“Flat head syndrome” (Plagiocephaly)

Definition: plagiocephaly comes from the Greek word “plagio”, meaning oblique and “cephaly” referring to the skull.

The baby’s skull is made up of bones that have not yet fused, allowing the skull to grow as the brain grows. This also makes it prone to changing shape where pressure is applied overtime.

Positional plagiocephaly occurs as a result of pressure from outside forces on the baby’s skull (such as sleeping on one side). This pressure leads to flattening on one side, which can cause a shift in the placement of other bones in the skull, leading to a change in head or face shape and appearance.

Nelson’s Textbook of Pediatrics, 20th Edition (page 2821)

It is much more common now, as a result of “back to sleep”, where doctors now recommend having babies sleep on their backs as part of safe sleep campaigns.

How common is it?

By 4 months of age, the incidence is 20%, which means that two out of every ten children will have plagiocephaly. Infants under 4 months of age cannot reposition their heads well, and so may sleep or lie down with their heads in the same direction every time. It is most commonly seen at this age, although it can be seen as early as 6 weeks old. It generally starts to get better around 6 months of age because of better head control.

What are some risk factors?

  • Sleeping on their backs with their head in the same direction each time.
  • Congenital torticollis, a condition where the muscle in one side of the neck is shortened and tighter, leading to difficulty in turning the head.

There are some other risk factors, as shown in the table below:

Nelson’s Textbook of Pediatrics, 20th edition (page 2819)

Can you prevent positional plagiocephaly?

Yes, there are things you can do to prevent it, and also to treat it should it occur! I have listed the prevention and treatment options.

  1. Alternate positions: whenever your baby is on his or her back, whether that is during play or sleep, try to get your baby to lie on both sides of their head. There are a few tips to help you achieve this, outlined below. The earlier you start this, the more time your baby will have to get used to it!
    • During sleep:
      • Change the direction they are sleeping in each time they go to sleep. Babies usually look toward a light source or into the room, so if you change the sleep position (i.e., their head at the head of the bed, alternating with their head being on the foot end of the bed), they will likely turn their head naturally.
      • If you are using a mobile, change the placement of the mobile.
    • During play:
      • You can use brightly coloured or toys that make light or noise to get your infant’s attention and get them to turn their head in different directions minimizing the time on one side.
    • Hold your baby in different ways during feeding, playing, or sleeping.
    • Supervised tummy time! 10-15 minutes at least three times a day, or as many times they would like. This would also help with development of gross motor skills like rolling and sitting up.
  2. Physiotherapy: useful for repositioning strategies. Also, if your baby has torticollis, physiotherapy will help release the tightening on the affected side, allowing your baby to move his or her head more freely in all directions.
  3. Helmet therapy: can be used in severe cases. As the skull is growing rapidly in the first few weeks of life, the purpose of the helmet is to help development occur symmetrically. The protects the areas that are flat while the child’s skull grows into the flat spot. Helmet therapy can speed up symmetrical development of the skull compared to repositioning alone. In Canada, according to the Canadian Paediatric Society, the maximum age to consider helmet therapy is 8 months. There is minimal benefit after 10 months of age (Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis, 6th Edition, page 892). However, it can be expensive and needs to be worn essentially all day for many months. It can also cause irritation, discomfort and pressure sores.

Interesting fact: right-sided plagiocephaly is more common, which is thought to be due to mothers being right-handed and baby being in right side down position to nurse causing flattening of that side. (Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis, 6th Edition, page 892).

In a nutshell, positional plagiocephaly is very common, as babies lie on their backs and do not have great head control until 4 months of age. The natural course of positional plagiocephaly is that it improves overtime. Prevention can be through repositioning therapy and physiotherapy. Treatment includes the same, and if the asymmetry in skull shape is severe, helmet therapy can be considered.

I would love to hear your experiences with positional plagiocephaly. Did you have helmet therapy? Did you choose not to? What are your thoughts?

Toxic Stress: What’s Love Got To Do With It?

What is Toxic Stress?

Stress is a hard-wired response of our mind/body to certain situations.

Positive Stress: There’s a level of stress that is healthy, and can even be good, to be experienced as a child. At a mild level of stress that does not last long, a child can learn to overcome the stressful event and gain confidence in their own abilities. They can build resilience skills. This is a positive level of stress.

Tolerable Stress: When an infant/child experiences a higher degree of stress this can exhaust their coping mechanisms, and this can impact their development and how they cope with stress. If the stressful event is short lived, or there are protective factors such as a supportive caregiver to help them navigate their way through their stressful experience, this can help a child cope and protect them from the negative effects of stress.

Toxic Stress: At a severe level of stress, particularly if it lasts a long time, without supportive factors, a child’s development can be affected. This can impact their ability to learn, their ability to form healthy relationships, their ability to complete school and hold a job as well as their mental and physical health. Toxic stress can include abuse, financial strain on the family and intimate partner violence.

https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

What can cause Toxic Stress?

Family stressors, trauma, financial difficulties, poverty, neglect, abuse, among others. A child’s ability to cope with the stress can change the impact the stressful event may leave on the child. The genetic makeup of the child can change the impact the stressful event can leave on the child. Moreover, the developmental stage at which the child experiences the stress can change the impact the stressful event leaves on the child.

How can toxic stress impact my child’s health?

