I had the distinct opportunity to attend the Collaborative Improvement and Innovation (COIN) meeting for the Safe Sleep initiative in Alabama this week and met some motivated leaders in the field who are passionate about making a difference in the arena of protecting infant life. This initiative will be collaborating with the Safe to Sleep campaign through the National Institute of Health. Encompassing 13 states, the five areas of focus for COIN are 1) Safe Sleep 2) Perinatal Regionalization 3) Smoking Cessation 4) Interconception Care and 5) Elective Deliveries before 39 weeks. All five focus areas have a single goal: lowering the infant mortality rate- saving babies' lives.
During the meeting, a common theme resounded. The second leading cause of death in children under the age of 18 years old is sleep related deaths. The first leading cause is attributed to vehicle accidents. Astonished? I am, too! What that means is in the state of Alabama the second leading killer of children is PREVENTABLE! In order to break this down, I feel it is first essential to explain and over explain what SIDS is not so that people realize they can prevent infant death....they can save babies' lives.
SIDS is the unexplained death of an infant under one year old diagnosed after autopsy, death scene investigation and child/family medical history review. If the cause of death remains unclear or unknown it is labeled SIDS. I bring this up again because many people think of any infant death as SIDS and that there was "nothing that could prevent it". If it is a true SIDS case and all of the requirements are met, then yes, you can't prevent it when you don't know happened. The actual SIDS rate is very low. However, if the death was preventable, IT IS NOT SIDS!
What is preventable? Sleep related deaths. And because they are preventable, they are NOT SIDS. A sleep related death is when a baby suffocates laying in an adult bed. A sleep related death is when a baby is trapped under another child and smothered during sleep. A sleep related death is when a baby is left to sleep in a car seat, his or her head falls forward and cuts off the airway causing the baby to stop breathing. A sleep related death is when a baby slips between the crib and the mattress because it is not properly fitted and becomes trapped. A sleep related death is when a baby is smothered by pillows, blankets and stuffed animals in the crib. It is gruesome, it is gory, but it is absolutely necessary for all of you to understand you can prevent sleep related deaths. And it is also essential to understand that we are not fighting SIDS here, we are fighting accidental deaths.
I firmly believe people have it in their minds that sudden infant death has us all clutched in its grasp with no recourse. It is simply not true. We must, MUST understand the distinction between SIDS and a sleep related death if we are ever going to move forward in lowering the infant mortality rate. What you know can save your baby's life.
It is a grave injustice for parents to be given a SIDS diagnosis for the death of their infant when in fact it was a sleep related death. This only puts future children at risk for an accident of the same kind. Being told "there was nothing you could have done, it was SIDS" when it was actually an accidental suffocation, entrapment or parent overlay will do nothing to help those parents. We have a responsibility as a medical community to be honest and upfront so parents can not only protect their own children, but also become advocates for other parents as well in safe sleep practices for infants.
Safe sleep means:
1) An infant should have their own sleeping environment with a firm sleep surface (crib, play yard) where they sleep alone
2) Nothing soft or plush should be put in the baby's sleeping area like heavy, thick blankets, pillows or stuffed animals
3) A baby should not sleep in an adult bed, on the couch or in a recliner due to the risk of suffocation
4) A baby should not sleep in a car seat, swing or bouncer due to the risk of closing off the airway
Be safe out there and know that you can protect your baby's life!
Sunday, November 18, 2012
Thursday, October 11, 2012
Plagiocephaly and Craniosynostosis
I'd like to share a case study of an infant I have been seeing for ~5 months. He was first referred to me in the clinic for flattening of the back of the skull (positional plagiocephaly) at 4 months old. We started on a stretching program to stretch his neck muscles that were tightened (torticollis) and a positioning program to correct the flattened area of the skull. He made a full recovery from the tightened neck muscles and his head rounded out to within a few millimeters difference from left side to right side. A few months later, he returned for developmental delay due to a weak trunk and not sitting. Through the course of treatment, his mother, pediatrician and myself noted a protrusion on his forehead that was becoming more prominent. After a trip to Vanderbilt to consult with a cranio-facial surgeon, he was diagnosed with single suture craniosynostosis. There exists in the skull a series of sutures that are open at birth to allow an infant to pass through the birth canal. These "soft spots" remain open through the first year to accommodate the growing brain and fully fuse by adulthood. If any one of these sutures closes prematurely, it is termed craniosynastosis.
