A new case report has hit the Asia Pacific Chiropractic Journal covering the chiropractic-plus-helmet co-management of an infant with plagiocephaly. Plagiocephaly is the clinical term for when an infant develops a flat spot on their head (usually at the back or slightly to the side). Cases of Plagiocephaly have been on the rise since the “Back to Sleep” recommendation for Sudden Unexplained Death in Infants (SUDI) was launched. While placing infants on their back to sleep is certainly the best information we have so far on SUDI, Plagiocephaly has risen from a prevalence of 1 in 300 (approx.) to somewhere between 16 and 48% [1]. In most cases it is mild and thought to be harmless. However, in more severe cases, orthotic or even surgical intervention is required.
The question of whether or not it truly is harmless is not solidly answered yet. There are indications that school aged children may score lower in cognitive and academic outcomes if they suffered from moderate to severe Plagiocephaly [2]. Still more research is being undertaken to examine the possible effects on neurodevelopmental delays, motor skill development and more. Frankly, given the profound amount of neuronal and developmental growth during infancy, it is a topic well worth investigating. But while the academic jury may still be out for deliberation on that, there is good news: A growing number of chiropractic case reports have indicated positive results for plagiocephaly.
The latest emerges from the desk of renowned chiropractor and research contributor Matthew Doyle who put together a literature review and case report on a recent case. While the literature review itself is well worth reading, the case in question is noteworthy, as it was significant enough for the infant to be fitted with a helmet (a move usually reserved for moderate to severe cases).
The Case Report
The five-month-old infant was presented for assessment and care at a chiropractic clinic. This infant had previously presented for care at 11-17 weeks old for colic and “general wellbeing.” This time, the mother was seeking a ‘shared care’ approach, combining helmet therapy, physiotherapy, and chiropractic. At this stage in the infants development, the mother had noted issues with head shape asymmetry, poor neck movement, and issues with digestion.
Chiropractors who care for infants often take into consideration the first nine months of life – those spent inside the womb. Interestingly, this was the mothers first full-term pregnancy. She had sadly suffered from two previous miscarriages, and during this pregnancy, she had fall (mid-way through gestation) onto concrete resulting in sacroiliac joint pain and sciatica. During the first term there was severe morning sickness reported, multiple hospitalizations due to hyperemesis (which is excessive, unrelenting vomiting).
She had a family history of scoliosis, and a history of long-term fluoxetine usage for depression/anxiety. Infant was reported to be engaged for weeks prior to birth and being head down during labour (38+1 weeks gestation). There was no doula present during labour, gas and epidural were given, vacuum extraction assistance required for vaginal delivery. While the baby was alert post birth, jaundice was noted.
These findings are noteworthy, and while no causal relationship can be established, it does paint a picture of the stressors that were present during this child’s entry into the world. While it is fair to say that every mother is doing the very best they can in the lead up to and during their child’s birth, it is also worth taking into consideration when bringing your infant (and yourself) in for post-partum care. These little nervous systems are very sensitive.
Examination and Care
The chiropractors examination revealed the following: “Decreases in left lateral flexion and left cervical rotation were noted. Vertebral subluxations were listed at her occiput bilaterally, T3 and S2 Facial symmetry changes were noted with anterior displacement of her right ear, right frontal bossing, and contralateral bossing of her occiput resulting in a parallelogram shaped head. Cranial restrictions were recorded at the occiput, right temporal, and right sphenoid. No evidence of lambdoid craniosynostosis was found which commonly presents with a more trapezoidal head shape. Her asymmetric tonic neck reflex was weak on the right.”
For the non-chiropractors among us, this examination revealed issues with movement and rotation on the left side, subluxations on both sides at the back of the head as well as the mid back and the base of the spine. Visual changes and asymmetry of the face were present and her neck reflexes were weak on the right.
These findings indication that the infant was on the more severe end of the plagiocephaly spectrum and schedule of chiropractic care commenced. The care schedule included three visits a week in the week leading up to Christmas, none over the Christmas and New Year period, and then three visits a week for three weeks before going on holiday. She had a helmet fitted before holiday and stopped at 10.5 months of age. Regular visits resumed after returning from the three-week trip. The infant was under chiropractic care for twelve months with 35 visits in total, as well as helmet use for 4.5 months (from six months to 10.5 months).
Doyle remarked that:
“Common chiropractic interventions included dural released with occipito-sacral decompression; cranial techniques as indicated on assessment visit to visit, including plagiocephaly specific contacts per Stephen Willians text on an anterior-posterior strain pattern; adjustments of the upper cervical vertebral subluxation using a touch and hold technique from 5.5 months of age (prior to this age the primary subluxation patterns were addressed with cranial work); seated anterior thumb lifts for thoracic subluxations from 9 months of age; ankle and hip mobilisations.”
Now, the case is interesting in that the course of care was interrupted by holidays, but assisted by the helmet which may have stopped the worsening of the condition while the infant was not under care. But it is worth pointing out that during the first five weeks of care, the plagiocephaly physiotherapist noted atypical positive improvements.
Additionally, “Over the course of her care the child demonstrated improvements in her primitive reflexes and within-limits development of her length, weight, and head circumference. Her cervical range of motion improved with decreased restriction in lateral flexion and left rotation. Her asymmetry decreased a total of 11mm (20mm-9mm for a cranial vault asymmetry index change of 8.5%)[1].”
At the 12 months review the mother reported an improvement in sleep quality, less days where she was ‘rundown’, decreased allergies/rashes, and decreased colds/flu duration throughout chiropractice care. While these were not the primary reasons for the infant’s chiropractic care, they were also noteworthy.
The full report and literature review can be found at the reference below [1] and are well worth a read given the depth and commentary offered up by the author.
Whlie again, case reports are limited in that we can’t generalise findings to the entire population, they do give us some very real clinical gems. This one is no exception, showing how helmet care plus chiropractic care can result in significant improvements for the infant – not only in terms of their plagiocephaly but in other non-musculoskeletal manifestations of health as well.
Reference:
Doyle M. Improvement in plagiocephaly, cervical range of movement, primitive reflexes, and subjective parental feedback in an infant co-managed with chiropractic care and helmet therapy: a case report and review of the literature. Asia-Pac Chiropr J. 2020;1.2:online only. URL https://apcj.rocketsparkau.com/plagiocephaly-reduction–doyle/
