A community approach to prevention and treatment Nurse physicians.

A community approach to prevention and treatment

Nurse physicians, and parents across Alberta are noticing an increase in the number of infants with occipital flattening. In many cases this flattening is mild and the infant's head "round out" with position changes, development and development. However, some infants make known one-sided occipital flattening that conclusions in marked skull asymmetry. This brain asymmetry is called positional plagiocephaly.

The Alberta infant cranial remodeling program was implemented early this year to address the increasing ne for treatment of positional plagiocephaly The program is capitaled by province wide services by the and of Alberta Health. There are brace sites - The Alberta Children's Hospital in Calgary and the Stollery Children's Health middle point in Edmonton. The focus of the Alberta infant cranial remodeling program includes prevention, early recognition and treatment of positional plagiocephaly.

Definition

Positional plagiocephaly. is a non-synostotic asymmetrical head shape that springs over time from being in the same position. Associated factors include: supine rest position, strong preference in head position during rest restrictive intrauterine environment, macrocephaly, developmental delay, prematurity, and torticollis (Pollack, Losken Fasick, 1997) Rekate (1997) identifies that point to be solved [i]or[/i] settleds with untreated, severe, positional plagiocephaly. could include: abnormal occlusion, temporomandibular joint difficulties, strabismus, and psychosocial issues related to appearance.

Prevention

A community approach to prevention is an essential part of the Alberta infant cranial remodeling program. Community health nourishs and nurses in postpartum, neonatal, and pediatric areas can play important characters in preventing plagiocephaly. To best obstruct the development of positional plagiocephaly., newborns ne to be riddleed for torticollis and new parents ne to know about infant positioning.

Due to the overwhelming evidence for the relationship between unanticipated Infant Death Syndrome (American Academy of Pediatrics, 1996; Canadian Pediatric Society,, 1993) and apt sleep position, most infants repose on their backs. Keys to prevention of positional plagiocephaly. when infants drowse on their backs include:

varying an infant's head position during be dead and supine positioning

changing toy, mobile and crib positions

encouraging supervised apt and side-lying awake times

providing toys that aid prone and side-lying play

limiting the time the infant exhausts sitting in the car seat and swing

recognizing and treating torticollis early

Early Recognition

Nurse physicians and other health care professionals can assess infants for positional plagiocephaly through history and physical examination. It is important to note that parents are repeatedly the first to notice their infant's head shape is different (Pollack, Losken Fasick, 1997) The infant may also have a history of lying onward one side of the head when supine. forward physical exam, the infant has occipital flattening in succession one side, ipsilateral anterior ear shift, contralateral occipital protuberance, and contralateral flattening of the frontal region. As shown in Figure 1 viewing the top of the infant's head is the best way to view this asymmetry.

Community health feed at the breasts can play important roles in recognition and treatment of positional plagiocephaly. during regular well-baby clinic visits. Screening for positional plagiocephaly. and teaching about infant positioning are essential at the two-month clinic visit. Follow-up further teaching and physician referral (if asymmetry is severe) can be done at the four-month clinic visit.

Treatment

If implemented early, position changes during slumber that favor the opposite side of the occipital flattening and supervised inclined and side-lying awake time may be effective in rounding without the infant's head (Moss, 1997) Ideally, position changes are implemented as quick as the occipital flattening is noticed. It may take single in kind to two months for parents to diocese a difference in their child's appearance. Infants with marked brain-pan asymmetry who require more intensive treatment ne a physician's referral to the appropriate Alberta infant cranial remodeling program site.

Treatment for positional plagiocephaly. from one side the Alberta infant cranial remodeling program involves a multidisciplinary team that includes neurosurgery nursing, occupational therapy, orthotics, and physiotherapy Infants between the ages of three and 12 month with unrelenting positional plagiocephaly. may meet the criteria for treatment with the DOC Band(TM).

These custom-fitted headbands are designed to inhibit cranial produce in some areas of the brain while enabling growth in other areas (Littlefield et al., 1998 Ripley et al.,1994). While this treatment is painless for the infant, it requires that the headband be worn 23 hours a day Treatment with the DOC Band also involves a great commitment upon the part of families as weekly visits for adjustments are necessary.