow shape (scaphocephalic),

often

> with a ledge or prominence at the very back. Sometimes the in utero

> restriction does not deform the head directly, but does cause the

> development of a torticollis as discussed above.

>

> Prematurity - As stated in the earlier post, an infant's cranium

> becomes much more rigid during the later part of pregnancy. In

fact,

> the fetal cranial bones increase in stiffness tenfold during the

last

> 10 weeks of pregnancy. Thus, if a child is born premature, his or

> her head is much more malleable than a child delivered full term.

> However, there is more to consider - Premature infants often spend

> more time in the NICU where their heads are rotated side-to-side.

> This can also cause a long, narrow head shape as discussed

earlier.

> Premature infants also often lag behind in terms of developmental

> milestones which may not allow them to reposition their heads as

> easily as full term children.

>

> Multiple-Births. My personal favorite (being an identical twin

> myself). We have completed several papers that have documented

that

> multiple birth infants (twins, triplets, and higher) are

> significantly more likely to develop plagiocephaly than their

> singleton counterparts. From the discussion above, you've probably

> guessed why - they have in utero constraint, are often premature,

> often spend extended periods of time in the NICU as well as have

some

> developmental delays, sleep on their back, and have a higher

> incidence of torticollis.

>

> While these are not all of the factors, they are the most

prevalent.

> How other factors, such as genetics, racial ancestry, and gender,

> contribute to the development of plagiocephaly remains unclear.

>

>

>

> Sincerely,

> Tim Littlefield

> Cranial Technologies, Inc

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