The Ultimate Guide to Plagiocephaly & Torticollis

Contents:

Who am I and why should you listen to me?

About The Author Payel Banik D.O.

Why we wrote this

Important details around these conditions

What exactly do these confusing Greek words mean?

How are these two conditions typically diagnosed?

Did I do anything to cause the problem?

How can birth be traumatic causing

About The Author Payel Banik D.O.

For more than a decade, Dr. Banik spent 20,000 hours training, studying, and applying advanced anatomy and physiology on her patients, looking to find the heath within the human body. She helps pregnant (and postpartum) mothers aged 24+ to be able to move easier, live with less pain even if they have lost hope, and have the best shot of a natural delivery . PLUS, she helps parents have peace of mind for their infants by NATURALLY encouraging the body to heal itself: addressing plagiocephlay, torticollis, reflux, colic, constipation, difficulty breastfeeding, etc. – all from ONE physician

Dr. Banik is a dually board certified physician who has spoken on the Whole Mother radio show multiple times regarding this subject, and opened Osteopathic Healing Hands in May of 2014. She has patients fly internationally to get treated by her.

Dr. Banik is actively involved in educating her community in Houston with scientifically proven methods to help people make better decisions about their health and to brighten the DAY of anyone who enters our world.

Why we wrote this

I LOVE the internet! Technology is AMAZING! Unfortunately, there is a bunch of really bad, inaccurate information, or exceedingly complicated medical jargon out there.

How is the average person supposed to know how to fix a problem without knowing who is trustworthy enough to fix it? It only compounds the problem when you don’t know which sources are credible and which are not.

As a dually board certified physician who specializes in helping babies all across the country, I wanted to provide the ultimate guide for plagiocephaly and torticollis. The goal of this guide is to help you make the best (and medically sound) decision possible for your family based on up to date research.

It only made sense to provide one central guide answering the most common questions around babies with flat or misshapen heads (plagiocephaly), along with infants who prefer to side bend or look towards one direction (torticollis).

Since, we are talking about your child’s health, the last thing I want is to have something come into harm’s way with your child, especially if it could have been prevented. We, as parents, do everything we can to protect, nurture, and take care of our children.

“I read it on the internet, it must be true”

Unfortunately, not everything you find online is safe. I have done my best to translate the difficult medical speak into something anyone could understand.

This all started when my husband joined different online groups and started to see the same questions appearing time and time again. My husband quickly found out there really isn’t one consolidated place where all the relevant pieces are put together. He has helped me aggregate these common questions into this document.

Important details around these conditions

What exactly do these confusing Greek words mean?

The term “plagiocephaly” is a Greek derivative that means “oblique head.” ^[i] Most skull deformities present at birth are the result of molding while the baby is in the womb or during delivery.

Brachycephaly is a flattening of the back of the head, also likely due to this molding.

Scaphocephaly is when the head shape is long and narrow, which may be positional (from side-lying in the NICU) or may be due the premature closing of skull sutures between the bones.

For the purpose of this document we will refer to all these different head shapes as plagiocephaly, as the treatments are the same.

“About one in four U.S. infants has some degree of positional plagiocephaly.^[ii]” Uterine constraint, like fibroids and multiple-birth infants, and forces exerted on the skull during complex delivery associated with forceps or vacuum-assisted delivery^{[iii], [iv], [v]}, can all contribute to molding of the skull.

Infants born prematurely also have a greater incidence of skull deformity attributable to molding after birth.^[vi]

Most of these deformities improve spontaneously during the first few months of life if the infant does not rest his or her head predominantly on the flattened area of the skull.

Because the bones of the head are so malleable, if the infant continues to rest his or her head on the flattened side or back of the head, the deformity may become worse. ^{[vii],[viii],[ix]}

Infants with torticollis have some limitation of active rotation of their heads away from the flattened side of the back of the head (occiput). Again because the bones of the head are so malleable in infancy, the preference may lead to positional plagiocephaly.

Torticollis has two components. Either the person prefers to look toward one side or they tilt their head to one side and look toward the opposite side.

Torticollis or “wryneck” in the young often arises from the trauma of giving birth or malpositioning in the womb. The baby’s bones of the skull are designed to be as free as possible to allow for passage through the birth canal.