After some research, it became evident that although craniosynostosis is rare (reports stating 1 in 2000 to 1 in 4000) it is important for parents and physical therapists alike to be aware of it when it comes to plagiocephaly (misshapen head). It is therefore encouraged for pediatric physical therapists to check whether the soft spots are still open with each baby with a diagnosis of plagiocephaly. This is especially true with babies with a diagnosis of brachycephaly- a type of plagiocephaly. Fusion of the metopic suture (the suture on the forehead) causes a triangular shaped head with a narrow forehead and wide back of the head which is also the cranial shape with brachycehpaly. In my travels across the country, I have spoken with many PT's and orthotists alike who say "It is more difficult to treat a baby with brachycephaly with a cranial remolding helmet," with some claiming very little success with this head shape type. Perhaps it is actually a single suture craniosynostosis of the forehead suture (metopic) rather than a failure of the helmet in these cases.
Every tool we can put in our case is a benefit to a child. If you have a story you would like to share on this topic, I'd like to open it for discussion.
Monday, September 24, 2012
Press Release
The National Institute of Health is pleased to announce the launch of the Safe to Sleep Campaign which enhances the previous Back to Sleep Campaign of 1994. This campaign is different from the original program in that it expands the focus from only Sudden Infant Death Syndrome (SIDS) to all sleep-related, sudden unexpected infant deaths. As part of the initiative, the NIH has announced Safe to Sleep Champions in the states with the highest numbers of SIDS and other sleep-related deaths to promote the new campaign.
Stephanie Pruitt, Pediatric Physical Therapist and author of The Truth About Tummy Time: A Parent’s Guide to SIDS, the Back to Sleep Program, Car Seats and More has been named a Safe to Sleep Champion by the National Institute of Health as a spokesperson for the North Alabama region. Pruitt, along with 35 other Champions in the states of Alaska, Arkansas, Delaware, District of Columbia, Georgia, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, West Virginia and Wyoming will be promoting the Safe to Sleep Campaign in various media outlets throughout the month of October, National SIDS Awareness month, to spread the word about the new campaign.
“What you know could save your baby’s life”, Pruitt says stressing that a safe sleep environment can determine your baby’s survival. “Although the SIDS rate has declined in recent years, the rates of other sleep-related deaths like suffocation, accidental strangulation and entrapment have increased making this program so important for parents and caregivers of infants up to one year old.”
The main message of the new campaign is a safe sleeping environment. This includes a separate sleep environment for the infant (like a crib, bassinet or play yard) with a firm mattress that fits the bed snugly. Infants should not be placed to sleep in an adult bed due to the risk of overlay, entrapment or suffocation. All soft, loose items like stuffed animals, thick, heavy blankets or pillows should not be placed in the sleeping area as they pose a risk of suffocation. The American Academy of Pediatrics recommends placing the baby on the back to sleep for every sleep in a safe sleeping environment.
For more information on the Safe to Sleep campaign, visit www.nichd.nih.gov/SIDS
For more information on The Truth About Tummy Time A Parent’s Guide to SIDS, the Back to Sleep Program, Car Seats and More visit www.abouttummytime.com
Wednesday, August 1, 2012
New AAP Recommendations for Safe Sleep
It is with great pleasure that I am posting the new American Academy Recommendation for infant sleeping. The policy statement released in October 2011 is now making its rounds in the medical community with the NICHD launching the Safe to Sleep campaign in the near future. I am almost moved to tears to read in the opening paragraph of the policy statement, "The AAP, therefore is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS." Also in that opening paragraph is, ""...other causes of sudden unexpected infant death that occur during sleep, including suffocation and asphyxia, and entrapment...have increased in incidence, particularly since the AAP published its last statement in 2005". I am SO excited to hear about the newly expanded campaign as it makes all the effort of educating about safe sleep for the last several years worth it!
