What type of specialist for flat head?

lorist202 · October 2014

DDs head is extremely flat in back. The pedi keeps telling me to do more tummy time, but she won't sleep that way. Her head is also in the 70th percentile, so its large and heavy. I have always been a naysayer regarding helmets, because DS had a flat spot, and at age 3, it has corrected itself. However, in this case, I think DDs forehead and face are being affected.

I want to get a second opinion. Do I start with another pedi in her group, or should I see a specialist (referral not necessary)? What type of specialist for this, if so?

jenn43 · October 2014

You need to see a plastic surgeon who specializes in craniosynostosis.

tsylvestre · October 2014

You could as for a second opinion. Also, you could ask for a referral to someone who makes helmets (ortho tist). They can tell you if it should be treated. Sometimes it corrects itself but if it is changing the shape of baby's face it can lead to other problems. In the mean time, lots of tummy time and supported sitting helps. Sleep should still be on the back.

sarah_beth2005 · October 2014

A pediatric plastic surgeon. He/she will refer you to a DME provider for a helmet, or a physical therapist to work with baby on strengthening her neck, so that she can support herself better at tummy time or with assisted-sitting. Our son just started in a helmet 2 weeks ago, and we can already see improvements! The DME provider also gave us a great pamphlet of alternative tummy-time exercises/activities -- everyday things you can do to get baby off the back of their head (since we had to wait a month before we could order the helmet, because insurance wouldn't cover it until he was 12 weeks adjusted age...).

clwheel · October 2014

You can also try repositioning. DD has a flat spot on the right, back side of her head because she favored looking right a lot, and honestly we didn't think about it until we started noticing the flat spot so I partly feel at fault for it Anywho. I've been actively trying to keep her up (jumper, bumbo, tummy time, etc) and at night or when she is napping we turn her head to look left. Its slowly rounding

cookieinva · October 2014

You do not need to see any kind of plastic surgeon. My DS had a severe flat spot (plagiocephaly) and his head is I think 85%? I don't know but big. Our pedi referred us to physical therapy, to strengthen hs neck as torticollis caused the flat spot. No point in getting a "helmet", in our case a DOC band, if you aren't going to do PT to address the underlying cause. The PT referred us to Cranial Tech in suggesting his flat spot was severe enough to warrant a DOC band. You do not *need* a referral for Cranial Tech. Our insurance covered it because we had been doing PT and everything else along with it. The way it worked was to go there, they do a bunch of measurements, prepare a report, send it to the pedi, at which point in our case the pedi prescribed or recommended it, so then it was covered. You might try just contacting Cranial Tech. There are one or two other companies but they are one of the big ones, I don't know the other's names but one of them makes a star band, I think they call it.

jenn43 · October 2014

cookieinva said:

You do not need to see any kind of plastic surgeon. My DS had a severe flat spot (plagiocephaly) and his head is I think 85%? I don't know but big. Our pedi referred us to physical therapy, to strengthen hs neck as torticollis caused the flat spot. No point in getting a "helmet", in our case a DOC band, if you aren't going to do PT to address the underlying cause. The PT referred us to Cranial Tech in suggesting his flat spot was severe enough to warrant a DOC band. You do not *need* a referral for Cranial Tech. Our insurance covered it because we had been doing PT and everything else along with it. The way it worked was to go there, they do a bunch of measurements, prepare a report, send it to the pedi, at which point in our case the pedi prescribed or recommended it, so then it was covered. You might try just contacting Cranial Tech. There are one or two other companies but they are one of the big ones, I don't know the other's names but one of them makes a star band, I think they call it.

I agree, if your pediatrician is 100% positive it's positional plagiocephaly, and not craniosynostosis. If you're not sure of the diagnosis, then you need to see a plastic surgeon. Cranial techs and physical therapists only treat positional plagiocephaly.

cookieinva · October 2014

jenn43 said:

cookieinva said:

You do not need to see any kind of plastic surgeon. My DS had a severe flat spot (plagiocephaly) and his head is I think 85%? I don't know but big. Our pedi referred us to physical therapy, to strengthen hs neck as torticollis caused the flat spot. No point in getting a "helmet", in our case a DOC band, if you aren't going to do PT to address the underlying cause. The PT referred us to Cranial Tech in suggesting his flat spot was severe enough to warrant a DOC band. You do not *need* a referral for Cranial Tech. Our insurance covered it because we had been doing PT and everything else along with it. The way it worked was to go there, they do a bunch of measurements, prepare a report, send it to the pedi, at which point in our case the pedi prescribed or recommended it, so then it was covered. You might try just contacting Cranial Tech. There are one or two other companies but they are one of the big ones, I don't know the other's names but one of them makes a star band, I think they call it.

I agree, if your pediatrician is 100% positive it's positional plagiocephaly, and not craniosynostosis. If you're not sure of the diagnosis, then you need to see a plastic surgeon. Cranial techs and physical therapists only treat positional plagiocephaly.

