The DOC-band can only correct a child’s head shape if it is worn 23 hours out of the day. To be effective, it must be on as much as possible. Babies are growing and changing constantly. Between birth and 6 months of age, babies are tripling in size. So are their heads. Because of this rapid growth and because each helmet is custom made to the beginning head shape, any time spent out of the band will likely lead to a poor fitting band and less than optimal results.
As a clinician with Cranial Technologies the first thing I looked at when my second daughter Cora was born was the shape of her head. It was perfect, at first. She was a large baby (10 lbs 13 oz), great sleeper, and had a strong right rotation preference. At around two weeks I started to notice some flattening on the right side of her head.
So, for the next two months we worked diligently on repositioning in hopes plagiocephaly could be avoided. Every few minutes I felt like I was rotating her head back to the left. I instructed family members on how she must be held in order to keep her from looking right. I changed sleeping and feeding positions. But my little girl was very stubborn and on top of a rotation preference she cried every time I placed her on her tummy.
When Cora was three months old I made a consult appointment at Cranial Technologies to find out just how severe her flat spot was. While sitting in the consult room waiting for my fellow clinician Rachel to give us her recommendation I felt nervous. Was it going to be as bad as I thought? When Rachel brought up Cora’s image I could tell right away my baby needed a band. What happened next surprised me…I cried! I knew that plagiocephaly was treatable, but looking at the images of my baby’s misshapen head I couldn’t help but think, “How could I let this happen? I’m a physical therapist for goodness sake!
Two weeks later Cora was fit with her first band. Looking back, I had a lot of anxiety about her starting treatment. I was worried about what people would think, how much would she improve, and how quickly she would improve. I somehow figured that since I’m a clinician she would get through treatment in record time with a ‘perfect’ head (all while knowing as a clinician that there is no such thing as a perfect head).
One thing I’ve learned in my adult life is that nothing ever goes as you plan. As Cora got to the end of her first band I knew she needed a second and felt once again that I had failed her. After seven weeks in the DOC Band Cora’s head shape did improve, however much of her forehead and ear asymmetry hung on. The mother side of me struggled with the decision to do a second band but after consulting several senior clinicians I decided that going into a second band would be the best thing for my little girl. I know that a second band will further improve facial and ear symmetry, decrease her risks of poor safety helmet fit and reduce the risks of jaw alignment issues.
As we’re coming to the midway point of Cora’s second band and I’m writing this blog I’ve had time to reflect on the past few months and have composed a list of what I will take away from this experience as both a mom and a clinician.
- When a parent says, “My kid hates tummy time,” I know the struggle is real. Nobody wants to make their baby cry. But for those parents whose baby doesn’t like tummy time, it gets better! Try something that is flashy and blinks, it will easily distract baby for several minutes a few times a day.
- For the first couple of weeks the band feels like another child; you must know where it is at all times and you have to keep it clean.
- It is common for a parent to feel guilty your child was diagnosed with plagiocephaly. I felt that way and I’ve had many parents tell me they feel the same. It’s important to acknowledge those feeling but then let it go! I knew that I tried my best to keep Cora from having a flat head and that is all I could do. Most parents have never heard of plagiocephaly and therefore don’t know to reposition their baby. At least there is something that can be done to improve baby’s head shape.
- Deciding to do a second band is a tough decision, not because of the commitment but because I had to accept that my initial expectations were not necessarily realistic. As a parent and a clinician, it’s important to focus on the positive and not perseverate on what your expected outcome was.
- Going through with treatment in a DOC Band is totally worth it! By placing my baby in a band, I know that I have done everything in my power to reduce any functional implications from plagiocephaly.
- It’s going to feel REALLY good to graduate!
I am forever grateful for my career at Cranial Technologies. As a clinician, I have the satisfaction of knowing that I make difference every day. As a mommy, I knew I could rely on Rachel and all the employees at Cranial Technologies to guide us through the process of placing sweet Cora in a band.
Ally Jobe is a Physical Therapist and a clinician with Cranial Technologies in the Fort Worth, TX clinic. She has specialized in pediatric physical therapy since graduating from the University of North Texas Health Science Center with her doctorate in PT. Ally has written a blog describing her perspective as a clinician and as a mother having her second child treated for plagiocephaly in the DOC Band.
Fit, Movement and Comfort – the DOC Band
For most babies, the DOC band does not affect their daily routine at all. Each band is designed and manufactured specifically to fit each child. Most babies move through their daily activities without any disruptions from the band. This includes sleeping, eating, rolling, crawling, and all other developmental milestones.