Sometimes they can get stuck, which will affect the nerve (called the spinal accessory nerve) that plays a major role in neck muscle functioning. For example, one of the bones at the base of the skull is called the occiput. Another bone is called the temporal bone.

There is a hole created between these two bones called the jugular foramen through which many nerves and veins pass through. Now, if you imagine a traumatic birth experience where the bones of the occiput and temporal bone squished these nerves, then one side of the neck muscles would pull harder than the other side resulting in torticollis.

Rarely, torticollis may be a consequence of hemorrhage (within the sternocleidomastoid muscle) and/or subsequent scarring within the sternocleidomastoid muscle.^[x] It may also be a result of visual complications where an abnormal head position is adopted to compensate and maintain single vision instead of double vision. This is known as ocular torticollis. ^[xi]

How are these two conditions typically diagnosed?

For plagiocephaly, it is important for the pediatrician or other examiner to look down at the top of the head, view the position of the ears, and note the position of the cheekbones (maxilla).

By doing this, the typical plagiocephalic positional skull deformity, which forms a parallelogram, will be observed.

For torticollis, the rotating-chair or stool test is a procedure that assists in the diagnosis of torticollis associated with positional skull deformity.

The examiner sits on a rotating chair or stool and holds the infant facing the parent: the parent attempts to keep the infant interested in maintaining eye contact while the examiner rotates with the infant on the chair or stool and observes the infant’s head movements. ^[xi]

Did I do anything to cause the problem?

One of the most common questions we hear is “what did I do wrong?” First of all and most importantly, the short answer is you did not cause the problem. It doesn’t matter if it’s a flat spot, a pointed head, or a preference to look to one side.

You should not feel guilty for following the current recommendations.

Since the American Academy of Pediatrics Task Force on Infant Positioning and Sudden Infant Death Syndrome (SIDS) in 1992 recommended that healthy infants be positioned on their back for sleeping, the incidence of SIDS has decreased from 1.2 per 1000 live births in 1992 to 0.56 per 1000 live births in 2001.^{[xii],[xiii],[xiv]}

Coincident with this decrease in SIDS has been a drastic increase in positional skull deformity, estimated at approximately 13% in healthy singleton infants,^[xv],[xvi] which makes plagiocephaly relatively common.

Plagiocephaly is now estimated at approximately 13% in healthy singleton infants since the American Academy of Pediatrics Task Force on Infant Positioning and Sudden Infant Death Syndrome (SIDS) in 1992 recommended children sleep on their back^{[xvii],[xviii],[xix]}. In otherwords, kids have squishy heads when they are young. If you have them lie on their back constantly, it’s no surprise that part goes flat.

How can birth be traumatic causing these problems (and others)?

Birth is indeed a normal part of the cycle of life. Yet birth is certainly capable of becoming our very first trauma. This trauma may be extreme, producing obvious injury. However, even when a normal birth appears to be completely trauma free, the pressures applied to the infants head (cranium) can still cause some problems.

The tiny infant is extremely resilient; able to withstand tremendous pressures as we are squeezed through the birth canal, and forced to take our first breath. This first breath infuses our tissues with life, and expands our compressed bodies to ready ourselves for the world.

The infants head (occiput) plays a significant role in opening the birth canal. The normal pressures of birth cause the cranial bones to fold over one another. The membranes (meninges) and fluid (CSF) surrounding the brain act as a bouyant shock absorber. The nervous system, always attempting to maintain stability under duress, organizes around these forces. These protective mechanisms allow for maximum brain capacity and minimize brain trauma.

Many of the problems commonly experienced in infancy may be caused by the forces of labor and delivery.

The compressive forces of birth

If the compressive forces of birth are too great, the nervous system may become overwhelmed, and the skull bones may not be able to fully re-expand to their normal ease after the birth.

Some births may not appear at all problematic, but can still produce substantial compression. An abnormally quick labor may prove equally overwhelming as one that is long and difficult.

The newborn may become firmly imprinted by these compressive forces, producing structural imbalances and a variety of symptoms. These symptoms may range from minor variants of “normal” irritabilities to serious pathology.

