How does misalignment of the cranial bones occur?
Forceps delivery may result in compression of the sphenoid bone, which can restrict normal rhythmic skull bone movement.  But even in a natural delivery, there can be facial misalignment.  One of the most common examples is a left facial slant, where the left eye is smaller and higher, the cheekbone on that side is depressed, and the corner of the mouth droops slightly.  Misalignment of the cranial bones can also occur after birth if there has been prolonged lying on the back, torticollis (a crick in the neck), or misalignment of the body.

How do I know if my baby needs this treatment?
In many cases, the lack of balance and symmetry will be easily apparent.  Very often the baby’s head will return to a normal shape within 72 hours after birth, but if your baby is not sucking well or taking as long as, say, 45 minutes to feed, there is a possibility that correction through gentle pressure is needed.  Bruising of the head, colic and non-projectile reflux are similarly indications that reshaping might be needed.  Even if these symptoms are not present, however, your baby can benefit from treatment.  Difficulties can arise from the baby’s position in utero, especially in cases of multiple babies in the womb, and the shape of the mother’s pelvis.

Does the treatment hurt?
The treatment is very gentle and newborn babies will often sleep through it.

How long does it take?
A session with Caroline is one hour (or 30 minutes with very active children).  Three to ten visits might be needed, depending on the severity of the case and the age of the child.  Treatment of infants under two months is best as the bones are not fused at this point.

Plagiocephaly and Brachycephaly are medical terms given to the condition of flatness in the shape of the head.

Plagiocephaly is the name for flattening of the head in any of the four quadrants of the cranium (back, front, left, right).  It is this condition that often results in asymmetry of the head and face as the ear, forehead and cheekbone on the flattened side of the head are pushed forward.

In Brachycephaly either the front or the back of the head lacks projection.  This condition is not usually characterized by asymmetry of the ears and facial bones.

What causes a misshapen head?

The following may be causes of an improper development of the head shape among infants:

• Prolonged lying on the back;
• Torticollis;
• Misalignment of the body;
• Delivery at birth;

Misshapen heads have become markedly more common, since the introduction of the Back To Sleep Program designed to prevent Sudden Infant Death Syndrome (SIDS).  There has been a 40% decrease in SIDS since mothers have been taught to put their babies down to sleep on their backs rather than their stomachs.  Unfortunately, however, prolonged lying on the back is one of the causes of children developing a misshapen head.

Torticollis is a condition in which spasms in the neck prevent the baby from turning his head equally in both directions.  It may cause a child to favor looking either to the left or to the right.  Torticollis should be corrected as soon as possible or the face and head of a child may not develop symmetrically.  It is advisable to seek the assistance of a trained practitioner as early as possible for early assessment and prompt treatment.

There are a variety of causes misalignment of the body in infants.  Common causes are relatively large babies born from a small maternal pelvis, or multiple infants (twins) leading to crowding in the womb.  In the case of twins, one twin may be more compressed than the other in the womb.  Sometimes a baby’s head may become stuck in its mother’s pelvis or under her ribs, restricting the infant’s movement.  In one case that I assessed it was possible to see where the maternal ribs had pressed into the top of the baby’s head. When a baby’s pelvis is misaligned, the position of the head and neck will also be affected.

Given the softness of an infant’s bones, difficult or assisted deliveries may alter the alignment of a baby’s head and facial bones, particularly when instruments such as ventouse or forceps are used.  Forceps can leave an impression on the bones of the head, and ventouse can cause elongation of the head. Sometimes misalignment will correct itself although this depends on the amount of force that had to be used in delivering the baby safely.

Misconceptions:

Mothers often assume that baby’s condition is somehow their fault, wrongly believing the way they hold their baby or wash his hair is responsible.  This is certainly not the case.

Neither is the condition hereditary.  In fact, it can actually result from a perfectly normal delivery.  For example, one eye can be smaller and higher on the face; this is actually a facial slant caused by the facial bones dragging along the mother’s tail bone.  Just how prominent the facial slant is depends on the size of the head, the size of the mother’s pelvis and the position of her tailbones.  Around 70% of facial slants occur on the left side, as most natural deliveries lead with this side.  Often the bone on the back of head will also rotate, causing a less rounded skull.

Prevention

Crying & Sucking

Crying and sucking both help to shape a baby’s head by contracting the connective tissue.  If using a bottle to feed baby, make him work harder by using a slow flow teat.

Check Your Baby’s Alignment

Get a professional to check out your baby’s alignment a few weeks after the birth when the body and head have had a chance to stretch out and reshape.  If this does not happen, have someone trained in working with infants check and treat any misalignment of the pelvis, spine or head.  If you had a c-section with no complications and the head shape was perfect when your baby was born, arrange to see a therapist trained in head shaping if it suddenly starts to become flat.