Parents are instructed on how to monitor their babies’ skin during the first couple days of wear to allow the skin a chance to get used to band wear and there is not discomfort or sense of the band feeling “tight” on the baby’s head. Should parents notice any red spots, they should remove the band and not put it back on until the red spots have gone away at which time the band should be put back on.
I was working for Cranial Technologies when I became pregnant with my first son, James. Before starting as a baby imaging specialist, I would not have known a thing about plagiocephaly or brachycephaly, or have given them the slightest thought during my pregnancy. However, unlike the soon-to-be mamas around me, I worked with babies in the DOC Band® all day, every day, so I already knew a thing or two about positional plagiocephaly.
During my pregnancy, the amazing clinicians in my clinic were kind enough to show me different re-positioning techniques before James had even entered the world. Naively, I told myself that my baby would not need a band because I would do everything to ensure that his head would be perfectly round from birth.
Fast forward eight weeks into my maternity leave, I was slowly
watching my son’s head become flatter and flatter. I was so confused as to how this happened. I had fiercely examined James’ head shape hours after he was born (that’s normal, right?) and believed that he had the most perfectly round head at birth. My husband and I had done everything the clinicians at my clinic had instructed- tummy time, re-positioning, stretches, etc. We carried him upright in our arms instead of cradling him from the moment he was born. Like a drill sergeant, I got on the floor three times a day with a five-minute timer and cheered on my baby’s tummy time efforts. (Again, normal, right?!?) I was more than proud of the head control he developed from all our exercising. Reluctantly, I could still see that I needed to take my baby in for an evaluation.
James was three months old when he was seen for his initial evaluation in the West Houston clinic. Our clinician had recommended James enter treatment in a DOC Band. It was explained to my family James had severe brachycephaly and moderate – severe right plagiocephaly due to in-utero constraint and back sleeping. Somehow, learning James had developed his current head shape while in my womb reassured me. I knew I had not done anything wrong, but the facts were the facts: I was petite in structure, James was a big boy, and he was a wonderful back sleeper. I knew there was no reason to feel guilty or frustrated because there was nothing I could have done to prevent this. Not even five more minutes of drill sergeant tummy time mommy could have rounded out my baby’s head.
As a baby imaging specialist, I was lucky to already know exactly what the treatment process would entail. I knew that it would be painless for my baby, and that, of course, he would look absolutely adorable in a band. I also knew that this had nothing to do with his brain development. I’m ashamed to admit that my greatest fear was far more trivial than the concerns several moms would have regarding the health of their child- I was mostly concerned of the treatment time commitment.
I knew that James’ Doc Band adjustments would be one week apart because I wanted his treatment to start ASAP, but I honestly did not know how we were
going to make the time for this. I had already gone back to work full time, and my husband has a full-time job of his own. I have type 1 diabetes which comes with constant blood glucose monitoring and insulin regulations and endocrinology appointments. James was also exclusively breastfed, and I was pumping at work and at home during whatever time I could find. We had also just started James in daycare and were coincidentally beginning to see the need for several unexpected sick appointments with his pediatrician. She had recently prescribed him albuterol for a persistent cough that would need to be given every six hours through a nebulizer. I was clueless as to how we would squeeze a DOC Band into our already packed daily routine. Little did I know that out of an insulin pump, a breast pump, and a nebulizer, a DOC Band would be by far the simplest addition to our complicated family of medical devices.
My husband and I did our best not to overwhelm ourselves, and took each appointment one week at a time. James did his imaging appointment at the Pearland clinic, which was brand new at the time, and even smiled for me, his imaging specialist, during the entry imaging appointment. The fit appointment was as smooth as could be. James quickly adjusted to the band and didn’t have any problems with redness. He even slept well that first night with the band. James only had seven adjustment appointments until he was finished with his first band. Those seven weeks passed before our eyes, and I can’t exactly pinpoint why. Perhaps it’s because we adopted the DOC Band into our routine with open arms, and we occasionally forgot that he was
wearing it. Skin checks and band cleaning were all there really was to it. As far as weekly appointments, Monday is one of those days that approaches before we all know it. Seven quick Monday appointments later, we were done with the first DOC Band.
James continued treatment in a second band, and his results astounded us. James’ total treatment time was five months between the two bands. In hindsight, I’m grateful that we did not allow the frequency of appointments or 23-hour wear of the band determine our final treatment decision. James’ infancy and time in the band is so short in comparison to the rest of his life, and a round noggin is something he will wear forever.