The following are the new recommendations:
1) (not surprisingly) Back to sleep for every sleep
- Once an infant can roll from back to stomach and stomach to back, the infant can be allowed to remain in the sleep position that he or she assumes.
2) Use a firm sleeping surface- a firm crib mattress, covered by a fitted sheet
- infants should not be placed for sleep on beds because of the risk of entrapment and suffocation
- portable bed rails should not be used because of the risk of entrapment and strangulation
- Sitting devices, such as car seats, strollers, swings, infant carriers and infant slings are not recommended for routine sleep
3) Room-sharing without bed sharing is recommended
- infant crib, portable crib, or bassinet should be placed in the parents' bedroom. This arrangement reduces the risk of SIDS and removes the possibility of suffocation, strangulation, and entrapment that might occur when the infant is sleeping in the adults' bed.
-devices promoted to make bed sharing "safe" (co-sleepers) are not recommended
4) Keep soft objects and loose bedding out of the crib to reduce the risk of SIDS, suffocation, entrapment and strangulation
5) Pregnant women should receive regular prenatal care
6) Avoid smoke exposure during pregnancy and after birth
- Smoking in the infant's environment is a major risk factor for SIDS
7) Avoid alcohol and illicit drug use during pregnancy and after birth
8) Breastfeeding is recommended
9) Consider offering a pacifier at nap time and bedtime
10) Avoid overheating
11) Infants should be immunized in accordance with recommendations by the AAP and the CDC
12) Avoid commercial devices marketed to reduce the risk of SIDS
13) Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
14) Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly :)
The list goes on for a total of 18 recommendations. For a complete view of the policy statement click here.
The following are the new recommendations:
1) (not surprisingly) Back to sleep for every sleep
- Once an infant can roll from back to stomach and stomach to back, the infant can be allowed to remain in the sleep position that he or she assumes.
2) Use a firm sleeping surface- a firm crib mattress, covered by a fitted sheet
- infants should not be placed for sleep on beds because of the risk of entrapment and suffocation
- portable bed rails should not be used because of the risk of entrapment and strangulation
- Sitting devices, such as car seats, strollers, swings, infant carriers and infant slings are not recommended for routine sleep
3) Room-sharing without bed sharing is recommended
- infant crib, portable crib, or bassinet should be placed in the parents' bedroom. This arrangement reduces the risk of SIDS and removes the possibility of suffocation, strangulation, and entrapment that might occur when the infant is sleeping in the adults' bed.
-devices promoted to make bed sharing "safe" (co-sleepers) are not recommended
4) Keep soft objects and loose bedding out of the crib to reduce the risk of SIDS, suffocation, entrapment and strangulation
5) Pregnant women should receive regular prenatal care
6) Avoid smoke exposure during pregnancy and after birth
- Smoking in the infant's environment is a major risk factor for SIDS
7) Avoid alcohol and illicit drug use during pregnancy and after birth
8) Breastfeeding is recommended
9) Consider offering a pacifier at nap time and bedtime
10) Avoid overheating
11) Infants should be immunized in accordance with recommendations by the AAP and the CDC
12) Avoid commercial devices marketed to reduce the risk of SIDS
13) Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
14) Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly :)
The list goes on for a total of 18 recommendations. For a complete view of the policy statement click here.
Thursday, July 12, 2012
Why you Must Treat Torticollis even with a Helmet!
Since the last post "Cranial Remolding Helmets: To Be or Not to Be", my inbox is flooded with people asking for more information on why it is important to treat torticollis even when a baby has a cranial remolding helmet. Just to reiterate, the cranial remolding helmet is treating the flat spot on the head and ONLY the flat spot on the head (plagiocephaly). The subsequent shortened neck muscle(s) are still shortened and need to be addressed with a stretching and positioning program to ensure equal range of motion on both sides of the neck as well as balanced muscle development. The helmet is not designed to treat the neck or it would have a component that extends beyond the head to the neck as well.