Tummy Time

All babies should have tummy time six times a day.  This should be for as long as they can tolerate it, even if it is only for 30 seconds.  This not only takes pressure off the back of the head, but also strengthens the neck muscles to help with reshaping the head.  Many of the neck muscles are attached to the sides of the face and skull.

Head Brace/Helmet

Head braces or helmets may be considered for children who have not had their misshapen head condition corrected during early infancy, when the condition is more easily and more effectively treated.  Head braces or helmets are not fitted on children of less than eight months of age.  The helmet is worn for about 9-12 months, 23 hours a day, and requires adjustments every six weeks or so.

Other Tips

• Alternate sleeping positions from back to side, to the other side.
• Do not let your baby stay in a car seat or stroller for long periods of time.
• If you bottle feed, alternate the sides on which you hold your baby.

When should I seek help?

Of course you are concerned about your child, so be proactive and seek help.  A child does not outgrow the misshapen head condition, although it may improve slightly with time.  When a child grows hair it is less noticeable, but the problem is still there, so the sooner you seek treatment, the better.

An infant has seven soft spots in his head, and there is a lot of movement between the skull bones.  The first one starts to fuse after two months; this is the forehead, which is in two pieces in a baby.  I have seen many children come in for head shaping between the ages of nine months and 30 months when it is already too late to achieve significant change.  Some valid work can still be done at this age, but it can also be time consuming with a toddler who cannot lie still, so the treatment takes longer.  The earlier you seek treatment, the more effective it will be.

The parents will need to have a smart phone with a video so that they can show the different angles of the baby’s spine, head and face. Once the areas that are contributing to the flat head are determined, Caroline can teach the parent some gentle mobilisations to correct any restrictions. She will also offer a home exercise programme. This is an essential key in getting the baby to move in all directions rather than favouring one direction, which is a major factor leading to the flat head.

A treatment in the clinic can be arranged after the assessment whenever it is convenient for the parents to come to the clinic. The Skype or Facetime session will offer significant savings in both time and money for those parents coming in from other regions in Asia.

Physiotherapy for the treatment of flat head syndrome is often covered by medical insurance.

For more information go to

Key Benefits of Head and Face Shaping
Baby Head Shaping

A balanced, symmetrical facial structure isn’t just about structural beauty. While it is true that people who are photogenic normally have symmetrical facial features, there are health advantages to a symmetrical face as well. Shaping a baby’s head while the bones are malleable has many health benefits, in addition to the cosmetic ones.

People with balanced features are more photogenic, because photographs tend to exaggerate any facial asymmetries. While I wish that we were not judged by our looks alone, research shows that people who are attractive are perceived as more intelligent and successful and are given more opportunities in life.

I discovered the benefits of head shaping when I worked in the US with maxillofacial surgeons and orthodontists treating teenagers and adults to improve their bite. It was not unusual to see overcrowding of the upper teeth and a narrow palate (roof of mouth). To make room for the teeth, bars are inserted on the roof of the mouth in children to spread the palate apart. Some children have surgery to expand this bone. As I continued my training in this field I learned about how our bones are formed and what preventative measures can be taken. Often the position in utero or birth process can affect the shape of the head and face.

Frequently the over crowding of the upper teeth can be found in children who were delivered with forceps because the spoons of the forceps can compress the bones on the side of the head resulting in a compressed and narrow palate, which can create a lifetime of issues. As infants, these children may not suck well and take a long time to feed, up to 45 minutes or more. They can also be fussy on the breast.

Sometimes the forceps compresses a bone called the sphenoid, which can restrict normal rhythmic skull bone movement. The sphenoid bone movement impacts growth development, because normal sphenoid movement stimulates the pituitary gland, which triggers the release of hormones, including Growth Hormone.

Fortunately, this kind of condition can be easily treated by gentle pressure to spread the palate, and this treatment can be done at any age.

Natural delivery results in a different facial alignment, although not all natural deliveries result in a facial misalignment. One of the most common is a left facial slant: the left eye is smaller and higher, the cheekbone on the same side is depressed and the corner of the mouth droops slightly. This alignment occurs as the baby travels along the birth canal. The face drags along the mother’s sacral and coccyx (tail bone) bones and leaves an imprint on the face. Eighty percent of the time the baby travels on his left side. If a baby travels on her right side, the slant would appear on the right.

While not all natural deliveries result in a facial slant, some contributing factors are:

• Mother has a small pelvis and the baby has a large head
• Mother has a compressed sacrum or coccyx that deviates in or to the side. This condition is usually caused by a fall on the buttocks that was never corrected
• First child through the birth canal

During the first 72 hours after birth, the baby’s head will return to a normal shape, the overlap of the four bones on the top of the head usually smooth out and the head loses its cone shape. Sucking and crying help contract the connective tissue in the head called the dura, and this will help to re-align the skull bones. If, after several weeks, you notice the bones are “bumpy” on the top of the head or you notice some of the characteristics of the facial slant described earlier, you may want to consider head shaping. In addition to the facial adjustment, it may help to calm a fussy baby, since babies with “bumpy” heads tend to be more unsettled.