Cesarean Sections:

• May be necessary to save the life of the newborn.
• May be necessary when the infant becomes stuckin the birth canal for extended periods of time, putting extreme pressures on their little heads.
• May be scheduled, for a variety of reasons.

Many infants born by Cesarean Section first endure a long period of labor, with their heads lodged in the maternal pelvis. The delivering physician also may sometimes place considerable force on child’s cranium, attempting to free the infant from the pelvic bowl. Though born by Cesarean Section, these infants may well suffer the ill effects of significant cranial pressure.

Some infants born via cesarean section do not encounter any compressive forces. We might think that the lack of trauma in a C-section is the best for the infant. But other factors come into play:

We need to be squeezed through the birth canal

This squeezing initiates a cascade of events that readies us for the outside world:

• Fluid is squeezed out of our lungs.
• Pressure is created for a powerful FIRST BREATH
• Our central nervous system is stimulated and begins to organize.
• Dramatic changes take place in our circulatory system.

The changes taking place in the circulatory system are staggering. Intra-uterine life is very different than life outside the womb:

• The umbilical vessels spasm shut. Blood no longer comes from or goes to the placenta.
• A hole in the heart (foramen ovale) closes.
• The lungs now infiltrate and oxygenate the blood (ductus arteriosum closes).
• The liver now metabolizes (ductus venosum closes).
• The kidneys now filter the blood.
• The GI tract now absorbs all nutrients.

These adaptive changes must occur in a systematic and orderly manner, and place huge demands upon the newborn. When the transition to extra-uterine life is too quick, these changes in the vascular system become disorganized^[xx]. So there are a lot of factors playing into plagiocephaly and torticollis and it’s not your fault.

Why are torticollis and plagiocephaly a common diagnosis together?

If your little one prefers leaning their head to one side or looking to one side, then they are prone to developing a flat spot on their head on that side because the bones of the head are so malleable. The two diagnosis don’t HAVE to go together but often do.

Should you use a jumper, rock n play, or pack n play babies have torticollis / plagiocephaly?

In general, the jumper and rock n plays should not be used until your baby has developed the trunk strength on his or her own. These devices, while they may seem convenient and allow you a reprieve from time to time, may delay the developmental milestones of rolling over by 4 months, sitting unsupported by 6 months, and may also affect how they stand/walk (on their tippie toes vs. flat on their feet)

What has been shown to cause serious, adverse events on pediatric patients?

One of the more common themes we see are parents understandably in desperation to help their kiddos.

While chiropractic spinal manipulation has been shown to be effective for adults, supportive published research on pediatric spinal manipulation is currently inadequate with some potentially serious consequences. The technique known as HVLA (High Velocity Low Amplitude) is what you commonly associate with the popping and cracking, has shown to have serious adverse complications within infants.

One of the gold standards for pediatric care, The American Academy of Pediatrics holds a firm stance on this. On July 01, 2007, they warn “Serious adverse events may be associated with pediatric spinal manipulation” and call for an additional study to assess “the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.”^[xxi]

What might this rare, yet serious event be? The Journal of Pediatrics explains “An infant with congenital torticollis underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia.”^[xxii]

Asides from the risks of popping and cracking (HVLA) on infants, an additional question is: what exactly is getting popped on an infant? They are not fully developed (more cartilaginous and membranous than bony) and are therefore at greater risk of serious injury. Current recommendations from the AAP are to avoid chiropractic spinal manipulation.

Understandably before something becomes a standard it must be tested and proven safe. It appears the Journal of Clinical Chiropractic Pediatrics and others are currently working to show this is safe; however, there currently is not enough evidence presented to overcome the severe risks above.

Furthermore, the American Chiropractic Association (ACA) does not provide any evidence for chiropractic treating torticollis on its most recent updated page April 19, 2016)^[xxiii]

If chiropractic care has been shown to have adverse events, then why is it that my friend/relative swears by how much it helped them? The truth is that many chiropractors, physical therapists, and massage therapists get additional training in a technique called CST TM. You can see the chart below which includes CST TM for you to better understand what they treat, the amount of training they have, and the number of areas of the body they treat.

