How often do you see headmolding/plagiocephaly?

prmenrs, RN · Jun 1, 2011

It's a matter of priorities. Maintaining the baby's physiological stability: pulmonary, cardiac and neurological function trumps head molding every time.

That said, babies are repositioned as often as their stability permits. Some babies breathe more effectively in a certain position, and if you handle them, it effects their pulmonary/cardiac status in a negative way.

I feel compelled to ask for what reason do you need this information?

amybeets05 · Jun 2, 2011

I am a student nurse- and a mother of 2. My youngest is 16 months, and spent 2 months in a Level III nicu. He ended up getting plagio. Brachycephaly, to be exact. It was quite severe, and he had to wear a cranial remolding orthosis. I completely see, and saw back then, that other things are more important the first few critical weeks than worrying about head shape. However, it is something that I believe is not addressed in the NICU for babies that have extended stays. My son's plagio could have been prevented. The treatment was not covered by insurance and was $3800, and required us to drive 1 hr each way to the rehab clinic every day for 2 weeks for fitting, and then once a week for 4 months. He had to wear a "STARband" helmet every day, 23 hours a day. Where we live it is 100-110 degrees in the summer & fall. So, you can imagine what it was like. Not to mention the stares and questions. No one said a word to me about plagio prevention in the NICU or at discharge. The pediatrician caught it b/c it was so severe at his 4 month checkup. A normal cranial "vault" percentage is 80-85%, and my son's was 98%. Even after treatment, it is still 90%. So, I think this is an issue that needs to be given more attention, even if it is mostly cosmetic. I say mostly, b/c some kids even up needs facial reconstructing surgery to correct a very uneven bone structure in their face.

NicuGal, MSN, RN · Jun 2, 2011

It really isn't addressed because sometimes there isn't a thing you can do about it....we use positional devices, position changes and the such, but some kids just get it.

The damage is sometimes done early on within the first weeks or even months when they are so sick and those skull bones are at their most pliable. When the kids are more stable we will get them on their back and midline as much as we can. We also use gel pads and mattresses when they are at their sickest so that helps some too. But once they are extubated, we have to take those positional aids out of the bed as they are a risk.

Believe me, we are distressed sometimes on how their heads turn out, but our job is to get baby thru the rough parts alive and their head shape is low on our priority list Our kids are followed for 2 years at our Preemie Clinic and we have only had a handful that required the helmet therapy, so we must be doing pretty well.

BabyLady, BSN, RN · Jun 2, 2011

I have a ton of questions, but i'll only ask a few here. If someone is feeling super helpfull, they can PM me and i can ask much much more.
So how prevalent is is head molding in your nicu? When i say head molding, i mean plagiocephaly, brachycephaly, & scaphocephaly. From what i understand, the only preventative measure to developing molding of any type is constant position changing. How much time a day would you say you spend on changing head position specifically? Also, if a child is developing plagiocephaly, who is responsible for administering care to help combat it? How effective is it? What is typically done afterwards to help resolve the head molding issues? If there is some sort of device to help prevent head molding, would hospitals be willing to use it?
I ask because i have heard many instances where children develop plagiocephaly due to their preterm birth, and it remains with them untill their neonatal development specialist catches it and undergoes recorrective measures. The only problem is that sometimes the specialists believe the head molding will correct itself over time, and sometimes it does not. This leaves a very frustrated mother. Your thoughts please?

I'll be honest...you won't see those terms used on a regular basis in the NICU...you will hear them referred to typically in lay terms such as "right side is flattening" or "molding" or "toaster head"...obviously, the last one is not included in charting :).

We assess our babies and turn then on a q3 schedule unless we have a very, very critical infant and then they are turned q6. Physicial therapy works with the NICU very closely and are very instrumental in helping us with positions or positioning aids to make sure we don't have very many "toaster heads" going home.

babyNP., APRN · Jun 2, 2011

You also have to remember that many babies do much better on their bellies so that we can wean their oxygen FiO2 down--for the tiny ones, this can save them from more severe stages of ROP. I do try to put babies on their backs when they're little (and especially those first 3 days to prevent head bleeds), but molding for a few months versus long-term eye sight/oxygenation has to win out.

amybeets05 · Jun 3, 2011

That's great to hear that you all's NICU's use preventative devices and actually take measures to prevent it from happening. My son was in the only Level III NICU in the state, here in MS, and they didn't do anything like that. At all. They didn't even turn his head. If I had known at the time, I would have requested it or done it myself!