Helmet Head – Before & After

The original prognosis was that Elijah would have to wear a Doc band for 3-4 months, taking into consideration his age and severity of the plagiocephaly. However, it turns out that Eli is a professional at growing his head, and he was able to wear it for less than 2 months!

Here are some before and after comparison pictures to show how the helmet helped reshape his head.

As you can see, wearing the Doc band for just a few months has made significant improvement in the symmetry of his head. Although his head isn’t perfect, nobody’s is, and we are very happy that we made the decision to fix his flat spot. Not only was Eli able to wear it for a shorter period of time than expected, we also got a significant portion of the cost covered by insurance (see previous post).

At his age, his head is much less pliable, and he spends much less time on his back than in the first few months of his life. In addition, Eli has recently mastered the back to front and front to back roll and has decided that he is a tummy sleeper, so flat spots should no longer be a concern at all!

Helmet Head

Back is Best

The Safe to Sleep campaign (formerly known as Back to Sleep) was launched in 1994 by the American Academy of Pediatrics, which recommended that parents put their babies to sleep on their backs in order to reduce the occurrence of SIDS (Sudden Infant Death Syndrome). This recommendation was made based on physiological evidence and lower rates of SIDS cases in other countries where this was practiced more often. Since then, the incidence of SIDS has decreased more than half!

However, babies sleeping and laying on their backs for prolonged periods of time inevitably leads to more instances of developing flat spots. This is obviously a much better trade-off than SIDS, but it is an issue than can cause problems later in life. Although no evidence has been found linking a misshapen head to brain, vision, or hearing impairment, other concerns must be taken into consideration: jaw misalignment, hat/helmet fit, wearing glasses, facial asymmetry, etc.

Flat Spot

At Elijah’s 3 month appointment, his pediatrician noticed his flat spot. It was mostly due to him always favoring one side when he slept and a slight case of torticollis (tightening of muscles in the neck which can restrict range of motion). She referred us to Cranial Technologies to get his head evaluated. I really didn’t want my son to be one of those babies who had to wear a helmet. I didn’t want him to have to endure months of discomfort (although most babies get used to it after a few days). I didn’t want to have to possibly spend thousands of dollars on the helmet. And I didn’t want people to see him wearing the helmet and assume that there was something wrong with him.

Where did this stigma come from? Why do people associate headgear on children with mental disabilities?

I did extensive research on helmet use in children. I read about studies that indicated that there was no evidence that helmets actually improved head shape. Others said that over time, especially once the baby is mobile, the baby’s head will round out naturally by 18 months of age. Our pediatrician said in order for the helmet to work the most efficiently, it should be fitted before 6 months of age. So, I put off taking him to be evaluated and took it upon myself to make sure he spent as little time on his back as possible, when awake. I also tried to reposition him when he was sleeping, on the side of his head that he did not favor.

At his 6 month appointment, his pediatrician said that the flat spot had significantly improved but that she believes he would still benefit from wearing a helmet.

As his mom, I felt like I had failed him.

We took him to get his head evaluated, holding out hope that there was still a chance that the specialists would tell us that his case was so mild that no intervention was necessary.

After his evaluation, we were told that he has a moderate case, and that he would need to wear the helmet for ~3 months. I asked if it was possible that his head shape would resolve itself over time and was told that it most likely wouldn’t get worse, but it probably wouldn’t completely fix itself. I knew that even if there was a chance, once he got old enough for us to know for sure, it would be too late to correct. We did not think that was worth the gamble.

Insurance Coverage

The next step was figuring out if insurance would cover the costs. The full price of the helmet is $4000. Cranial Technologies has a deal with our insurance company where we would only have to pay $2500 out of pocket, if it wasn’t covered. If it was covered, we would pay $250. Which price we would be paying depended solely on whether or not there was an exclusion for helmets in our insurance plan.

A few weeks later, we got the call that the helmet would NOT be covered by insurance because it was considered an aesthetic treatment. Needless to say, my husband and I were not very happy about this news. It seemed ridiculous to us that the insurance company could justify that we were putting him through this treatment just for looks.

After getting this news, I scoured the internet forums for any options we had left to get coverage for his treatment. Some people suggested appealing, while others said appeals were typically fruitless if an exclusion was spelled out in the plan. One person mentioned that the exclusions are specific to the employer’s agreement with the insurance company and that they were successful in getting coverage after contacting their HR department. I figured it was worth a try and emailed my HR representative. She forwarded the email to the Benefits group, and they said they would look into the matter and get back to me. I didn’t hear back from them after a week and figured that was a dead end. However, 3 weeks later, I received an email stating they had reviewed the case and will make an exception and cover the treatment. The insurance company paid $3600 of the $4000 total, which was a huge help.

If your insurance is denying you coverage, contact your employer’s HR department and see if they can make an exception!

Progress

At his 3 week checkup, they saw a lot of progress on head growth. He’s been working hard growing that noggin and he may be able to get it taken off sooner than expected. They say that he will only need to wear it another 4-6 weeks!

 

Sleep Training

After you bring your new baby home, sleep becomes one of life’s most precious commodities. When the baby doesn’t sleep, one or both parents also don’t sleep. Some babies are naturally great sleepers while others require hours of bouncing, rocking, and soothing, just for a short nap. To make things even harder, there are so many precautions and recommendations about safe sleep for babies.