Executive Options Summary – Chart

The chart shows;

Treatment options (and helpful details)

For torticollis?

You have a handful of different options available based upon the problem the infant has.

Torticollis perpetuates the position of the head on the flattened side and can add to a greater facial deformity^[xxiv].

In short you have several different options: Neck Exercises, Physical Therapy, Surgery, Osteopathy, and CST (cranial sacral therapy ^TM)

• Neck Exercises – If torticollis is present, neck-motion exercises should be taught to the parents as part of management. Neck exercises should be performed with each diaper change. There are 3 repetitions per exercise, and it is estimated to take approximately 2 additional minutes per diaper change. One hand is placed on the child’s upper chest, and the other hand rotates the child’s head gently so that the chin touches the shoulder. This is held for approximately 10 seconds. The head is then rotated toward the opposite side and held for the same count. This will stretch out the sternocleidomastoid muscle. Next, the head is tilted so that the infant’s ear touches his or her shoulder. Again, the position is held for a count of 10 and repeated for the opposite side. This second exercise stretches the trapezius muscle. In addition, the parents may be taught the previously mentioned rotating-chair or stool technique as a therapy to enhance neck motion in the infant.
• Physical Therapy – Stretching exercises are performed and taught with the goal of attempting to loosen up the tightened muscles and strengthen the core.
• Surgery on the SCM – The severity of torticollis may be a factor, but surgery should be the last resort. Any of the options listed throughout the document would be better to try first.
• Osteopathy/OMT – In the United States there are two types of physicians you can see, allopathic (M.D.) and osteopathic (D.O.). They are similar in the respect that they both attend four years of medical school and specialize in any residency they qualify for. IE. Pediatrics, Family Medicine, Cardiology, OB, Surgery, Etc..A key difference between the two is that Osteopathic Physicians get additional training during their four years in medical school on how to treat patients with their hands, or Osteopathic Manipulative Treatment (OMT).This includes many different ways to treat the body, one of which is cranial osteopathy. After the minimum seven years of training (eight for the dedicated and specialized), a D.O. must continue this separate “language” or else it is forgotten.Torticollis in the young often arises from the trauma of giving birth or malpositioning in the womb. The baby’s bones of the skull are designed to be as free as possible to allow for passage through the birth canal. Sometimes they can get stuck, which will affect the nerve (called the spinal accessory nerve) that plays a major role in neck muscle functioning.One focus in osteopathic treatments is correcting anatomical dysfunction to allow for better function.For example, one of the bones at the base of the skull is called the occiput. Another bone is called the temporal bone. There is a hole created between these two bones called the jugular foramen through which many nerves and veins pass through.Now, if you imagine a traumatic birth experience where the bones of the occiput and temporal bone squished these nerves, then one side of the neck muscles would pull harder than the other side resulting in torticollis.The osteopath’s job would be to help restore the bones to where they’re supposed to be so it takes pressure off this nerve and the baby can naturally correct its own posture and the shape of their head.The Journal Of Pediatrics in 2006 pointed out the following ^[xxv]Osteopathic Manipulative Treatment (OMT), particularly Osteopathy in the Cranial Field, is safe, effective, and well-tolerated in treating plagiocephaly, torticollis, and recurrent otitis media (ear infections) .Those of us who use the osteopathic approach to medicine rarely need to refer our patients for physical therapy or orthotics. Since many people are not aware this is even an option, my practice often works well with physical therapists, as the parents understandably put them there as an option. My patients have seen a reduced number of sessions with their PT, and a decreased recovery time / resolution of plagiocephaly and torticollis.
• CST (Cranial Sacral Therapy ^TM) – We will need to briefly explain a little history so you can understand the difference between CST (Cranial Sacral Therapy ^TM) and Osteopathy in the Cranial Field (OCF) / Cranial Osteopathy

When Bruce Lee first came to America and decided to teach the “secrets” of Chinese martial arts to the western world, there was a huge outcry from the Chinese community. They essentially were concerned about sharing knowledge with those that they felt were inferior. Lee disagreed and decided to teach who he wanted. The rest is history.

The same is true with Osteopathy in the Cranial Field (OCF). Dr. William Garner Sutherland, is the father of Osteopathy in the Cranial Field or Cranial Osteopathy and began his work in 1898, dedicating his life to advance the art of osteopathy and continuing until the 1950’s.

