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 statement basically said that there could be a link between the back-sleeping and the problem. It didn't even mention helmets.

It took the Academy until 2003 to do that.

That year, for the first time, the Academy released a set of guidelines for the treatment of plagiocephaly. It wasn't exactly an advertisement for helmets: It noted studies that had found good results with helmets, and also one study that claimed just as much improvement with therapy alone.

Jeanne Hertz’s Tempe company is the nation’s leading helmet provider.
Peter Scanlon
Jeanne Hertz’s Tempe company is the nation’s leading helmet provider.
Phoenix neurosurgeon Kim Manwaring believed in 
helmets long before many of his peers.
Peter Scanlon
Phoenix neurosurgeon Kim Manwaring believed in helmets long before many of his peers.

But the paper did an important thing. Many doctors had believed that the deformities cleared up on their own. The Academy disagreed.

Instead, the paper outlined a series of actions: Parents should try to move the child's head into a new position at night. Neck exercises were a good idea. And if that didn't work, the answer might well be a helmet or, in rare cases, surgery.

The chief writer of the report was John Persing. Chief of Yale University School of Medicine's Plastic and Reconstructive Surgery Department, Persing was initially skeptical of helmets.

He's come around.

"I still would like to see a rigorous scientific study, to be honest with you," he says. "But my general impression is that a number of patients with irregularly shaped skulls seem to have better than expected results when they use the helmets."

Persing now believes the focus should be on prevention.

"This is something that's preventable, purely preventable," he says. "All these head shapes could be easily prevented -- and we could still see the benefits of the Back to Sleep program -- by doing a very simple maneuver."

For most babies, he says, it would only take one thing.

From the very first night home from the hospital, parents would put the baby to sleep on his back. And then they would make a conscious effort to alternate the baby's position: The first night, turn the infant's head to the right, and on the next, to the left.

Right. Left.

Right. Left.

If it's done from the beginning, Persing says, the baby wouldn't develop a strong preference for either side. And coupled with lots of time on their tummies, he believes it would keep flat spots from forming, much less becoming a favored groove that the baby rests on every night.

"Look," Persing says. "You have to acknowledge that SIDS rates have gone down. But we should also say, reposition the baby's head from day one. The more you put that out to the community, the more helpful it will be.

"If you did that, the DOC Band, in many of these cases, would really be unnecessary."

Despite the simplicity of the prevention message, Jeanne Hertz and the people at Cranial Technologies won't have to find new jobs any time soon. Prevention methods are still largely absent from the National Institute for Child Health and Development's Back to Sleep materials.

Instead, the agency seems stuck in the old days of trying to downplay the deformities. Door hangers that urge "Safe Sleep for Your Baby," handed out in doctors' offices and available on the agency's Web site, don't even suggest that babies' heads should be rotated, much less acknowledge skull deformities. The accompanying brochure notes only that "for the most part, flat spots on the back of the baby's head go away a few months after the baby learns to sit up."

The brochure suggests briefly that babies should spend time on their stomach. It also mentions, in passing, that parents can stop flat spots by changing the direction of the baby's head at bedtime.

But there's no suggestion it should be done from the first day. The information is buried in a separate section about flat spots rather than included in the list of instructions for sleep time.

The agency's longest promotional material, a 12-page brochure, is even more damning. Plagiocephaly, it says flatly, is usually a "benign condition." Flat spots "disappear" when babies sit up. They "seldom" require helmets.

As evidence, it cites a study in Pediatrics. But the brochure gets it wrong.

Any parent who took the trouble to find the study might be amazed: That study, the one that John Persing penned for the American Academy, suggests just the opposite.

Persing does not ever write that the condition is "benign" or that it "disappears."

Persing does not reject the benefits of helmets.

Instead, he details a full list of escalating treatments: alternating positions, limiting time in car seats, exercises, and, eventually, helmets.

Persing first explains the apparent discrepancy between his paper and the agency's brochure by saying that the information is there for the parents who want it. But he admits that the Academy has dropped the ball on prevention.

"It should be part of the teaching every pediatrician gives to family members," he admits. "As much as we talk about SIDS, we should talk about positioning the child and alternating the head."

Some physicians do that, he says. But, "it's not enough."

Marian Willinger, the SIDS special assistant for the National Institute of Child Health and Development, claims that the agency has addressed misshapen heads.

She points to a single paragraph in agency promotional materials that talks about tummy time. "When we say do something to prevent flat spots, it's inferred that these things should be done from the beginning."

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