We had an appointment Hanger Prosthetics. We had a lot of questions and were rather apprehensive about the doing this as the kids pediatrician really wasn’t very knowledgeable about the subject.

One of the first things that Julia, our assigned Orthotist, did was to get a large pair of calipers and measure the asymmetry of Stella’s head. Two measurements were taken in an X orientation from from each temple to the oposing back-side of the head. The result was 13 mm difference, which was well above the threshold of “medical relevence” (8 mm, IIRC). It wasn’t the worst she’d seen which was in the high teens.

The “good” news was that the severity was sufficient that insurance would pick up the bill. And, the bill was not cheep — list price for the whole procedure was about $2500! Regardless, we had committed to it and would have paid out of pocket if it came down to it. We made the commitment and proceeded to the next step: scanning her head.

The scanning process uses an laser scanner to map the precise shape and size of Stella’s head in order to build the custom helmet.

First, they put on a “sock” over her head. This served 2 purposes: kept the hair from showing up in the scan, and it allowed the positional reference transmitter/sensor to be affixed to her head without sticking in her hair.

iPhone, map

Then they affixed the sensor gizmo which lets the scanner know where it is scanning relative to Stella’s head movement.

iPhone, map

Then they darkened the room and scanned her head from top to bottom using about 10 swipes to get all the way around.

iPhone, map

Below is a screen shot of what the scan looks like after they applied a smoothing algorithm to remove the small bumps. I missed the shot, but, prior to the smoothing, the raw scanner output was a very precise rendering of Stella’s face with her little dimples and details of the hook and loop layers used to hold the sensor gizmo to her head.

iPhone, map

The blue lines scan are reference lines for where the top of her forehead is and an outline of where the ear holes need to be cut out.

And that was it. Quick and easy, well, other than trying to get a baby to hold her head still!

About 2 weeks later, the new helmet was ready.

Plagiocephaly, we came to find out, is very common with multiple births and especially common with Twin A–which Stella is. Stella was also the smaller of the girls at birth so she had her nice and chunky sister sitting on her head. Ouch. This leads to the shortening of the neck muscles that caused her to always want to look to the right.

Looking to her right at ~7 weeks

She began developing her flat area almost from the start. It was fairly noticeable at her two month check up and Dr. Rose asked us to try and reposition her head as much as possible to help her even out. We did. We fed her to the left, turned her to the left but she kept on looking right. It didn’t help that she was our better sleeper and when you have one baby fussing all night and one baby who sleeps pretty well you don’t mess with the sleeper if you can help it.

At her four month check up, the pediatrician we saw (Dr. Rose was away) remarked upon her head shape. It was taking on an oblong look. Not flat directly in the back but sloped to the side so that her forehead was pushing out somewhat. He suggested we look into getting a cranial helmet for her but felt it was more of a cosmetic decision. I didn’t want to helmet my daughter for cosmetic reasons–we’d keep trying to reposition her.

Then Stella grew. She went from a peanut to a coconut in the blink of an eye and by the time her six month check-up was due we knew we had to take steps to correct the head that wasn’t getting better on it’s own. On to the Internet and reading what we could about plagiocephaly. It turned out to be more serious than I had thought, especially because Stella was developing an alarming asymmetry that could lead to jaw problems, ear problems–including chronic ear infections and even vision problems. Not to mention an out of whack forehead isn’t exactly hidden by hair as commonly suggested for flat spots in the back of the head.

I found some blogs that chronicled other children and their helmets. I even posed the question of whether or not to go forward with the cranial therapy to our Parents of Multiples club, to see if the might be any wisdom to draw from.

The responses I received from the group were overwhelmingly positive. The kids had no trouble wearing the helmets and the therapy had greatly improved their heads. John and I were convinced. At Stella’s next appointment we’d go ahead and ask about the next steps.

Cleary, she's very concerned about the shape of her noggin...

We were slated to see Dr. Don at the girls’ six month appointment. I really like Dr. Don (next to Dr. Rose, of course) and felt he’d be able to give us some really good advice. As it turned out, little Stella had gone from the 25th percentile head circumference to a 75th percentile head circumference in two months. Yes, her head was growing fast and not rounding out on it’s own. Dr. Don agreed that we should go see a specialist and get an opinion on how to best proceed. He wrote out a prescription to help with insurance and we were off to Hanger Prosthetics.

6 Months Old -- just prior to our appointment at Hanger

6 Months Old -- This wasn't just a case of crazy parents wanting their kid to be perfect!

Continue on to part 2 — getting her head measured.