“The practice of OCF requires diligent study in applied anatomy, physiology, embryology, and pathology. Some osteopathic schools teach courses of study to their students, though most DOs seek training after they have graduated. It takes hundreds of hours of study and training to understand this specific field within osteopathy. Courses are taught to qualified individuals only: DOs, MDs, and DMDs. This is necessary due to the extensive medical background needed to understand and apply these concepts. The instruction absolutely requires a minimum of one highly skilled instructor to every 4 students, in order to give proper “hands on” training.^[xxvi]”

Dr. John Upledger was also a D.O., who controversially renamed OCF as “CST” (cranial sacral therapy ^TM) and branded it as his own discovery. From 1975 to 1983, Dr. Upledger was a professor of biomechanics at the College of Osteopathic Medicine at Michigan State University.

In 1985, Dr. Upledger founded The Upledger Institute to teach people worldwide, as he believed some of the basic techniques of osteopathy in the cranial field could be taught to the greater population, and also caused a divide within the osteopathic physician community. Upledger decided a similar path to that of Bruce Lee, choosing to go against his fellow physicians.

Currently, the typical people getting these several day certification classes are healthcare providers which include but are not limited to: chiropractors, physical therapists, massage therapists, dental hygienists, aestheticians, occupational therapists, etc. According to their website as of 12/4/16, more than 90,000 therapists have since been trained in CranioSacral Therapy.

The osteopathic community has not done a good job at explaining how CST teachings are basic techniques of Osteopathy in the Cranial Field.

The secret that many parents do not know about is that there are a handful of D.O.’s like Dr. Sutherland across the United States, around 1200 board certified physicians, who still practice this type of manual medicine.

The key difference between Cranial Osteopathy and CST is the education, knowledge, and skill of the provider. Many patients living in rural areas will have to travel several hours to find a board certified physician who incorporates OMT/OCF into their practice AND also specializes in infants/ children.

Osteopaths believe the sooner you can treat the problem, the easier and faster it is to correct. When treatment is started early before 4 months, on average, your osteopath will treat your child once a week for about 8-12 weeks for plagiocephaly, and our patients have seen improvements in torticollis within several treatments. Some patients spread out treatments every month, purely because they have to drive long distances. I am comfortable treating newborns, but this varies based upon provider.

You can find some osteopathic physicians in your area by going to the Osteopathic Cranial Academy’s Website here. Should you not find an osteopathic physician in your area you can look for a CST practitioner from their website here.

When and who gave you the diagnosis of torticollis?

Torticollis can be diagnosed soon after birth but some give it time to resolve on its own before recommending any intervention. It is usually diagnosed by a pediatrician or family physician.

What are your thoughts on surgery for torticolllis?

The severity of torticollis may be a factor, but surgery should be the last resort. Any of the options listed throughout the document would be better to try first.

Does torticollis effect when the baby rolls over and can sit up on their own?

If your child has torticollis, you may notice your baby prefers to roll to one side again and again before showing an interest in rolling to the other side. Torticollis may also shift the child’s center of gravity because the head is about 10% of body weight, which can make it more challenging to sit up on their own.

For plagiocephaly?

