Ruby’s Story, 2008
Ruby was initially diagnosed with occipital Plagiocephaly at 4 weeks old during a routine paediatric appointment. We were referred to the hospital physiotherapist to check whether Ruby had Torticollis. The physiotherapist checked Ruby’s neck range and advised that Ruby had full neck movement and no sign of Torticollis, although she did have a preference for holding her head to the left. The physiotherapist suggested that we maximise Ruby’s tummy-time, but otherwise did not appear concerned about Ruby’s flat head.
By the time Ruby was 11 weeks old the left side of her head had become quite flat. When looking from above, the shape of her head resembled a parallelogram rather than an oval. We also noticed that her left ear was placed more forward than her right ear, her left forehead was prominent, and her left eye and cheek appeared larger than her right. We compared the shape of Ruby’s head to photos on the Internet of other children diagnosed with Plagiocephaly and decided to seek specialist advice. We contacted Prof David David’s offices in North Adelaide and booked in for a consult the following week.
Prof David arranged for Ruby to have x-rays to rule out Craniosynostosis and then diagnosed her with moderate Plagiocephaly. Prof David advised that he does not support children being fitted with head-moulding helmets, describing the helmets as “vice-like” (this practice is often used in the United States to treat Plagiocephaly). Instead, Prof David encouraged us to reposition Ruby at every opportunity to keep her off the affected side. Prof David minimised our worries for the future by assuring us that with the use of repositioning alone, the heads of most children with Plagiocephaly round out by the age of 3 – 4 years.
In fact, Prof David has completed studies that compare the outcomes of repositioning versus the use of helmets, and the results for repositioning are comparable with the use of helmets – it just takes longer.
Following our initial consult with Prof David we worked out an intervention plan to address Ruby’s flat head. Here are the steps we implemented:
We used a purpose-designed sleep positioner that ensured Ruby slept on her back (as per Safe Sleep guidelines), but with her head turned to the unaffected side.
We used a small memory foam pillow under Ruby’s head when she enjoyed floor time.
We propped up Ruby’s left shoulder when on the change table so that her head fell to the right. We also positioned the change table so that she could see out of the window during nappy changes.
We positioned Ruby’s cot so that she looked to her right we when entered the room.
We minimised Ruby’s time in car seats, prams, bouncinettes and rockers.
When Ruby was in the car seat, pram, bouncinette or rocker, we used a head positioner to keep her looking forward rather than to her left side.
We persisted with short but frequent periods of tummy-time.
We used a sling to encourage Ruby to snuggle into our chests for naps, and when out and about. This kept Ruby off the back of her head, as well as encouraging bonding and attachment.
We alternated feeding positions.
We maintained these interventions for 4 months, but within 1 month we could already see significant improvement. You can see the improvement in Ruby’s head shape on Prof David’s website, where Ruby’s before and after photos are on display.
Ruby is now almost 10 months old and she only has a small area of flattening that remains on the left side of her head. Ruby still has slightly asymmetrical ears and facial features, but this is hardly noticeable and will probably continue to improve over the next few years. When we compare photos from when Ruby was 2 months old, to when she was 6 months old, the improvement is amazing.
We are very pleased with the improvement in Ruby’s head shape, and thank Prof David for his expertise and advice.