REPOSITION THERAPY

If you have questions, please feel free to join us on our support board http://www.CAPPSkids.org/board where we have a Repositioning Section and Repositioning Moderators available to assist you.

When deciding on a treatment for Positional Plagiocephaly it is best to do this in conjunction with a knowledgeable specialist.  However, since Repositioning does not require any custom fitted items, most parents will begin repositioning their child while they are waiting for their appointments with doctors.  However, it is important to note that if your child has Torticollis (a condition which causes a baby to have preference in looking in one direction), Repositioning can be very frustrating.  If you suspect that your child has Torticollis, please raise your concern with your doctor so that stretching exercises and/or PT can be started as this will be greatly beneficial to your Repositioning efforts.

Although Repositioning is basically the concept of doing what you can to keep the baby off of the flat spot, it is actually much more then that.  Repositioning is actually a mindset and is a 24 hour, 7 day a week job, especially in the beginning.  However, do no let this deter you!  The benefits of Repositioning can be tremendous!  Some babies respond so well to Reposition Therapy that no further treatment is needed, while others will receive a decent amount of correction which, in the long run, will cut down treatment time in Cranial Orthosis.

While repositioning it is very important that you take picture of your child, at the same angle each time, so that you can monitor progress.  Take pictures of both sides of your child's head, the back, the top (you may have to stand up on a chair to do this) and a full facial shot.  Since you see your child every day, it may be difficult to see change in your baby's head shape.  Taking weekly pictures will allow you monitor progress much easier and see subtle changes.

Repositioning During the Day

Repositioning is a 24 hour a day job, but many parents report that repositioning during the day is easier, but a bit more demanding.

Tummy Time - when the baby is awake and supervised is one of the most important techniques of Repositioning.  However, Tummy time is something that must be done in small increments several times a day for most babies until it become enjoyable.  Since most babies do not have the muscle strength in the beginning to lift their heads up and prop themselves up on their arms, Tummy Time can be very frustrating for them.  But do not let this deter you!  Try to make Tummy Time fun.  Use different items such as the Boppy Tummy Time Mat, flexible soft mirrors, and any favorite toys, to try and make Tummy Time enjoyable.  Also don't be afraid to get down on the floor and cheer your baby on.  Putting baby in new places may also help encourage Tummy Time to be more pleasurable.  One of our repositioning moms had great success in placing her child in different location of the house so that her baby was so busy exploring and taking in the new sights she forgot that she didn't like Tummy Time. The more minutes baby spends on his tummy, the more the muscles will strengthen and the more enjoyable these sessions will become.

    Low Stress Tummy Time - If you have some time and were planning on watching some TV, or relaxing, laying in a reclined position and letting baby lay on your chest/stomach, while on her Tummy, is also a way to sneak in some Tummy Time.

Car Seats - There is no denying that a baby needs to be in a car seat while in the car.  However there are some steps that you can take to keep the baby off the flat spot while traveling. 

Positioning the Car Seat - Take some time to notice where you baby focuses the majority of his attention while in the car.  If you baby likes to look out the window, position the car seat on the side of car so that the baby has rest on the rounded side of the head to look out the window.  If your baby likes to look into the car, then position the seat on the side of the car so that the baby has to turn to rest on rounded side of the head to look inside of the car.  If your baby has no preference, you can always help encourage the baby to rest on the rounded side by hanging some toys on back rest of the car's seat or using a suction cup type mobile and sticking it on the window.

Boppy Noggin Nest - The car seat is a perfect time to use the Boppy Noggin Nest to help alleviate some pressure from the back of the head.  Pictures and additional information form the Boppy Noggin Nest can be found below.

***Car Seats As Carriers/Strollers - The baby product industry have made too many convenient products.  We now have those nifty strollers that are car seat and stroller in one, as well as car seats that snap right into shopping carts.  Do not let these items of convenience tempt you.  Too many babies are spending WAY too much time strapped into their car seats while they are being shuttled around during errands and such.  There is no denying that a baby needs to be in a car seat while in the car, however in most instances there is no reason why the baby needs to stay in the car seat outside of the car.  Instead of leaving the baby in the car seat, put the baby in a soft carrier or sling and "wear" your baby as much as possible while running errands.  Yes it is true that this can be uncomfortable for you, and can play havoc on your back.  However, it will be very beneficial for the baby and your muscles will strengthen as time goes by.

Strollers - While it is preferable to use soft slings and carriers for a baby that is being repositioned, it is absolutely impossible for this to be done all the time, especially on long outings and on errands where you need both hands free and baby not right in front of you.

Boppy Noggin Nest - The stroller is another time when the Boppy Noggin Nest can be used.

Using a Fashioned Wedge - Many parents have great success in using a rolled up receiving blanket under the shoulder of the flattened side to prevent the baby from resting on the flattened side of the head.  In some cases the baby was too big for this to work, so parents used a bit of foam that they cut to suit there need.

Toys on the Stroller - Although it is much harder to encourage baby to look in one direction when in a stroller because there are no endless blank walls, you can try to encourage baby to look in the direction opposite the flattening by hanging some toys on the stroller on the side that you want her to look.  This may not be that effective, but it can't hurt to try.