Here is an analogy: If you were in a car accident sustaining injuries of a broken arm and a severe muscle strain in your back, would you not treat your back because you had a cast on your arm? The same applies for the difference between plagiocephaly (head flattening) and torticollis (shortened neck muscles). Because the two conditions coexist 80-90% of the time, they must each be treated in conjunction.
In a nutshell, you must treat the torticollis even if your baby has a helmet. For more information and research backing this claim, refer to the reference section of the book The Truth About Tummy Time. If changes are not made in the pattern of caring for your baby, the shortened neck muscles will not magically resolve on their own.
Here is an analogy: If you were in a car accident sustaining injuries of a broken arm and a severe muscle strain in your back, would you not treat your back because you had a cast on your arm? The same applies for the difference between plagiocephaly (head flattening) and torticollis (shortened neck muscles). Because the two conditions coexist 80-90% of the time, they must each be treated in conjunction.
In a nutshell, you must treat the torticollis even if your baby has a helmet. For more information and research backing this claim, refer to the reference section of the book The Truth About Tummy Time. If changes are not made in the pattern of caring for your baby, the shortened neck muscles will not magically resolve on their own.
Wednesday, June 13, 2012
Cranial Remolding Helmets: To Be or Not to Be?
It is common for parents to have many questions about cranial remolding helmets or orthotics. Here is what you need to know about them:
What is the helmet and what does it do? There are several different types (helmets, headbands) that all have the same goal of remolding the shape of your baby's head. The type used on your baby will be determined by the orthotist or cranial remolding center you go to for treatment. The theory is that the brain grows in the path of least resistance. The helmet or headband works by maintaining the high points or rounded areas of the skull allowing the flattened areas to round out as the brain continues to grow. Optimally, the helmet is fit by nine months old and is worn anywhere from two to nine months depending on the severity of the head deformity. The baby wears the helmet 23 hours a day and you must return to the orthotist or cranial remolding center for adjustments on a regular basis. Insurance does not always cover this treatment with the average costs of head remolding orthotics ~$3000.
Is there another option for treating a misshapen head? The short answer is yes! Conservative measures are very successful when a positioning program is put in place right away. This can mean from day one after birth to prevent head deformity in the first place or as soon as a flat spot is detected. A positioning program is clinically proven to work and involves changing the position of your baby every time you put him or her down. This means sometimes on the back, sometimes on the stomach, sometimes on the right side and sometimes on the left side. The variety of positions ensures equal forces on the head to allow a rounded head appearance as well as developing equal muscle strength on all sides. Head movement also develops the balance system itself. Another must is limiting the time your baby spends in carseats, swings and bouncers as all of these items contribute to flattening of the skull. These apparatuses are ok for brief periods to ensure not only a rounded head shape, but also developmental milestone acquisition.
Who should get a cranial remolding orthotic? In my experience, there are two groups who could benefit from a helmet for the treatment of a misshapen head (plagiocephaly). The first group are infants with a diagnosis of hydrocephalus or similar internal disease process that effects the shape of the head. With hydrocephalus, once the spinal fluid is properly regulated and shunted off the brain, the head may have an abnormal appearance. Where conservative methods could also work depending on severity, a helmet or headband would assist in the process of reshaping.
The second group is if the parents/caregivers do not have ample time to institute a positioning program. There is no judgement passed here, it is reality as we know it today in our busy world with both parents working, single parenthood, etc. And the daycare is not always willing, able or allowed to assist in the positioning program. A baby who spends the majority of his or her time confined in a carseat, bouncer or swing or flat on his or her back for whatever reason with little opportunity for floor/play time could benefit from a helmet or headband to ensure optimal rounding of the head if flattening exists. Be aware that people rarely go to an orthotist or a cranial remolding center to inquire about a hemlet without walking out of there with one--often regardless of how minimal or severe the case. So be prepared and stand your ground if you have reservations.
