To Helmet, Or Not To Helmet...

...THAT is the question. 

Whether tis better to have your child feel self-conscious about his misshapen head years down the line, or to do what you can now to fix it, and by doing so, prevent that potential pain and embarrassment...

If you're puzzled my Shakespearean-inspired soliloquy, here's some background info to catch you up:

I've mentioned on a couple of different occasions that our littlest Braly Boy has a case of the flat head. I first took note of it right before his two month checkup, and though I wasn't really concerned (Kaiser had experienced some flatness, too), I mentioned it to our nurse practitioner. Kathy said that it would likely round out with time, reminded us to keep up with tummy time, and also suggested rolling a towel and laying it under his right side when he slept. Over the next couple of months, we did everything we knew to do to help "the state of the melon". I flipped Porter around to face the opposite direction in his crib and on his changing mat, thinking perhaps looking up at/for Mommy was what gave him a preference to turn toward the right. Aside from bedtime and diaper changes, he spent virtually no time on his back -- only on his tum, in his exersaucer, upright in one of our laps, etc. At his four month appointment, Kathy told us to keep up what we were doing, and we'd make a decision when he hit six months. As I continued to see very little change in his head's shape, I knew that it was looking more and more like a helmet was a definite possibility.

As shared in my post about Porter's six month appointment, Kathy ended up giving us the contact information we needed to pursue this further. Four days later, we met with neurosurgery at Children's Hospital to determine what, if anything, needed to happen next to help our son's noggin. Cathy, a physician's assistant there, examined him, took measurements of his head, and assessed his ear placement. Based upon this, she said that Porter had a moderate case of plagiocephaly which would not impact his brain development at all, and that placing him in a corrective helmet was entirely up to us. Of course, I had a boatload of questions for her -- "How long will he have to wear it?" "Is it guaranteed to work?" "Do we have to do it right away?" "What percentage of people you see choose the helmet option?" "If it were your child, what would you do?" Cathy was very kind and patiently answered all of my inquiries. She said, on average, babies usually wear the helmets for 3-6 months, and as far as she knew they were effective. She told us we could wait to put Porter in it until he was nine months old, but she wouldn't wait any longer than that, because head growth starts to slow. She didn't know exactly how many of the children she evaluated actually ended up in helmets (obviously it depends upon the severity of their conditions). As for what she would do, Cathy couldn't give me a definite answer. In the end, she was as helpful as she could be, considering actually designing and fitting helmets is not her specialty. I left with a helmet prescription in hand, as well as a pamphlet with information for two orthotics companies in Pittsburgh.

At that point, we had to choose whether or not to utilize the prescription, and if so, when. My initial thought (and Brett's, as well) was that we should at least wait a few months to see if Porter's condition improved. I was really struggling with my feelings both ways. On one hand, I felt vain for wanting to put Porter in a helmet. He doesn't have to have a perfectly round head (and even after treatment, it won't be perfect); this is entirely a cosmetic issue. On the other hand, I felt vain for not wanting to put him in it. I hated the idea of people looking at my baby boy and wondering if something was wrong with him. (I know that may sound extreme and is totally not the case, but I'd be lying if I said it wasn't a thought of mine.) I desperately wanted someone to just tell us what to do!

But by the end of that day, after lots of discussion, Brett and I had decided that we were all in for treatment, right away. What changed our minds? Well, a few things, not the least of which were two fairly extensive email conversations with my friend, Jen, and a friend of a friend; both have sweet daughters with plagiocephaly whom they chose to put in helmets. The most important questions I asked of them were: "Has the helmet made a difference?" and "Are you glad you did it?" Obviously, I got the answers I was hoping to hear. Some other things these mommies said totally resonated with me, specifically the thought of opting out of treatment, and having their children coming to them as adolescents, asking whether or not their flat heads could have been fixed.

