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