Look for upcoming posts on why treating a misshapen head is so vitally important to your child. In the meantime, I am happy to answer any questions you may have. Good luck out there!
What is the helmet and what does it do? There are several different types (helmets, headbands) that all have the same goal of remolding the shape of your baby's head. The type used on your baby will be determined by the orthotist or cranial remolding center you go to for treatment. The theory is that the brain grows in the path of least resistance. The helmet or headband works by maintaining the high points or rounded areas of the skull allowing the flattened areas to round out as the brain continues to grow. Optimally, the helmet is fit by nine months old and is worn anywhere from two to nine months depending on the severity of the head deformity. The baby wears the helmet 23 hours a day and you must return to the orthotist or cranial remolding center for adjustments on a regular basis. Insurance does not always cover this treatment with the average costs of head remolding orthotics ~$3000.
Is there another option for treating a misshapen head? The short answer is yes! Conservative measures are very successful when a positioning program is put in place right away. This can mean from day one after birth to prevent head deformity in the first place or as soon as a flat spot is detected. A positioning program is clinically proven to work and involves changing the position of your baby every time you put him or her down. This means sometimes on the back, sometimes on the stomach, sometimes on the right side and sometimes on the left side. The variety of positions ensures equal forces on the head to allow a rounded head appearance as well as developing equal muscle strength on all sides. Head movement also develops the balance system itself. Another must is limiting the time your baby spends in carseats, swings and bouncers as all of these items contribute to flattening of the skull. These apparatuses are ok for brief periods to ensure not only a rounded head shape, but also developmental milestone acquisition.
Who should get a cranial remolding orthotic? In my experience, there are two groups who could benefit from a helmet for the treatment of a misshapen head (plagiocephaly). The first group are infants with a diagnosis of hydrocephalus or similar internal disease process that effects the shape of the head. With hydrocephalus, once the spinal fluid is properly regulated and shunted off the brain, the head may have an abnormal appearance. Where conservative methods could also work depending on severity, a helmet or headband would assist in the process of reshaping.
The second group is if the parents/caregivers do not have ample time to institute a positioning program. There is no judgement passed here, it is reality as we know it today in our busy world with both parents working, single parenthood, etc. And the daycare is not always willing, able or allowed to assist in the positioning program. A baby who spends the majority of his or her time confined in a carseat, bouncer or swing or flat on his or her back for whatever reason with little opportunity for floor/play time could benefit from a helmet or headband to ensure optimal rounding of the head if flattening exists. Be aware that people rarely go to an orthotist or a cranial remolding center to inquire about a hemlet without walking out of there with one--often regardless of how minimal or severe the case. So be prepared and stand your ground if you have reservations.
Look for upcoming posts on why treating a misshapen head is so vitally important to your child. In the meantime, I am happy to answer any questions you may have. Good luck out there!
Tuesday, June 5, 2012
Book Review
I am happy to share a book review from Australia by Whatson4.com.au: (http://www.whatson4littleones.com.au/review-parenting-support.asp)
"When I first began reading this book, I thought it may have been too scientific and not "easy reading" which is all I can cope with these days (new mother!). But I found it so informative, I couldn't put it down! I found the author's personal experiences portrayed in the book to be really honest, without being scary and gave some good advice on finding the right balance between following the SIDS recommendations and incorporating tummy time in your baby's day. There are some sections that were more scientific and statistical which would make it a very valuable resource for a health professional and a great resource to have as part of a library."
~Anna, mother to 1
"When I first began reading this book, I thought it may have been too scientific and not "easy reading" which is all I can cope with these days (new mother!). But I found it so informative, I couldn't put it down! I found the author's personal experiences portrayed in the book to be really honest, without being scary and gave some good advice on finding the right balance between following the SIDS recommendations and incorporating tummy time in your baby's day. There are some sections that were more scientific and statistical which would make it a very valuable resource for a health professional and a great resource to have as part of a library."
~Anna, mother to 1
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