• 1) Repositioning – Keep your child upright and off the back of their head as much as possible when they are awake. Encouraging tummy time, especially during diaper changes, helps. And physical therapy teaches parents creative ways to reposition their babies
• Osteopathy/OMT – In the United States there are two types of physicians you can see, allopathic (M.D.) and osteopathic (D.O.). They are similar in the respect that they both attend four years of medical school and specialize in any residency they qualify for. Pediatrics, Family Medicine, Cardiology, OB, Surgery, Etc.. A key difference between the two is that Osteopathic Physicians get additional training during their four years in medical school on how to treat patients with their hands, or Osteopathic Manipulative Treatment (OMT). This includes many different ways to treat the body, one of which is cranial osteopathy. After the minimum seven years of training (eight for the dedicated and specialized), a D.O. must continue this separate “language” or else it is forgotten.The Journal Of Pediatrics in 2006 pointed out the following ^[xxvii]The DO ( osteopathic ) approach to plagiocephaly differs from that in the MD (allopathic) literature^{[xxviii],[xxix],[xxx]} which sees the problem as largely cosmetic. The osteopathic literature^{[xxxi],[xxxii],[xxxiii],[xxxiv],[xxxv],[xxxvi]} discusses prenatal, natal, and postnatal influences on its development, and it emphasizes the clinical consequences related to various degrees and positions of distortion. Osteopathic Manipulative Treatment (OMT), particularly Osteopathy in the Cranial Field, is safe, effective, and well-tolerated in treating plagiocephaly, torticollis, and recurrent otitis media (ear infections).Those of us who use the osteopathic approach to medicine rarely need to refer our patients for physical therapy or orthotics. Since many people are not aware this is even an option, my practice often works well with physical therapists, as the parents understandably put them there as an option. My patients have seen a reduced number of sessions with their PT, and a decreased recovery time / resolution of plagiocephaly and torticollis.
• Helmets ^[xxxvii]– referred by pediatrician and/or neurosurgeon. They restrain head growth in certain areas while keeping pressure off other areas to allow the flattened parts to “catch up.” If parents choose to go the helmet route, concurrent osteopathic treatments can shorten the duration the helmet is used. Since the helmet restricts growth in certain parts of the skull, post-helmet osteopathic treatments unwind cranial strains induced by the helmet on these ossification centers.
• Surgery – if your child has bones that are fused prematurely (called craniosyntosis), then this requires surgical correction. Craniosyntosis is a diagnosis confirmed by CT scan, which is better at imaging bone, and therefore MRI is not needed for evaluation in this instance ^{[xxxviii],[xxxix]}.

What are the medical findings around when should my child NOT get a helmet?

The AAP (American Academy of Pediatrics) believes “there is currently no evidence that molding helmets work any better than positioning for infants with mild or moderate skull deformity.^[xl]” They recommend orthotics “for severe deformity, the best use of helmets occurs in the age range of 4 to 12 months”. However, in a March 2014 Journal Article from the British Medical Journal disagreed. They stated “Based on the equal effectiveness of helmet therapy and skull deformation following its natural course, high prevalence of side effects, and high costs associated with helmet therapy, we discourage the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation.^[xli]“

Why do some parents feel pressured to purchase a helmet?

Some parents have expressed frustration that they felt sold to. On Glassdoor, a website that lets employees publicly rate their employers, the findings were shocking, as you can see below.

Some employees felt guilt about selling helmets knowing that the patients did not actually need them. Others cited lack of experience for the work done, with inadequate supervision, ultimately leading to unqualified providers treating beyond their ability. This can put your child at risk.

Hopefully, these six comments are not indicative of all orthotic stores; however, the employee feedback should cause concern in the parents looking into orthotics.

After reading these employee reviews, ask yourself, do I feel they really have my child’s best interest at heart?

The only company that did not have any reviews, positive or negative, was Starband. You can see the unedited publically available responses below.

• Example one – This employee talks about the lack of training she was provided because they were too busy, and how they were guilting parents into helmets when they were not needed.

Example two – An employee who is a RN was encouraged to “lie” to the parents about the progress of their child’s head shape, and the 2 week training was terrible and not effective. She was then expected to see patients on her own with no help or guidance from management or other staff. It was “THE worst job experience I have ever had in my 10 years of being an RN.”

Example three – The prior employee stated that the only thing the company cared about was making money, not helping shape infants heads. They treat any baby even if they don’t need it. Remember, helmets are only supposed to be recommended as an option under severe cases.

Example four –This employee was upset about “management always pushing for more sales. The last week of each month we are pressured to come up with sales numbers that may not be obtainable.” This is why having someone with the most experience can be in the best position to help.

Example five – This employee was upset with the top level management ethics and morals as there is a “strong movement towards less educated practitioners to reduce compensation and effect the bottom line.” There are businesses that can afford to cut corners and the end result isn’t compromised. Is your child’s health worth being one of them? Asides from the loss of money, what else could possibly go wrong with having your child’s head in the hands of inexperienced workers?

