Early Head Start

 Early Head Start: A Preventative & Corrective Program for Infants & Toddlers with Congenital Head & Neck Challenges By Dr. Yvette Flores, PT, DPT 

Congenital head & neck challenges can be detected by a PT specialist as early as the first day of life. However, infants with a head & neck challenge typically don’t show obvious signs until 3 months of age. Such signs are a positional favoring such as turning or tilting the head one way more than the other way. The most obvious sign frequently seen at 3 months of age is a developing flat spot in the back of the head. If left un-treated, this flat spot can worsen pretty rapidly to the point of requiring use of a pricey, corrective helmet to improve the head shape. More and more pediatric specialists are now recommending the Early Head Start program to identify infants at risk, prevent or correct head deformation, and correct the root cause of the neck challenge within the first 6 months of life.There are several markers that place a newborn at risk. Knowing these signs allow Pediatricians and new parents to screen for risk and follow the Early Head Start 3-step program, if warranted. Such signs are: a clear favoring turning his/her head one way, tilting his/her head to one side, or a developing “flat spot” in the back of the head. These signs are most obvious when the infant is asleep in a car seat/ stroller, or when the infant is tired or not feeling well. Sometimes, parents notice these signs before the physician does, and when brought up with the physician, are instructed to alternate head position during back sleeping. Traditionally, parents are also given a handout on a couple of neck stretches to do at home. If parents are not successful with their attempts to follow the handout, they are then referred to a physical therapist for proper instruction. Today, parents are referred directly to a PT specialist for successful early intervention, thereby minimizing head deformation, need for a costly helmet, need for extensive physical therapy and/or need for invasive measures such as surgical release of the tight muscles.

The Early Head Start program is designed to detect newborns & infants at risk, identify the cervical muscles involved, and initiate the steps to full correction and recovery. Step #1: Early identification allows for early intervention. Step #2: Early intervention prevents head deformation, tighter neck muscles, and habitual favoring. Step #3: A course of physical therapy will help to ensure complete resolution within the narrow window of time available for full correction, should an infant already exhibit head & neck challenges.

The bottom line: The Early Head Start program saves families hundreds if not thousands of dollars in medical expenses, ensures healthy head and neck development, full range of motion, strength, normal symmetry, and promotes age-appropriate gross motor skills.

The Early Head Start 3-Step Program

Step #1: Identify markers for risk (birth to 12 weeks old)

Unusual positioning in utero or lack of adequate space in utero, especially during the last trimester, is a common marker for risk. The most popular examples include: breeched positioning, diagonal positioning with head down under pelvis, multiple births, first time Mom (possible small uterus), and baby has a larger than average head size. Another common marker is a traumatic birth. Popular examples include emergency C-section, cord wrapped around neck, vaginal delivery with a very long labor, baby getting stuck in vaginal canal, use of a vacuum or other aggressive means to remove baby. A premature birth followed by a stay in the NICU, can also be an identifying marker for a congenital head & neck challenge. Lastly, if your baby appears to have a strong dislike toward tummy time, especially after the age of 3 months, there is a chance that he or she has a congenital head & neck challenge.

Step #2: Early Intervention (birth to 12 weeks old)

Receive instruction and tips on (1) how to alternate head position during naps and sleep time to prevent flattening of the back of the head, (2) how to introduce and build up daily tummy time for symmetrical neck and back strengthening, (3) how to maintain a symmetrical head position, especially when in a carrier such as the car seat or stroller, and (4) recommended tools such as car seat head positioners and sleep positioners, to make your efforts easier.

Step #3: Physical Therapy Program (initiate between birth to 5 months for optimal results)

A course of physical therapy (PT) is the best conservative approach toward full correction. The ideal age range to start PT, which yields the best prognosis for full correction of a head and neck challenge, is between 8 weeks to 16 weeks old. If a baby has unaddressed head & neck challenges greater than 32 weeks, the window for full correction is significantly narrowed and the likelihood of a longer PT program and need for helmet therapy is higher. On average, full correction of the underlying cause can be achieved within 4 to 12 sessions. More may be needed, depending on the severity of your baby’s condition and the success of the instructed home program. A PT program entails neck stretches for tight muscles, strengthening exercises targeting weak neck muscles & back and core muscles, manual therapy of soft tissue and joint mobilization, and age-appropriate gross motor activities to maintain and improve upon symmetrical body balance and strength. A tailored home program will also be given on the first visit and modified as your baby progresses through his or her PT program.

*For more information, please visit our website: www.BabyTherapySolutions.com. If your baby has not been screened for a potential head & neck challenge and you would like our professional opinion, please contact us regarding our 15 minute complimentary screen. If you have been told by a physician or other infant healthcare provider that your baby has a positional favoring or developing flat spot, we recommend a PT initial evaluation as soon as possible. Please call to discuss details of this evaluation and schedule an appointment. Your pediatrician will get our report of findings and the next step, if any is required, will be determined. Physical Therapy Solutions is located at 2634 Wilshire Blvd, Santa Monica CA 90403. (O) 800-507-2634, (F) 310-774-3652.

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