SIDS danger. Back is best. No loose blankets. No stuffed animals. Nothing in the crib. Flat, firm surface only. Sleep in the same room until 6 months. Don’t co-sleep. Avoid sleeping in car seats, swings, bouncers, etc. Make sure the baby is not overheated.

This can be extremely overwhelming, particularly when a desperate and exhausted parent is trying to get the baby to sleep by any means necessary.

‘The baby will only fall asleep in the swing. Does this make me a bad parent?’

In the first three months, you’re in pure survival mode. Don’t worry about bad habits, spoiling the baby, or holding the baby too much. Do whatever needs to be done to keep the baby thriving and happy. But after the baby gets to be 4-6 months old and is still waking up 6 times a night, the idea of sleep training starts to get tossed around.

What is sleep training?

It refers to helping a baby learn how to fall asleep and stay asleep throughout the night without assistance. This is done by taking away sleeping aids (rocking, patting, shushing, feeding, pacifier) that the baby depends on to fall asleep and letting the baby fall asleep on his/her own by learning to self-soothe. The belief is that if the baby is used to having these aids to fall asleep and wakes up in the middle of the night without them, falling asleep again will be much harder to do. Successful sleep training would ideally result in better rest and less stress for both the baby and the parents.

Research

Critics claim that allowing the baby to be in distress for prolonged periods of time could be detrimental to development and cause learned helplessness. However, there is not yet any evidence that support these claims. A study that examined the differences in children who had and had not been sleep trained five years earlier found no significant differences in traits such as sleep problems, behavioral problems, mental health, and attachment issues.

Studies do show that sleep deprivation has long-term negative consequences and can lead to depression-like symptoms and attention issues. This would not only affect the health of the parents but also their ability to care for their child effectively. Sleep deprivation of the baby also affects the baby’s mood and can inhibit attention and learning.

Sleep Training Methods

It is agreed upon across the board that newborns should NOT be sleep trained. They have not yet developed the ability to self-soothe and cannot form good sleeping habits at that age. Four to six months is the most common age range that sleep training experts believe a baby to be ready for sleep training. There are a wide range of methods that are commonly utilized. The five most well-known methods are listed below:

  • No Cry Sleep Solution – Uses gentle techniques such as fading (using a preferred sleep association less and less each night) or substitution (substitute a sleep association with a different sleep association; easier to eliminate since it is not as preferred by the baby)
  • Sleep Lady Shuffle (Gradual Withdrawal) – Sit in a chair next to the crib and verbally soothe and shush baby. Move the chair further away from the crib every night until you are out of the room.
  • Pick Up Put Down (PUPD) – Put baby to bed awake and check on baby at graduated intervals (i.e. 3, 5, 7 minutes) if baby is still crying hard. Pick up baby to soothe and then put down.
  • Graduated Extinction (Ferber) – Put baby to bed awake and check on baby at graduated intervals (i.e. 3, 5, 7 minutes) if baby is still crying hard. Verbally soothe or pat baby to comfort.
  • Weissbluth (Cry It Out, Full Extinction) – After the bedtime routine, put the baby in the room and do not return until the next morning (except for feedings).

Elijah’s Sleep Training Story

We decided to start sleep training Elijah when he was around four and a half months old. He has never been a terrible sleeper but was constantly waking up three to four times a night, and it was really taking a toll on my sleep. His primary soothing mechanisms were feeding and the pacifier, so the goal was to eliminate both of these sleep associations. For the bedtime routine, he had a bottle before bath time, in order to separate any feeding associations. Because he was still relatively young, I did not cut out night feeds entirely, but I did not feed him until it had been at least four hours since the last feeding to make sure that he was actually hungry and not looking to eat for comfort. I also took away the pacifier at night time. 

My original intention was to use the Ferber Graduated Extinction method for sleep training. I purchased and read the book, “Solve Your Child’s Sleep Problems,” in order to prepare. Once we began training, however, I quickly realized that checks at intervals did not soothe Elijah but rather prolonged his distress. So I stopped going in, and I watched him on the baby monitor to make sure he was okay. The first night was the longest stretch of crying (~25 minutes) before falling asleep. He also woke up a few times during the night and cried around 10-15 minutes each time. He adjusted quickly and after a few days, there was no crying at all at bedtime before he fell asleep – just some grumbling. It also helps that he’s not a crier by nature, so I can typically tell when he’s just fussing and when he actually needs something.

Just because a baby is “trained” does not mean they will be a good sleeper from that point on. Regressions can happen when the baby is sick, teething, or for seemingly no reason at all. He does still have nights where he wakes up more often, but this is not the norm. I try to stay consistent with my techniques, and he typically goes back to his normal sleep patterns after a day or two.

Final Tips

A baby’s personality is very important to consider when deciding whether or not to sleep train. Only you know your baby best and whether or not he/she is ready for sleep training and what method will work the best. Some babies respond to training faster than others and methods can be adjusted accordingly.

Sleep training is not necessarily a requirement to foster good sleeping habits. Some babies are able to develop good sleeping habits naturally over time, but in other cases, bad sleep habits are carried into toddler-hood, preschool, and beyond, when bad habits become much harder to change.

Sleep training is not for everyone, but it did work for us.

 

✿ Katie ✿

Featured image by Alison Wong of New Mom Comics