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One less thing to worry about for infants with flat heads

September 24, 2009 |  4:01 am

The “Back to Sleep” campaign is credited with averting more than 2,000 cases of sudden infant death syndrome each year. But placing infants on their backs instead of their stomachs has caused the rate of deformational plagiocephaly to surge.


At Wake Forest University Medical Center’s North Carolina Institute for Cleft and Craniofacial Deformities, the increase has been “exponential,” according to staffers there. The number of infants who come to the clinic to be treated for deformational plagiocephaly – a fancy way of saying a flat or misshapen head – has grown to 2,000 per year.

The condition isn’t merely cosmetic. Babies can wind up with eyes, ears or teeth that are out of alignment; temporomandibular joint problems; delays in psychological and motor development; and ear infections.

Researchers at the North Carolina clinic wanted to determine whether a diagnosis of deformational plagiocephaly was associated with an increased risk for ear infections. The smushing of the malleable infant skull can shift and shorten the eustachian tube, which links the middle ear to the nasopharynx. If the tube is unable to drain mucus from the middle ear, bacteria can build up and cause ear infections.

The researchers included 1,112 patients who were treated at the clinic over a two-year period. The average age of babies on their first visit was 5.6 months, and most were treated with band helmets.

Overall, 559 patients – or 50.3% – had an ear infection by their first birthday, according to results published today in the Journal of Craniofacial Surgery. That’s about the same as for infants in general, according to data from the Centers for Disease Control and Prevention.

The researchers found that cases were more likely in babies with more severe deformation. For children with an “initial craniofacial asymmetry severity level” of 1 to 3 on a 5-point scale, 48.8% had at least one ear infection. For children with a severity score of 4 or 5, the incidence rose to 53.9%, according to the study. But the difference between the groups wasn’t statistically significant.

Overall, it would seem that parents coping with a diagnosis of deformational plagiocephaly could breathe a sigh of relief, safe in the knowledge that they need not worry about an increased risk of ear infections as well. But the researchers concluded that the loose correlation between degree of deformity and the rate of ear infections be investigated in future studies.

-- Karen Kaplan

Photo: This baby with deformational plagiocephaly isn't necessarily at increased risk for an ear infection. Credit: Cranial Technologies Inc. / Associated Press
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Comments (2)

Why does back sleep prevent SIDS?

Because infants tht sleep on their back sleep "less deeply" and thus the small number of infants (probably less than 1%) who are susceptible to Apparently Life Threatening Events (ALTE) survive them at an approximatly 50% higher rate.

Your story suggests that all infants have an equal risk of SIDS. This is incorrect. 1% of infants are at a very high risk of SIDS. For this population of infants if you put them on their backs the risk decreases 50%. For the other 99% of infants there is 0% reduction in risk of SIDS because there was never a risk in the first place. Doctors cannot determine which children are at a high risk of SIDS so they tell all parents to put their children to sleep on their back.

What happens from a physiological standpoint?

To understand this one has to know the difference between Rapid Eye Movement (REM) sleep and Non-REM sleep. Non-REM sleep consists of 4 sleep stages (1 through 4). Stages 3 and 4 combined are knows as Slow Wave Sleep (SWS). SWS is when infants die of SIDS. When infants are put to sleep on their backs they get much less stage 3 and stage 4 NREM sleep than when they are put to sleep on their stomachs. No big deal right as long as it prevents SIDS?

Well, during the day when we learn out temporary memories are stored in the Hippocampus and then at night they are "downloaded" to the Neocortex for permanent storage. The "downloading" of information only takes place during SWS. It does not take place during "lighter" stages of sleep. As mentioned early during this "Downloading" of information when infants are in very deep sleep a small percentage of them seem to have an increased risk of dying of SIDS. Prior to 1992 over 70% of U.S. parents put their children to sleep on their stomachs. Since 1999 over 70% of U.S. parents have put their infants to sleep on their backs. Considering that there are over 4,000,000 babies born in the U.S. each year we now have a large enough population to determine if interfering with SWS has caused any long-term negative effects. This is very interesting.

Most of these “flattenings” resolve on their own as the baby matures, but to be safe it is best to give your baby as much SUPERVISED tummy time as possible. Don’t have them constantly in a car seat or bouncy seat, and flip them head-for-toe in their crib every other day (still on their back, of course) as they tend to look towards a door or sound and this will force them to change their head position accordingly.


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