Head Games

Parents are being told to sleep babies on their backs to avoid SIDS. The medical establishment has ignored the unintended consequences -- and that's making one Tempe company very, very successful

The study, published in Pediatrics in 1998, gave a reason: "They were fearful of the possibility of SIDS."

The combination of beds and car seats acted almost like the cradleboards that Native Americans in the Northwest had once used to deform their babies' heads intentionally: one flat surface after another, for hours on end.

After 16 months, many back-sleeping babies' heads were already wider than their parents', and flat as a board. "On some of these heads, we joke that you can drop a plumb line down the back," one researcher admits.

Harlie Kanner (left) explains helmeting to Anna Craft, whose son Caedin has plagiocephaly.
Peter Scanlon
Harlie Kanner (left) explains helmeting to Anna Craft, whose son Caedin has plagiocephaly.
A six-month-old boy with plagiocephaly (left), and after seven months of helmet treatment.
photos courtesy of Cranial Technologies
A six-month-old boy with plagiocephaly (left), and after seven months of helmet treatment.

That was creepy enough. But what really troubled parents were cases where the heads were misshapen, a condition known medically as plagiocephaly.

It started harmlessly enough. The baby would favor one position for sleeping, and that side of the skull would start to flatten. But then, every time the baby was on his back, his head would roll right back onto the flat plane. Meanwhile, the other side bulged out.

Many parents in those early days of back-sleeping felt they had no choice but to take action -- including surgery. But when it came to effective alternatives, Phoenix was ahead of the curve.

In the late 1980s, a few years before the Back to Sleep campaign, Kim Manwaring, the Phoenix Children's Hospital neurosurgeon, had heard that doctors in Seattle were treating some skull deformities without surgery, by using a soft helmet.

Manwaring and his partner, surgeon Stephen Beals, began kicking around ideas. "We started talking," he says. "Could we improve on this, and treat these cases non-surgically?"

With that idea, they got in touch with Jeanne Hertz. A Milwaukee native, Hertz had moved to the Southwest and opened a small orthotics company in Phoenix.

She understood what the surgeons wanted. In 1988, after two full years of experimenting, she settled on her design for the Dynamic Orthotic Cranioplasty Band, or DOC Band.

In simple white foam, with a semi-rigid shell, it resembles a bike helmet with the top cut off. Custom-made for each baby's head, it's light enough to be worn 23 hours a day, for several months on end, but still designed to make a powerful impact.

Manwaring and Beals began to use the DOC Band for babies with plagiocephaly. "It became a big commitment on the part of our clinic," Manwaring says.

That big commitment still meant pretty small numbers. In her first year after completing the design, Hertz sold just six DOC Bands. "This was certainly never going to be a way that you'd make money," she says dryly.

The American Academy's 1992 decree that babies should sleep on their backs changed everything.

"We'd put all the time and effort and research into this," Hertz says. "So when parents came clamoring to their doctors, saying, 'Our babies' heads are deformed,' the surgeons knew to refer them to us. When they saw we were doing good work, they'd send us more."

Because Caedin Craft is 10 months old, he cannot understand why he is in a medical office, stripped to his diaper while a strange lady applies plaster-drenched cloth strips to his skull. At first, he watches her warily, trying to decide whether all this is okay, and then he makes up his mind.

It isn't. He starts to cry.

Caedin's mother, Anna Craft, is dressed for the mess in blue jeans, tennies, and a white tee shirt. She drove him this morning from their home in Avondale to this office on the Phoenix Children's Hospital campus knowing exactly what was coming, but she still looks nervous.

She holds his legs down firmly as the technician works to mummy-wrap the top of his head, supplying a continuous soothing patter. "What a big boy," Anna murmurs. "It's okay. . . . You're a brave little boy, yes you are, yes you are."

The plaster now forms a mask over Caedin's eyes. Below, his tiny nose is turning bright red at the tip. He howls, an angry baby cry that's all noise, no tears. Anna's eyes well up.

"He's doing just fine," the technician, Harlie Kanner, tells Anna quietly, never pausing from applying the cloth, never taking her eyes off Caedin.

"Mom's got tears and you don't," Anna tells Caedin, smiling ruefully as one drops onto her cheek. "Who's the one being the big old baby? It's not Caedin!"

"One more piece," Kanner murmurs, affixing it to the back of Caedin's neck.


He's wailing now, and Kanner doesn't waste a second. She shapes the plaster into a ridge along the crown, scratches some quick lines with a pencil, and expertly cuts the newly formed plaster cast in two. It slides off Caedin's head; he stops crying immediately.

For most American babies with skull deformities, this is now the worst they have to endure: a 15-minute session to make a cast of their head.

From here, workers in Tempe will make two models of Caedin's skull: one as it is, one as it should be. Then they'll make him a DOC Band, fashioned just-so to fit each of his bumps and flat spots. Every few weeks, his mom will bring him back to the office so they can adjust his band, opening up space so his head can grow.

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