I presume plagio since OP's pedi didn't diagnose anything and just rec's more tummy time. That suggests plagiocephaly without officially diagnosing.

jenn43 · October 2014

cookieinva said:

jenn43 said:

cookieinva said:

You do not need to see any kind of plastic surgeon. My DS had a severe flat spot (plagiocephaly) and his head is I think 85%? I don't know but big. Our pedi referred us to physical therapy, to strengthen hs neck as torticollis caused the flat spot. No point in getting a "helmet", in our case a DOC band, if you aren't going to do PT to address the underlying cause. The PT referred us to Cranial Tech in suggesting his flat spot was severe enough to warrant a DOC band. You do not *need* a referral for Cranial Tech. Our insurance covered it because we had been doing PT and everything else along with it. The way it worked was to go there, they do a bunch of measurements, prepare a report, send it to the pedi, at which point in our case the pedi prescribed or recommended it, so then it was covered. You might try just contacting Cranial Tech. There are one or two other companies but they are one of the big ones, I don't know the other's names but one of them makes a star band, I think they call it.

I agree, if your pediatrician is 100% positive it's positional plagiocephaly, and not craniosynostosis. If you're not sure of the diagnosis, then you need to see a plastic surgeon. Cranial techs and physical therapists only treat positional plagiocephaly.

I presume plagio since OP's pedi didn't diagnose anything and just rec's more tummy time. That suggests plagiocephaly without officially diagnosing.

When OP asked for a second opinion. She meant a medical second opinion, not random people on an internet board. She said she was concerned, and doctors have been wrong before, so seeking a second opinion is completely reasonable. This could be another pediatrician, or she could skip right to the appropriate specialist. But no one on here has examined her baby and can diagnose plagio vs craniosynostosis.

clwheel · October 2014

Wow. Just trying to help.

Maladroit · October 2014

I think it depends on the place, too. DS has what the pedi thinks is positional plagio, but his ears are offset and it's really obvious now. She referred us to the Neurosurg clinic and PT.

harmonicbabe26 · October 2014

Flat heads and plagio are not medical issues, so she doesn't need a plastic surgeon to consult on this... Another pedi/ NP in her pedi practice should suffice. From there, it's up to the parents to decide if they want to proceed with banding treatment (at Cranial Tech or similar place).
If flat spot/plagio is caused by torticollis, obviously PT is needed, parents should ask their pedi for referral or find someone in their area. That's not hard.

My DD didn't have tort but she still favored one side when she slept (she was breech and it had something to do with how she was wedged inside me). By 3-4m of age I could see a clear flat spot on one side. Her ped kept dismissing my concerns, so I talked to another ped as she recommended seeing Cranial Tech. Based on their measurements and statistic she had mild/moderate plagio and some facial feature distortion, with ear rotation.
DD was in a Doc Band for 10-11w I think, starting at 6m, and I did my own neck strengthening work (just googled what stretches are recommended) and her situation improved dramatically! Her head is perfect, facial features evened out and her neck muscles loosened up completely.
It was the best decision we made for her!
Don't be scared of having a baby in a band if you decide to go that route. A few short weeks of parental self consciousness (bc baby doesn't care) is a small price to pay for a perfect, round head for a lifetime...

jenn43 · October 2014

harmonicbabe26 said:

Flat heads and plagio are not medical issues, so she doesn't need a plastic surgeon to consult on this... Another pedi/ NP in her pedi practice should suffice. From there, it's up to the parents to decide if they want to proceed with banding treatment (at Cranial Tech or similar place). If flat spot/plagio is caused by torticollis, obviously PT is needed, parents should ask their pedi for referral or find someone in their area. That's not hard. My DD didn't have tort but she still favored one side when she slept (she was breech and it had something to do with how she was wedged inside me). By 3-4m of age I could see a clear flat spot on one side. Her ped kept dismissing my concerns, so I talked to another ped as she recommended seeing Cranial Tech. Based on their measurements and statistic she had mild/moderate plagio and some facial feature distortion, with ear rotation. DD was in a Doc Band for 10-11w I think, starting at 6m, and I did my own neck strengthening work (just googled what stretches are recommended) and her situation improved dramatically! Her head is perfect, facial features evened out and her neck muscles loosened up completely. It was the best decision we made for her! Don't be scared of having a baby in a band if you decide to go that route. A few short weeks of parental self consciousness (bc baby doesn't care) is a small price to pay for a perfect, round head for a lifetime...

I love how supportive the Bump is, and I know you all want to reassure OP that her baby is fine. But sometimes that support crosses the line into giving medical advice. Even if you are a doctor, giving medical advice (such as whether or not someone should see a specialist) regarding a person you've never met or examined, and whose medical history you don't know can be harmful.

Yes- looking back I realize I told OP that she "need[s] to see a Plastic Surgeon." I obviously need to be more careful of the way I phrase things as well. So let me rephrase now and just say that a plastic surgeon is traditionally the specialist who diagnoses positional plagiocephaly vs. craniosynostosis. If you wanted to see a specialist, this is who you would see.

And now lets all leave the medical advice for OP's doctor.

Have a great weekend, and Happy Halloween!

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