Once we'd made the choice to go forward, I contacted Union Orthotics and Prosthetics to schedule an appointment. Given the opportunity, I would have brought Porter in the next day, but there was information that needed to be acquired from the hospital and filed with our health insurance first. I was encouraged by the lady with whom I spoke, though, who said that in her experience, our provider had only denied one claim. We ended up having to wait almost two weeks for this process; of course, this momma wasn't impatient at all. :) Finally we got the thumbs up, and I received a call back to set up our initial visit for today.

This morning we had to be up and out the door earlier than normal for our 8:30 appointment at Union. Kaiser kept saying that we were taking Porter to the doctor, and I said it was kind of like that, but we were going to get Baby Brother a helmet to help the shape of his head. When I was filling out paperwork during our wait in the front, Porter started to fuss, and Kaiser said, "I guess Poa-tah doesn't want a helmet!" I replied, "You think so? I think Porter's excited about his helmet!" Ha!

 Wondering just what's in store for him at this place...

We had a really nice visit with Amanda, the orthotist who met with us today. We were taken back to a really kid-friendly room with toys, books, and puzzles for the boys to enjoy. Amanda explained more about the STARband helmet (what it is made of, how it is fashioned, how it works to remold the head, etc.). She gave me a little preview of what Porter's process would look like, as far as easing into the helmet (which he will eventually wear 23 hours a day) and our follow-up visits. The most important thing that took place during this appointment was a scan of Porter's head to get a 3-D image of its shape. In order to get an accurate image, my dude had to sport a sweet stocking cap and loosen his collar so that his neck could be scanned, too. 

 What up, Homeboy?

The scan itself went very smoothly. It wasn't Amanda's first rodeo, and she had all the props she needed to, with Mommy's help, get Porter to lay perfectly still for 1.5 seconds. Immediately afterward, we were able to view Porter's head on the screen:

 Much clearer than my ultrasounds!

The boys continued to play while Amanda did some work at the computer to create a simplified report for me to take home. Here is the outline of the circumference of his head:

Here's a pic I took today of his melon from above, for comparison's sake:

Then Amanda went over the report with me. Porter's diagnosis is a moderate case of right posterior plagiocephaly. The lines forming an "X" on the image above are measurements of his head taken at 30 degrees to the left and right of the midline; the difference in the length of those two diagonals is currently 8.9 millimeters. The goal through treatment is to get that number to decrease, although there is no specific "magic number" we have to reach for him to cease wearing the helmet. Rather, she said that this decision will be based upon our visual assessment of his head's roundness, and how pleased we are with it. In addition to the flatness in the back, the right side of his forehead protrudes slightly, and his right ear is pushed slightly forward; she said the helmet should help correct this, too. Porter's head will be scanned again after three months, and we will be able to lay that new image over this one to compare the shape and assess his progress. The appointments in between will be used to take manual measurements and to adjust the helmet, if need be. She encouraged me a couple of different times by saying that she really thought, because Porter's flatness is not too severe, his head should respond well and we should see good results in a not-too-long time frame. I hope and pray that she is right!

Before we left, we scheduled our next appointment for June 2, by which time Porter's helmet will have arrived from Florida (where STARband is located). At that time we'll get the low-down on putting it on and taking it off, cleaning it, the wearing schedule, etc. So if you're dying to see our boy in his headgear, you'll still have to wait a couple more weeks! You know I'll be sure to post updates and plenty of pics. :)

Oh, I almost forgot; while we were there, Amanda pulled out a special coloring book and crayons for Kaiser. Of course, he acted into it at first, then quickly lost interest after scribbling a little on one page. I just had to share this. It's actually a little storybook, with rhyming and everything. Great in theory...

...but kind of weird in reality. Inside the pictures are rather creepy-looking, in my opinion, and the lines make me giggle. ("My mom and dad say tummy time rules, and so I help when I come home from school.") It totally reminds me of this book -- but I feel a little guilty making fun, since it's trying to help children understand a real issue, and all. Although, I guess I don't feel too guilty, since I'm telling you about it anyway!

And so begins our journey to fix our Porter Boy's "crooked" head... ;)