Kenneth has sported a fairly severe flat head since he was only a few weeks old. Of course, when he was born, he had a bit of a molding issue, but his head was not nearly as frightening as Andrew's was at birth. Anyway, I thought that Ken was perfect and precious from the start, but his head shape began to get really quirky and flat by two months. During a sick visit at two months old, a pediatrician (not my regular) acted frightened and/or offended by his flat head. I was fully aware of his misshapen head, so the fact that she noticed it did not alarm me. However, her reaction and list of solutions (reposition Ken several times daily and give him more tummy time) nearly convinced me that I was an unfit mother. In my mind, I was defending myself and thinking: I move him several times throughout the day, I turn his head & stimulate him with toys so that he doesn't only lie on his favored side, and I force him to participate in completely unwanted tummy time. I left with the burden of feeling judged and with an amoxicillin prescription for Ken's ear infection.
Fast forward to his four month well baby check. I pointed out my continued concern about his head given his lack of movement, and my sweet, non-alarmist, experienced pediatrician explained that it should improve as he begins rolling over more, etc. Ken's doctor did not think that he had any signs of torticollis, but she referred him to be evaluated a physical therapy/rehab clinic to be sure. On February 28th, a therapist agreed that he did not have torticollis. He was developmentally hitting the necessary milestones and showed full range of motion in his neck. Ken began rolling over around six months, but he was still sleeping on his back. By seven months, Ken began to sleep on his belly, but we were not seeing any improvement in his head shape. So, I scheduled a visit with our pediatrician. She agreed that the flatness was not improving, and she said that although she was not concerned about his head fusion, she recognized that it was one of the more severe positional plagiocephaly issues that she had seen. Then, she referred us to a neurosurgeon.
In late June, Ken got up close and personal with a neurosurgeon and his physician assistant. The P.A. saw us first. He measured Ken's head, Nick's head, and Andrew's head. He explained that he did not think that Ken was not suffering from synostosis. Then, he brought out the gavel. Judgement dose #2 came in the form of this aging male P.A. who said, "You stay home with the kids, right?". Then he proceeded to explain how stay at home moms, and more specifically I, need to put kids on their belly more. They (the babies) don't like it, but it needs to happen. If I remember correctly, he actually told me to "suck up" the crying that would occur during tummy time. He also explained that had he seen us when we first noticed the flatness, he could have completely prevented the problem by suggesting these things and by having me actually implement them. Awesome. Thanks. Needless to say, he was fairly certain of the type of mother I was and had he been grading me, I felt a very strong C- from his attitude. Then, the neurosurgeon came into the room, explained again that Ken was not suffering from synostosis. His head was growing at a normal rate with his father's and his brother's. We had two options: see if he grows out of the flatness on his own or get a molding helmet. He did not seem to be a huge proponent of the helmet, but he did not quite discourage it either. He said that he would write the referral for the helmet, but the decision was up to us. Positive results were not guaranteed with or without the helmet. Super options, right?
NOTE: NICK DID NOT FEEL LIKE THE P.A. MADE ANY KIND OF JUDGEMENT TOWARD ME. Clearly, my husband must not be a stay at home parent. It is my full-time job, and I know when my work is being critiqued and criticized.
The next step since we were considering the helmet was a cranial scan. I decided that having a cranial scan did not force us into getting a helmet, and I was interested in what the scan would show. The scan was actually really cool. And, it gave us an even more specific diagnosis according to his head measurements: right side asymmetrical brachycephaly. The cranial scan suggested that a helmet would be a good choice for Ken. However, both the woman that performed the scan and the woman from the orthotics company explained that there were no guarantees with the helmet, it needs to be worn 23 hours a day, his head should improve on its own over time, and it is costly. How costly? 3,000 costly.
I know what you are thinking. Surely insurance would assist with a medical device that is suggested by several different medical doctors, therapists, etc. Nope! As a TRICARE beneficiary, I spend much of my time reading their policy manual (kidding), and Chapter 8, Section3.1, E reads:
Cranial orthosis (DOC Band) and cranial molding helmets are not covered for the treatment of nonsynostotic positional plagiocephaly (deformational plagiocephaly without synostosis) or for the treatment of craniosynostosis before surgery.
TRICARE is not alone in this policy. So, here is the final question: To helmet or not to helmet? We tried to ignore the cost of the helmet when making our decision, and still our decision was not to helmet Ken. We hope and pray that we are making the correct choice. Ken's pediatrician and a few other valued medical voices in our lives have concurred that this is a valid, if not good, choice.
We'll have to see if all of our subsequent children have flat heads. The number of children with flat heads has increased exponentially since parents have been directed to place babies on their backs to go to sleep (to prevent SIDS). That could be part of the explanation for Ken's head shape along with his lack of mobility, but let's be honest, it probably has more to do with my poor mothering!
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| My very scientific photo to document my concern for his pediatrician on May 22. |
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| Last week at Boone Park. Helmet free and ready to play. |
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