Example six – This employee is understandably upset about the “very unprofessional and unethical” experiences they had. Asides from making recommendations to babies who don’t need them, the company lets orthotists treat torticollis when the qualified physical therapists are busy. This is really egregious and dangerous. Think of asking an IT computer professional to perform surgery on your child. It’s a really bad idea.

To helmet or not to helmet? We are getting conflicting advice.

This can be confusing, especially when your pediatrician, neurosurgeon, or AAP is recommending the helmet but another medical journal discourages it and you’re seeking an alternative. You may even go to the orthotics appointment and feel like you’re “just being sold something.”

Osteopathy is an option that is not commonly known, even among the medical community. If you do decide to go the helmet route, having periodic osteopathic treatments can shorten the length of time your child is in the helmet, and it has the added benefit of undoing the bony strains the helmet may cause. We are also happy to discuss with your pediatrician any questions or concerns they may have regarding osteopathy.

Who teaches non physician healthcare professionals techniques to help my infant?

There are other basic osteopathic techniques that chiropractors (and other healthcare professionals such as physical therapists, massage therapists, dental hygienists, aestheticians, occupational therapists, etc.) can get licensed on. The largest institution providing these certifications is the Upledger Institute.

This was founded by an osteopath who wanted to teach basic osteopathic techniques through different workshops. These classes are typically held in a hotel and are open to anyone who wants to learn; however, if you are not a healthcare practitioner and/or student with a solid anatomical and physiological working knowledge, you will not get licensed or certified to do hands-on body work.

Most states do require you to have a license to legally practice a hands-on therapy such as CranioSacral Therapy (CST) in the United States.

Since we are not currently aware of the different state laws for licensing to practice hands-on therapy, at MINIMUM you should always make sure your provider has a valid license to practice any hands-on body work, including but not limited to CST.

All providers can vary in competency and effectiveness.

These providers can be effective, and *should* know when to reach out when a problem is beyond their capacity. Sadly we have heard instances where this was not always the case. It is always a good idea to ask a non physician provider how frequently they refer out and under what situations.

This can help you understand if they are comfortable within their limits.

I don’t want to let a few bad apples spoil the entire bunch and thus have really great relationships with many of these people in our community.

Good providers know when they have done everything they know to do, but are not sure what to do next. We (osteopaths) are the answer for them, and thus these practitioners are where we get many quality referrals.

What treatment can help both torticollis and plagiocephaly at the same time?

Physical therapy may help stretch the muscles being contracted in torticollis but will not address the original compression of nerves causing the torticollis. Physical therapy may help in teaching repositioning for babies with plagiocephaly but does not address the root cause of why your baby prefers to look to one side or reshape the head. The helmet, if you choose to go that route, will not address the torticollis.

Osteopathy addresses the original compression of nerves causing torticollis and has been shown to improve both diagnoses of plagiocephaly and torticollis at once, since they are related^[xlii]. Think of it as one stop shopping.

Torticollis in the young often arises from the trauma of giving birth or malpositioning in the womb. The baby’s bones of the skull are designed to be as free as possible to allow for passage through the birth canal. Sometimes they can get stuck, which will affect the nerve (called the spinal accessory nerve) that plays a major role in neck muscle functioning.

One focus in osteopathic treatments is correcting anatomical dysfunction to allow for better function. For example, one of the bones at the base of the skull is called the occiput. Another bone is called the temporal bone. There is a hole created between these two bones called the jugular foramen through which many nerves and veins pass through. Now, if you imagine a traumatic birth experience where the bones of the occiput and temporal bone squished these nerves, then one side of the neck muscles would pull harder than the other side resulting in torticollis.

If your little one prefers leaning their head to one side or looking to one side, then they are prone to developing a flat spot on their head on that side because the bones of the head are so malleable.

The osteopath’s job would be to help restore the bones to where they’re supposed to be so it takes the pressure off this nerve and the baby can naturally correct its own posture and the shape of their head.

What are the benefits to treating the child earlier instead of waiting?

The closer in time to the injury or strain or trauma your child has endured, the faster the issues may be resolved. For example, if you have a splinter in your finger, and you take it out immediately, you may say, “ow” for a few minutes to hours but your body heals itself rapidly. If the splinter is left in for a few days, an infection may develop, and then antibiotics and a procedure to get the splinter out may be needed and the recovery will take much longer. Therefore, it is beneficial to address the issues at hand sooner rather than waiting.