Infant (bouncy/cradle) Seats and Swings - Just like the infant car seat, infant swings and infant seats are very tempting to parents, and many babies are spending too much time in them.  While it is true there are times when you need a baby to be in one of these devices, like when baby has been screaming for the past hour and the swing or vibrating bouncy seat is the only thing that will soothe him, but don't be tempted to let baby be in them too much.

Boppy Noggin Nest - The Infant swing and the infant seat (if the design of the seat allows) are another great time to use the Boppy Noggin Nest to help take pressure off of the back of the head.

Using a Fashioned Wedge - Many parents have great success in using a rolled up receiving blanket under the shoulder of the flattened side to prevent the baby from resting on the flattened side of the head.  In some cases the baby was too big for this to work, so parents used a bit of foam that they cut to suit there need.

Placement Of the Swing or Seat - Promoting a child to look in the direction opposite of the flat spot is much easier to do in an infant swing or seat.  When your baby is in a swing or seat, be sure to position the swing or seat so that a blank wall is on the same side as the flattening of the head.  Since babies like stimulus in their environment placing a boring blank wall on the side of the flattening will encourage baby to rest on the rounded side of the head to see all the action in the room.

Holding Baby and Feeding Time - While you are holding baby you can also be repositioning.  If your baby has not reached the point where she is holding the bottle on her own or is still nursing, you can use feeding time as another opportunity to keep baby off the flat side of the head.

Holding Baby - If you are just hanging out and have baby cradled, be sure that baby is resting in the crook of your arm off the flat spot.  If you have baby sitting up, try and promote her to look in the direction opposite the flat spot by having a blank wall or a low stimulus area on the side of the flattening.  Even though there is no pressure on the back of the head while the baby is being held up, promoting her to look in the direction that you want will get her more accustomed to looking in the direction and help "train" her to stay off the flat spot.

Holding Baby While Giving a Bottle - When holding your baby during feeding time, be sure that the rounded side of the head is resting in the crook of your arm.  This may require you to switch your usual feeding arm and can be a little awkward at first.  However, given time you and baby will get accustomed to the new position.

Holding Baby While Nursing - Although keeping the baby off the flat side while nursing is a little more complicated then when bottle feeding since you can't just switch arms, it is still very possible by changing nursing positions.  Using the "football hold" on the side where your baby would typically rest on the flat spot may be a solution.  If you are having trouble finding a comfortable position, perhaps speak to your pediatrician, lactation consultant, or Physical Therapist (if your child has one) to seek out other positioning options.

General Day Time Tips

Diaper Changes - When you change baby's diaper, do it from the side of the head that is rounded, so that baby is looking at you and is relieving pressure off the flat side of the head.  If you use a changing table and a flexible mirror can be secured to the side of the table, this will also be helpful to promote baby to looking in the direction of the rounded side of the head.

Repositioning at Night

In this section we discuss repositioning at night.  It must be stated that we at CAPPS are 100% supportive of the Back To Sleep Campaign.  It is also important to note that parents must always be cautious about items that they place in the crib as to not create a suffocation hazard in the crib, therefore parents need to pay particular attention when baby has the ability to roll.  All the methods discussed have been supplied to us by other Repositioning Parents as techniques that have worked for them.  CAPPS  Strongly recommends that all ideas be discussed with your child's Pediatrician beforehand to ensure the safety of your child.

"Spooning" - For those that are not adverse to the family bed, the practice of "spooning" can be used to secure baby off the flat side of the head.  By having baby lay along side of you, on the rounded side of the head, you will be able to reposition baby.

Changing crib/baby placement - Most babies like to look into the center of the room instead of looking at a wall.  If baby has to lay on the flat side of the head in order to look into the center of the room, change the position of baby so that her head is where the foot of the crib is. This will force baby to have to lay on the rounded side of the head in order to look into the center of the room. If the idea of having baby's head pointed where her feet should go, does not appeal to you, you could also change the placement of the crib so that baby's head is where the head belongs, but so that she has to lay on the rounded side of the head in order to look in the center of the room.

Changing the outlay of the crib - A very helpful tool for repositioning your baby in the crib is to change all the stimuli (i.e., crib toys) in the crib so that baby has to rest on the rounded side of the head in order to see them. But please be aware of which way baby tends to look.  If she tends to look into the center of the room, it would be more beneficial do the previous tip (changing crib/baby placement) and then place all the toys on the side of the crib that is in the center of the room.

Adding more stimuli - Adding items such as flexible crib mirrors, mobiles and hanging crib toys to the side of the crib where baby has to rest on the rounded side of the head, should also be of great benefit.  If you are concerned about the items being in the crib, they can be secured on the outside of the crib as well.

Positioners - When baby is small and not yet rolling, postioners can be helpful to parents in repositioning baby at night.  When baby is older and stronger, you may have better luck fashioning your own positioner.  Parents have had good luck buying large pieces of foam and constructing their own positioner in the shape of a large wedge and securing it under the crib sheet.  Similarly, other parents have had success with folding a large afghan into a wedge shape and securing it under the crib sheet.

 

Commercial Products to Assist Repositioning

There are many products available that will help parents with their repositioning efforts.