Before the birth of her triplet sons, Michelle Axford had never seen a baby wearing a helmet.
Triplet sons of Dan and Michelle Axford, Lake Linden, Michigan, wear custom-fit helmets to correct flat head syndrome. They are (from left): Brady, Lukas and Tyler, at 9½ months.
After coming to Marshfield Clinic for the babies' six-month check up, she learned her sons had a common condition that could be treated successfully by wearing custom-fit orthotic helmets.
Axford and her husband, Dan, relied on the expert staff at Marshfield Clinic and Ministry Saint Joseph's Children's Hospital in Marshfield for the prenatal, neonatal intensive care and post-natal care of their sons.
The babies developed flat head syndrome after birth, partly from sleeping on their backs, and also because of torticollis, a tightness in the neck muscles typically caused by positioning in utero. This causes the baby to prefer one side of the head.
Causes of flat head syndrome
Babies can develop a flat spot on the back of their heads from lying in one position.
It can be on one side of their head, referred to as plagiocephaly, or a uniform flat spot on the back of the head, called brachycephaly.
Doctors refer to these conditions as flat head syndrome.
A couple of factors contribute to plagiocephaly: The American Academy of Pediatrics "back-to-sleep" campaign encourages babies to be placed on their backs to reduce sudden infant death syndrome (SIDS).
Baby equipment that promotes lying on the back also adds to plagiocephaly, and the need for helmet treatment, said Patti Willkom, Marshfield Center pediatric occupational therapist.
Team approach means thorough evaluation
Pediatricians at all Marshfield Clinic locations check for plagiocephaly at well baby visits.
Pediatricians refer the baby to Pediatric Neurology, Occupational Therapy and Orthotics if the doctor suspects any form of skull deformity.
"We see these babies to rule out any underlying skeletal or neurological conditions, which may predispose the baby to torticollis and consequently plagiocephaly," said Monica Koehn, M.D., Marshfield Clinic pediatric neurologist.
The orthotist takes baseline measurements to assess the degree of deformity, which determines if helmet treatment is necessary.
Occupational therapists evaluate the baby for torticollis and any developmental concerns.
"I also instruct the parents in repositioning strategies to keep the baby off the back of their head, exercises for the baby's neck as needed and talk about the importance of tummy time for the baby," Willkom said.
Measuring baby's head without sedation
Before the baby can wear the helmet, exact cranial measurements are needed.
Michelle Axford watches as her son Tyler has his cranial shape measurement taken by Gary Ovaska.The STARscanner™ laser scanner has been used for a year and one-half in the Orthotics Department, thanks to a generous donation from Children's Miracle Network.
At many clinics, the child must be sedated for this procedure, and the orthotics and doctor's offices may be in separate locations.
At Marshfield Clinic Marshfield Center, the Orthotics Department uses a laser scanner to measure the baby's head in a matter of seconds, eliminating the need for sedation. It's one of the fastest, most precise ways to collect a three-dimensional head shape for custom helmet molding.
"Parents also like the convenience of getting all their appointments done here in one day, with all providers in one location," said Gary Ovaska, a certified orthotist and Marshfield Center Prosthetics/Orthotics assistant manager.
"The scanner is essential not only in initial measurement of the baby's head, but with ongoing care when re-fittings of the helmet are needed as the patient grows and improvement in head shape is seen," said Rhonda Helmke, whose duties include managing Orthotics/Prosthetics.
Wearing the helmets 23 hours a day helps focus growth in a targeted area, with treatment taking about three to five months.
Ovaska points out that the best outcomes are achieved when helmet wearing begins at an early age – between four to nine months. This time is ideal because of the rapid cranial growth and pliability of the skull during this time.
"Because of the laser scanner, we no longer need to sedate babies, and therefore shorten the elapsed time between diagnosis and treatment," said Dr. Koehn.
"The children tolerate the helmet very well. The helmet also provides an added safety buffer for those common tumbles babies take their first year of life," she added.
Helmet offers extra benefit
First-time mom Michelle Axford attests to the value-added benefit of the helmets.
At 10 months, Tyler began the progression from crawling to sitting. "He's taken some tumbles, but he takes them in stride thanks to his helmet," she said.
Having her babies wear helmets all the time, except for bathing the boys and cleaning the helmets, was not the easiest thing to do, she said. "Nobody wants to do it. But you have to do this to help your child."
Husband Dan agrees, saying, ‘You've got to do what's in their best interests."
As for the babies, "The helmets did not bother them a bit," Michelle said. In fact, when they are removed for bathing, she said the boys touch their heads, as if to say, "Hey, where'd it go?"
The Axfords, who traveled five hours from Michigan's Upper Peninsula to Marshfield for their sons' care, say they would "definitely recommend this treatment to other parents.
We are thrilled with the changes, and all of our family members have seen a noticeable difference in the babies," Michelle said.
Toddlers now helmet free
The boys are doing well "post helmet." No adjustment period was needed after the helmets were removed, she said.
"Our friends and family also think the boys have a nice head shape."
The decision to use helmets may have been difficult at first, Michelle said. "In the grand scheme of things, it is a short amount of time for a lifetime of difference."