What other benefits can osteopathy provide for my infant?

• Chronic Ear Infections
• Constipation
• Colic
• Reflux
• Sleeping
• Difficulty Breastfeeding

What are the recommended timeframe estimates for treatment?

• Repositioning – daily for several months – usually most effective under 6 months before your baby is mobile
• PT – usually 2-3 x/week for 4-8 weeks
• Osteopathy – ~1x/week for 8-14 weeks
• Helmet – 23 hrs/day x 6-10 months between 4-12 months of age – not effective after 12 months old^[xliii]

What options are available if I can’t afford services?

Some parents have taken up fundraising on their own behalf using crowd sourcing. There are groups of wealthy individuals wanting to help those in need and that qualify. These are known as grants. In order to apply for the grant please contact the organization directly. This list is not meant to be comprehensive, but rather a starting place to help point you in the right direction.

• Care creditOne non-traditional option that can help to cover healthcare costs is Care Credit. The company provides health care loans at a low interest for families that might not be able to afford treatment otherwise. For example, at our office we provide zero percent financing for 6 months for patients in need.
• Crowdfunding
  • The Hero Network – https://www.heronetwork.com/
  • Go Fund Me – https://www.gofundme.com/
• Foundations / Non Profits
  • (Plagiocephaly) First Hand Foundation – firsthandfoundation.org
  • (Plagiocephaly) – The Halo Project – http://plagiobaby.org/scholarships-through-the-halo-project
  • (Plagiocephaly & Torticollis) The Lindsay Foundation – https://www.lindsayfoundation.org/
• Travel Expense Costs
  • National Patient Travel Center – http://patienttravel.org/
  • Air Care Alliance – http://www.aircareall.org/
• Military familiesMay be able to obtain special grants for helmets and bands through their local Military Relief Organizations.http://www.military.com/spouse/military-life/military-resources/military-charity-associations.html
• Early Childhood intervention

While we have not dealt with this personally, we have heard that some states have helped families needing financial assistance for torticollis. I am not aware of this assistance for plagiocephaly. This is typically administered through CHIP / Medicaid.

This program provides support and services to families with children, birth to a specific age, who have developmental delays and disabilities. The age varies depending upon your state.

For example, we were told after speaking with the family liaison for the ECI in Austin, that no one will be denied assistance based on their inability to pay.

Also, these programs work based off what each state determines as a qualified developmental delay. Guaranteed acceptance is given if your child has one of these diagnoses.

Please keep in mind if your child has torticollis and your state does not list this as one of the qualifying diagnosis, do not despair. Your child may still be eligible for treatment.

It is worth noting that anyone can refer themselves to the program; you don’t need to have a physician referral. Anyone in need can start this process. This means you or a family member can do this on your own. The process as we understand it is:

• Determine the appropriate childhood intervention program you need to call based upon the state you live in.
  • http://ectacenter.org/contact/ptccoord.asp
• Contact the respective office to determine if your child has developmental delays, and schedule an evaluation
• A service coordinator would come to your home or daycare center to evaluate your child.
• If services are determined necessary and an agreement is signed, then there is a sliding fee schedule for payment of the family which is administered by CHIP/ Medicaid.
  • Check with the office to better understand costs and which insurance programs are accepted (if any) for your state

Strengths & Weaknesses Of Each Non Surgical Option

• Osteopathy

• PT (Physical Therapy)

• CST ^TM

• Helmet

What are the next steps?

Should you be interested in learning how bad your specific infant’s situation is, call our office at 713-527-8499 and ask to find out if you qualify for a FREE 15 minute consultation with Dr. Banik. We always provide new patients with forms to help educate our fellow pediatricians who might not be familiar with what we do.

Don’t delay, call us now!

Health Advice Disclaimer

We make every effort to ensure that we accurately represent pregnancy and infant advice displayed throughout this Guide.

There are no guarantees with pregnancy, delivery, and newborns except that we promise to do the best we can to give your child the best shot at a fulfilled life.