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Quinta-feira, 22 de Novembro de 2007

Plagiocefalia

Aos 2/3 meses começámos a notar que estava a ficar com a cabeça torta. De tanto se virar para a esquerda a cabeça já estava a ficar com um bico dum lado e redonda do outro.
Estava constatemente a tentar fazer com que o bebé olhasse para a direita e não para a esquerda para tentar contrariar a "torteza" da cabeça.
A pediatra também achou a cabeça um bocadinho plana demais, mas apalpou as cabeças dos pais e achou que devia ser um pouco genético

Aos 4 meses e meio já achava a cabeça demasiado plana, mas que devia ser tudo posicional. Fizemos ecografia e raio X à carola do puto para ver se estava mesmo tudo bem.
Os resultados foram todos normais, e o médico que fez os exames sugeriu que quando ele se começasse a sentar a cabeça deveria ir ao sítio.

Aos 6 meses ainda não se sentava sozinho, e para tirar as teimas vamos mesmo a uma consulta com um neurocirurgião infantil para lhe ver a cabeça.

Em tempo algum isto me preocupou muito. Sempre achei que era totalmente posicional* e que certamente nada de errado se passa com a carola do puto. O problema, a existir, é principalmente estético e também só se nota no perfil.

Do que li por aí, a correcção passa geralmente pelo uso de um capacete 24h/dia durante vários meses. Dizem que os bebés se habituam e nem se chateiam muito, mas eu não me parece querer sujeitar o meu miúdo a isso (se o problema for apenas estético).


What causes plagiocephaly?
Another increasingly common reason that some babies develop a flat spot is that they spend so much time on their back. Starting in the early '90s, parents were told to put their babies to sleep on their back to reduce the risk of SIDS. While this advice may have saved thousands of babies' lives, experts have also noted a fivefold increase in the incidence of misshapen heads since then, says Michael Edwards, a pediatric neurosurgeon in Sacramento, California.

Babies are born with soft, pliable skulls, and when babies sleep on their back every night, their head can develop a flat spot where it presses against the mattress. This happens most often in infants who are born with a common form of torticollis, a condition in which a tight or shortened muscle on one side of the neck causes the head to tilt to one side. Premature babies are particularly at risk. (See below for tips on repositioning your baby to avoid both SIDS and plagiocephaly.)

A baby may also develop an abnormally shaped head if development in the womb is constricted somehow. This can happen when there's more than one fetus, if the mother's uterus or pelvis is especially small, or if there's too much or too little amniotic fluid. It can also happen to a breech baby whose head gets wedged under the mother's ribs.

What should I do if my baby's head seems to be developing a flat spot?
In many cases, even a serious-looking flat area will round out on its own as a baby starts crawling and sitting up (especially if you follow our repositioning tips below). But to be safe, it's a good idea to insist on a referral to a pediatric neurosurgeon or craniofacial specialist as soon as you notice the flattening. A specialist should be able to tell whether your baby's situation is severe enough to warrant treatment and what your options are. Get the referral and make an appointment right away because you may still have to wait weeks or even months to see a specialist for a diagnosis, and the earlier you catch a severe case, the easier it will be to correct.

What's involved in getting a diagnosis?
In most cases, the specialist will need only an X-ray to distinguish plagiocephaly from craniosynostosis (which requires a different treatment). But some doctors may also recommend a special kind of CT scan. In certain cases, a very experienced specialist may be able to tell just by looking at your baby's head what's causing the deformity. He will want to know whether your baby was born with the flat area or whether it developed several weeks after birth. If you can't remember when you first noticed the flattening, go back and carefully examine any pictures you have of your newborn.

If the doctor determines that your baby has plagiocephaly, he'll most likely recommend repositional therapy first — that is, ways you can reposition your child to avoid putting pressure on the flattened areas. This kind of therapy is most likely to be successful if you try it before your baby reaches 6 months of age; after that it's much harder to control the position your baby sleeps in. If repositional therapy doesn't correct the problem, your doctor may recommend cranial orthotic therapy, a band (or sometimes a helmet) custom molded to fit your child's skull. (Reconstructive surgery is no longer recommended except in the most severe cases or in the case of craniosynostosis.) If your baby has torticollis, she will have to have physical therapy as well to treat this condition.