Properly aligning the forehead, one of the seven facial bones that shape the eye, will not only help to open up the smaller eye; it will ensure the frontal sinus can drain properly.

Having eyes in the same horizontal plane is important for head and neck alignment. We have a strong reflex to have our eyes level because this is how we track moving objects. This reflex is so strong that, as we become upright, if one eye is higher or lower we will tilt our head to make them level. This will lead to neck pain and possibly a curvature of the spine (scoliosis).

When an infant is born, the forehead is in two pieces and then begins to fuse at an early age, finishing at 8 years of age. It is the first bone to fuse, so it is essential to have this treated early. Many mothers are told that it will correct itself, but it won’t. Growing hair to cover the asymmetry will minimize it, but the misalignment is still there.

If the cheekbone has been compressed during delivery, then the upper jawbone, the maxilla, will also be compressed. Misalignment of the maxilla can affect the drainage of the maxillary sinuses and can adversely affect the position of the upper and lower teeth. In addition, the maxilla determines our appearance as adults. For the most part, babies are all eyes. The lower part of the face develops over time as infants chew solid food and talk. The maxilla starts to grow as the child ages and becomes a teenager and determines how the child will look as an adult. A balanced maxilla contributes to facial symmetry as well as the position of upper teeth in relation to lower teeth.

Does your baby have a flat head and or Torticollis?

A baby with a flat head is a common reason that parents seek treatment. While it is true that hair will eventually cover the misalignment, a flat head may be the cause for other health related issues.

When an infant is born, the occipital bone at the base of the skull is in four pieces, which fuse at about 8 years of age. The spinal cord joins the brainstem through the foramen magnum, a large hole at the base of the skull, which is surrounded by the four occipital bones. If the occipital bone is compressed, the size of the foramen magnum may not reach its intended size thereby impeding the nerves that travel from the brain and spinal cord. Misalignment of the occipital bone can affect the alignment of the head and neck, leading to a lifetime of spinal problems.

If the infant’s head is flat to one side, then all the bones on that side will move forward so the ear, forehead and cheekbone are all forward. This occurs because the occiput (the bone at the back of the head) is compressed and rotated down, a common occurrence in a natural delivery.

A compressed and rotated occiput can compress and pinch the nerves—any combination of nerves that travel from the brain to the body. These nerves are called Cranial Nerves 9, 10 and 11 and control the tongue, internal organs (including the heart, lungs, stomach and all digestive organs), and the neck muscle (the sternocleidomastoid) respectively. Torticollis, or wry neck, is common and in literature thought to occur in infants because of birth trauma or intrauterine malposition, but it is not really known. Infants with torticollis will have limited neck side bending and rotation to the opposite side of the muscle. I would like to note here that torticollis in the literature often refers to a spasm of the sternocleidomastoid muscle for unknown reasons. Because I have seen at least a thousand babies with this condition and have found that decompressing the occiput will often produce excellent results, I can only surmise that this is beneficial. The traditional physiotherapy approach to stretch the muscle is not as effective and, if it is helpful, takes many sessions and is painful for the child who cries during the session.

Babies with compression of the occiput, with or without a flat head, can also have colic or non- projectile reflux, which can be caused by possible compression of Cranial Nerve 10 or the Vagus Nerve that gives the message for all the internal organs to perform their functions. This compression occurs between the opening where the occiput and temporal bone come together at the base of the skull forming the opening called the Jugular foramen. Mothers are often told to “wait it out”; however, manual therapy treatment to manipulate the bones into the correct position may solve the problem and prevent other problems from occurring later. The symptoms of colic may be “outgrown,” but if the occipital bone compression remains, symptoms may present later with a different diagnosis. For example, one study reports that adults with irritable bowel syndrome had colic as infants. With manual therapy treatment, the infant can have a gentle adjustment that will allow the bones to fuse properly—treating the cause of the problem and not just the symptoms.

Especially difficult deliveries or multiple births

Your child can benefit from treatment regardless of the type of birth you had. Difficulties can arise from the baby’s position in utero (especially if there are multiple babies in the womb), the shape of the mother’s pelvis, or an infant who has suffered fetal distress. You may consider having the baby checked if there is bruising on the head at birth, since bruising may indicate that other problems are present.

Spinal alignment

It is impossible to treat the neck and head if the pelvis and spine are out of alignment. It is common for these parts of the body to be out of alignment from the baby’s position in utero or during the delivery. The first step, therefore, is to check the alignment of the pelvis and spine before any head shaping treatments occur.