Savannah Elkins is a Baby Imaging Specialist at Cranial Technologies since 2016. The Texas A&M University graduate lives with her husband, son, James, and dog, Sandy, in Pearland, Texas.
Do I have to cut my baby’s hair and why?
Depending on the length and thickness of your baby’s hair, a haircut may be necessary. Because each helmet is custom made for each child, a properly fitting band is one of the most important factors affecting the outcome. An in-depth 3D image of your baby is an essential first step to guarantee proper fit of the band. When there is a lot of thick hair on the baby, it adds thickness to the 3D surface representation of the baby’s head, and this may result in a helmet that has a lot of movement. A DOC Band with excessive movement can lead to problems with comfort, skin tolerance, and most importantly, the effectiveness of the band.
Are Baby Positioning Devices Causing More Harm Than Good? by Tara Held, MSPT
I am a pediatric physical therapist with 18 years of experience helping little ones achieve their fullest gross motor potential and teaching families how to understand baby development. I have become a specialist in addressing and correcting head molding in babies, and want to share some information about common baby positioning products you might be using that put your child at risk for developmental delays and positional plagiocephaly.
Rock ‘n Play
Let’s talk about one of the most popular baby holding devices that many of the parents I see are using…The Rock ‘n Play. So many of my clients report that their babies had spent extended amount of time in a Rock ‘n Play, and then noticed head flattening, neck tightness, and motor issues.
How is this product possibly causing these issues?
Well, let’s start with normal development…Your newborn should be able to move their head side to side, kick their legs, reach their arms out, and stretch out of the flexed position in which they spent months developing in the womb. This allows them to work against gravity and strengthen their muscles, as well as work out any minor asymmetries in their neck muscles that might have been present at birth. A firm, flat surface is ideal for these exercises. And you definitely should place your baby on their back when sleeping, in order to reduce the incidence of SIDS.
The Rock ‘n Play prohibits these normal movements and holds your baby in static positions for long periods of time, encouraging increased neck tightening and head molding. And even though the surface is padded, pressure is still pressure. It doesn’t take much force to misshape your newborn’s soft skull bones.
Another product to explore is the Bumbo Chair. Although this seems like a great way to “jump start” sitting skills in a baby, it actually does the opposite. Babies are placed in the Bumbo chair before they are developmentally ready, and with poor postural alignment as well. Their spines are rounded, pelvis in a posterior tilt, and head jutted forward…all inappropriate for seated posture and spinal alignment.
Many times, little ones don’t have active head control when put in this chair, so they are basically put into a position where they get no proprioceptive input, vestibular input, or tactile response. To summarize…the baby is passively strapped into a seat with no ability to practice sitting balance, weight shifts, trunk rotation, or age-appropriate strengthening of muscles- all which will provide the necessary sensory and motor input needed to achieve motor milestones.
Safety issues are also a concern, as with any positioning products. Please never leave your baby unsupervised on a high surface in the Bumbo Chair or improperly buckled into a Bumbo Chair.
Does using a baby walker get your baby walking earlier? Not exactly. Again, when overused, a baby walker can have the reverse effect on motor skills, and even cognitive development. When a baby sits or stands in a walker, the tray around them doesn’t allow them to see their legs move, and get the visual feedback needed to learn as they move through the environment. It does not allow natural standing posture, promotes toe-walking, and prohibits normal coordination and reciprocal motion needed for the skill of walking. Being placed upright before your little guy can weight bear on his legs will interfere with the natural progression a baby needs to follow: sit to crawl to stand to walk. And it goes without saying that there are endless physical dangers when left unsupervised in a walker, such as falling down steps, reaching for dangerous hot surfaces, poisonous materials, etc.
“What product out there is safe for my baby?” Well, these products are helpful to a new parent, but MODERATION is the key. The problems start when these products are over-used.
Instead, encourage your baby to play, explore, move, and grow in healthier ways… supervised floor play time with toys placed on either side of your baby or supported above your baby (like a baby gym toy), tummy time activities, side-lying exercises, sitting on your lap or held upright, close to you in an infant carrier, and 1:1 interaction with your little one in any developmentally appropriate position.
Your baby will thank you!
Tara Held is a clinician at Cranial Technologies, assessing and treating babies with positional plagiocephaly, address neck muscle imbalances, and correct abnormal head shapes. She has been a pediatric physical therapist for 18 years, specializing in treatment of torticollis, plagiocephaly, movement disorders, neurodevelopmental delays, and sensory processing disorders. She has experience in early intervention and school-based settings, hippotherapy, aquatic rehab, pediatric yoga and Pilates, and outpatient rehabilitation.