What does repositional therapy involve?
If your baby's case is not severe, your practitioner will probably tell you to try several things at home to help your baby's head round out. First, try to make sure your child spends plenty of time on her tummy (while supervised and awake) during the day to strengthen her neck muscles. You may start out trying this for only a minute or two at a time. Stronger neck muscles will allow her to move her head around more during sleep, so that it doesn't always rest in the same position.

Your pediatrician may also recommend alternating your baby's sleeping position from back to side. You can keep her from rolling onto the side where the flattening is by placing a rolled-up towel or blanket behind her head or by placing crib toys on the opposite side of the flat area to entice your baby to look in that direction. You might also try putting her down to sleep in her crib with her head pointing in the opposite-from-usual direction. She'll want to look out into the room and will probably flip her head over to do so, giving the flat side of her head a break from the mattress. And be sure to alternate her position from one side to the other when bottle- or breastfeeding.

Finally, try to be aware of how much time your baby spends in a car seat, stroller, infant carrier, bouncy seat, or infant swing where she may be leaning back and putting pressure on her flat spot. Make sure you take her out of these devices for a good part of each day and hold her or play with her on her tummy instead.

What does cranial orthotic therapy involve?
If your baby's plagiocephaly is severe, she'll probably have to wear a special custom-fitted headband (called a cranial orthotic) for 23 or 24 hours a day to correct the shape of her skull. This treatment generally lasts from two to six months, depending on how early you start and how severe the problem is. This therapy is most successful when started before the age of 6 months. Some experts think the headgear offers little help after 10 months, but others say it can be used as late as 18 months.

Your doctor can tell you where you can get a band made. You'll probably want to research the comparative success rates of several devices before you choose one. Once you do, they'll need to take a casting (or a scan) of your child's head to custom-fit the device. While casting isn't fun for a baby, it's painless and takes only a few minutes. As frightening as the headgear may sound and look, it's lightweight and most babies are not bothered by it or quickly get used to it. Treatment can cost up to $3,000. Some insurance companies will cover it under their orthotic benefits, but others consider it cosmetic or investigational and won't pay for it. However, many parents have successfully appealed their insurance company's rejection and received payment in the end.

The success rates for this kind of therapy are high when it's started early. If you're starting treatment late, you should know that your baby's skull may not become perfectly symmetrical again, but you can take heart that when your child's hair grows in fully, it will most likely hide any remaining flatness.

Where can I get more information?
Two Web sites that offer information about this condition, lists of specialists, and access to support groups are Plagiocephaly.org and CAPPS (Craniosynostosis and Positional Plagiocephaly Support).


*o Gabriel dorme 99% das vezes direitinho de barriga para cima e mesmo quando tinha só um mês se o tentassemos virar ou colocar de lado, ele sozinho voltava à posição inicial.
publicado por Claudia Borralho às 12:33

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Terça-feira, 11 de Setembro de 2007

o teu primeiro galo

Foi mesmo antes de irmos de férias. Estavas ao colo da mãe, e a mãe estava sentada à secretária a olhar para o computador. A mãe já sabia que tu às vezes te inclinavas para a frente e tentava manter-te a uma distância de segurança. A mãe distraiu-se, tu lançaste-te para a frente e pumba! Testa na esquina de vidro da secretária. O que tu berraste! A mãe achava que tinha sido só do susto, mas depois quando acalmas-te reparei que lá estava um galito, uma coisa mínima, mas a mãe ficou logo preocupadissima!
Tratar de um galo a um miúdo com um ano ou dois é uma coisa, mas a um bebé, chiça penico que preocupação.
Fui logo pôr-te gelo na testa e depois liguei para o doi doi trim trim para saber se estava a fazer a coisa certa.
À parte as belas perguntas de despiste para abuso de substâncias e maus tratos (!) lá me disseram que sim, que fiz muitissimo bem em lhe colocar gelo (a mãe toda orgulhosa e já menos preocupada) mas que seria bom vigiar-te, porque as pancadas na cabeça às vezes só 24h ou 48h mais tarde é que mostram os seus efeitos (aiiii).
Fui colocando mais gelo (10m a 15m, 20m se ele aguentar) a intervalos de 3h / 4h, e acordar-te de noite de duas em duas horas. Não é necessário acordar totalmente, só para ver se o bebé reage.
No dia seguinte já não tinhas vestígios do galito :) (era mesmo pequenino, o pai nem o conseguiu notar no próprio dia).
publicado por Claudia Borralho às 16:31

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