Does it hurt?

The treatment is very gentle, and newborn babies will often sleep through it. The first 24 hours following a treatment will produce a change for either the better or worse. Often the infant will have a large bowel movement and may sleep more. Occasionally the child may cry more for the first 24 hours. The baby is adjusting to a new position and the crying helps to contract the dura and align the skull bones. Even if the baby cries after the first visit, they will not normally cry after every visit.

How long does it take?

A session with Caroline is one hour and with very active children 30 minutes. A baby who suffers from colic and reflux should experience a noticeable improvement by the third visit, and there may be improvement after the first.

Head shaping can take three to ten visits, depending on the severity of the misalignment and the age of the child. The age of the child will have an effect on the success, since the forehead starts to fuse after two months of age. Once the bones start to fuse, it may not be possible to re-align the forehead and to some extent the back of the head. Treatment with infants under 2 months is therefore best, as the bones are not fused and the baby is content to breast or bottle feed or suck on the mother’s finger or a pacifier. Sucking during treatment is helpful as the cranial bones naturally move while sucking.

Working with infants six months and older is challenging, as the child often wants to roll and move about. Between the ages of 8 or 9 months to 18 months is the most challenging; after a few tries, if I’m unable to make the best use of the time because the infant is not able to lie relatively still, I suggest coming back after 18 months of age. Keep in mind that the results as they get older may not be optimal for the shaping of the head, but any restrictions of the connective tissue because of the misalignment will be released.

Insurance coverage and fees

Most medical insurance covers physiotherapy services. You may require a doctor’s note to receive reimbursement from your insurance provider. You can check with your insurance provider prior to starting treatment to determine what kind of coverage you have for physiotherapy services, and what, if any, paperwork is required. Colic and reflux are routinely covered. Misshapen head or plagiocephaly is often covered especially since it is so common these days with babies left lying on their backs to prevent SIDS.

Conclusion

This article provides an overview rather than a detailed explanation of a complex subject. If you require further information, please email me at caroline@thebodygroup.com, and I can answer your questions or direct you to literature if you wish to learn more.

Mothers’ feedback

I am so relieved that I decided to take my 5 week old son for craniosacral therapy at The Body Group. Caroline Rhodes and her staff treated Nicholas for the obvious symptoms he suffered as a result of a traumatic delivery which resulted in and aggressive vacuum birth. Nicholas endured serious bruising and swelling on the top of his scalp and forehead at the hairline. The doctors and nurses advised us that “babies heal quickly so don’t worry the bruising will go away.” However, what they don’t mention are the side effects which could arise from such a traumatic birth. I understand that injuries of this nature could cause complications in the lungs of the newborn and also emotional issues later in development. This is why I sought further understanding and treatment from Caroline. Aside from the basic craniosacral techniques, Caroline also performed a few sessions of head shaping which smoothed out the raised area created from the bruising and swelling which occurred. As a bonus, I even learned some techniques to calm Nicholas when he becomes distressed. Now Nicholas is almost 3 months and seems to be healthy and growing nicely. I have already recommended my friends to bring their newborns to see Caroline and would continue to encourage others to learn more about craniosacral therapy and the short and long term benefits for their babies.

Maria McCabe, Sai Kung

“In March 2004 we noticed that our five month old daughter Thea was developing a badly misshapen head – a large “flat” patch on the rear right hand side of her skull, and that her face was becoming noticeably lopsided.

I voiced my concerns to our pediatrician who simply told me to turn her head onto the other side when she was asleep and that I should not be worried, as “when her hair grows you won’t notice it”. Hardly inspiring stuff!

We spoke next to our GP, Dr Kath Reynolds, who was happy to refer us to Caroline Rhodes.

We saw Caroline for the first time at the end of April who explained in great detail the problems with Thea’s skull and also discovered that she had a rotated pelvis.

For the following three months we saw Caroline twice a week for cranio-sacral therapy designed to correct the flat spot on Thea’s skull and to even out her lopsided face. The sessions involved very gentle pressure being applied – which Thea seemed to actually enjoy! The whole experience was tremendously reassuring with a professional team who are always calm and ready to explain everything they were doing. It was great to finally find people who acknowledged that there was a problem and could demonstrate a straight forward way to fix it.

My husband had some doubts about the “new fangled” (his words!) treatment that Caroline offers and was so skeptical he even came along to check it out for himself. He asked numerous questions which Caroline was happy to answer and was so impressed that he became an immediate convert. Shortly afterwards he even went to Caroline for his own foot problems!

Six months down the line Thea has a normal rounded skull, her eyes are in line and her face looks properly proportioned. The greatest compliment we can pay Caroline and her team is the fact that no one today can believe that Thea ever had a problem with her skull.”

Louisa Barton