There are complex mechanisms by which mental and physical health and wellbeing can be affected, resulting in chronic disease that can last a lifetime. Some of these negative effects include:

  1. Negative impact on child development
  2. Learning problems
  3. Behavioural problems
  4. Mental health problems such as depression
  5. Social problems
  6. Increase in infectious diseases
  7. Heart disease
  8. High blood pressure
  9. Diabetes
  10. Earlier adult death
  11. Premature aging

https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Fabout.html

Maternal mental health during pregnancy has been found to impact a fetus’ immune response, and chronic stress/anxiety in mother during pregnancy can lead to more illnesses in newborns.

So, what’s love got to do with it?

When I say love, I basically mean responsive caregiving. That could be from a parent, a guardian, anyone who is in a position to care for a child. When you think back to people who were there for you during a difficult time, those are likely the people that made a difference to how you got through it. Caregivers that provide support, unconditional love, a non-judgemental, understanding listening ear – they can all help mitigate the negative effects of toxic stress.

Animal models have helped understand the impact of supportive caregivers on the stress response. During the early period of a baby’s life, the family environment can impact how we respond to stress. In fact, even if we are genetically susceptible to negative stress responses (such as high levels of anxiety, reduced resilience, etc), our environment can work to impact which genes are turned on/off (epigenetics). That is, a supportive caregiving environment can affect the way our genetic code is expressed, to help a child mentally and physically cope with stress in a much healthier way.

In studies of rodents, those whose mothers were highly nurturing showed well regulated stress response in the body, whereas those who were born to low nurturing mothers showed a dysregulated stress response. A supportive environment provided at any time in a child’s life is beneficial, but there are also certain times this is more beneficial than others as their brains are developing.

The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy (Pediatrics, Volume 131, Number 2, February 2013)

The Adverse Childhood Experiences Study

Also known as the ACE Study, is a study that investigated childhood abuse and family challenges and their impact on later life health and wellbeing. The higher the ACE score (which is based on factors that contribute to toxic stress), the greater your likelihood of developing health problems as a result. If you are curious about your own ACE score, check out the CDC Website on the ACE study, and scroll down to Survey Questionnaires.

Conclusion

So, there is some evidence that the environment in which we raise our children can impact not only their mental but also physical health.

Can you think of a time an event in your childhood left you stressed and how adults around you impacted how you coped with this stress? I would love to hear your thoughts!

Bronchiolitis

What is bronchiolitis?

The airway consists of a large tube, called the trachea, which breaks down into to smaller tubes (bronchi). These bronchi break down further into bronchioles, so, sort of like mini bronchi. It is these smaller airways that are affected in bronchiolitis. “Itis” means inflammation. So, bronchiolitis is inflammation of the smaller airways.

There is a build up of mucus which can block the smaller airways also. It affects children under the age of 2 years, as their airways are smaller.

What is the difference between bronchiolitis and bronchitis?

Bronchitis is caused by inflammation of bronchi, whereas bronchiolitis is caused by inflammation of the bronchioles. Bronchitis tends to occur in older children and adults.

What is the difference between bronchiolitis and the cold?

The common cold affects upper airways, including ear, nose and throat, whereas bronchiolitis affects lower airways.

What causes bronchiolitis?

Respiratory Syncitial Virus (RSV), among other viruses can cause bronchiolitis.

What are the symptoms of bronchiolitis?

Cough, stuffy and/or runny nose, fever, wheezing. Other, more serious symptoms include difficulty breathing, sucking in of the skin in the neck, in between the ribs or under the ribs, poor feeding or difficulty sleeping. Be sure to take your baby to the doctor/ER if any of the more serious symptoms occur.

How long does it last?

Like many viral illnesses, it usually lasts 7-10 days, but the cough can last up to a few weeks.

How is it treated?

If your doctor gives you the go ahead to look after your baby at home, there are several things you can do to help your baby through their infection (see previous post on getting your baby through respiratory illness). Sometimes, symptoms tend to get worse before they get better (for example, if your baby has RSV bronchiolitis, symptoms may get worse around days 3-5 of illness and then get better afterward).

  1. Saline nasal drops and aspiration (before feeds and sleep)
  2. Frequent, smaller amounts to drink
  3. Control fevers with tylenol/advil if your doctor has cleared you to use it
  4. Ensure immunizations are up to date
  5. Avoid other triggers and allergens (smoking and allergens can make breathing problems worse)
  6. Avoid sick contacts and practice good hand hygiene to avoid another illness
  7. Sometimes, babies can respond to inhalers (speak to your doctor to see if your baby may need them)

If your baby has severe symptoms including poor feeding, seek medical attention right away.

Literacy: Part One

Literacy refers to the ability to read and write and do basic arithmetic, which is divided into different levels based on one’s ability to understand and use the information to function within society and at work.

According to Statistics Canada and Human Resources Development Canada, literacy is measured on a score of 0-500 (5 Levels), with a minimum score of 300 required to be able to have a job and Level 3 to be the basic level at which an individual can function well in society.

Millions of Canadians cannot read well enough for daily activities.

What can we do about it?

Children are born with the ability to learn rapidly, as their brains are taking in information and making connections. What they learn in the first few years of their lives will set the foundation for the rest. Literacy skills are like a muscle – the more this muscle is worked, the more it will grow. If it is not worked, it will get weaker.

Children spend the first few years of their lives learning to read. After this, they read to learn.

Children learn language before they start school, and it is their caregivers they learn the most from during this time. Over the next few weeks, I will be discussing literacy and its importance, as well as how caregivers can help their children develop early literacy skills.

What are some effects of low literacy?

  1. School problems
  2. Not completing school
  3. Unemployment
  4. Negative impact on health
  5. Poverty

I will discuss this in more detail in the coming weeks.

I will leave you with this question: When should you start reading to your child?