If I say the words plagiocephaly and torticollis, do you know what I’m talking about?

Have you ever seen a baby wearing a helmet? Or have any of your kiddos needed a helmet?

Eight years ago I would have had no idea what plagiocephaly or torticollis meant, and I don’t think I saw many babies in helmets to even think much of it. I honestly don’t think I knew much until I started following Baby Begin on Instagram four or five years ago.

And since then I’ve learned so much and want you to learn the same! That’s why I’m interviewing Jennifer Barnard of Baby Begin. Jennifer and her team specialize in infant torticollis, plagiocephaly, and baby development, and she is a wealth of knowledge.

I’m excited for you to hear from her!

Tell us about yourself and Baby Begin.

I’m a pediatric occupational therapist and my specialty is infants. I own a company called Baby Begin and we specialize in plagiocephaly, which is the infant flathead, which affects about 50% of newborn babies. And the thing that causes the flathead is torticollis, which is a tight neck.

So we treat plagiocephaly and torticollis, and then we do infant development. I have therapists that work for me and we see babies in the home, in our office, and virtually around the world.

Baby Begin has been around for 17 years and we’ve treated around 10,000 babies so far. When we start seeing them before four months old, we have about an 80% success rate of keeping babies out of a helmet. Even for those we are not able to keep out of a helmet, we are able to make their head look better and make sure their development stays on track.

I do want to note, however, that a helmet is a very small piece of the whole puzzle. We are not anti-helmet; in fact, when babies need it, they need it and they work beautifully. And we refer for helmets all the time.

But if there’s an option to prevent the helmet as well as help a baby with their development so they thrive in their motor skills, that’s the key – that’s where the magic is. The head shape is just a little piece of it all.

What are the causes of plagiocephaly?

An obvious cause of plagiocephaly is putting babies on their backs for sleep. That puts pressure on the back of the skull for many hours a day.

There are also many popular “containers” parents use regularly with their babies (i.e. Bjorn bouncer, swings, car seats) that cause flat head syndrome.

So when you combine laying our babies on their backs to sleep with putting them in containers, plus a turn preference or tight neck (torticollis), it’s hard to prevent a misshapen head.

Even your arm can misshape a baby’s skull! If you’re always holding your baby in your left arm (most of us are when rocking or bottle feeding), our arm is on the right side of the baby’s head all the time. Then when you put her down, she might be sleeping on her right side, and now there’s pressure on that side of her head for 20 hours a day!

But if we can get a baby out of containers and doing more tummy time, and parents are watching which way the head is turning, you can probably prevent plagiocephaly.

How should we think about our baby’s sleep if lying them on their back can cause a flat head?

This is such a good question because our goal in life is to get our babies and our children to sleep. And when they’re sleeping, we don’t want to wake them up!

Let’s first talk about birth to four months. Because after four months, the head is set; it gets flat in the beginning, so that’s when you have to be really diligent.

We want our baby sleeping as much as possible, but we need to be very cognizant of where that head is. We want to make sure that the baby is looking 30% to the right, 30% straight, 30% to the left, and doing tummy time when they’re awake. This helps vary the pressure on the back of the head.

Think about your baby’s nap time…was their head mostly to the right or to the left? If it’s most often turned in the same direction when they’re asleep, we need to be careful. It’s that external force at one spot of the head that flattens it, not a baby that sleeps with their head in a variety of positions.

So we want our baby sleeping as much as possible, we just have to be really leary of which position it is and if they have a favorite.

Why is a bassinet better than a “container”?

A flat surface, such as a bassinet, crib, pack ‘n play, or the floor allows for freedom of head and neck movement. When you add any sort of an incline to it, now you’re adding gravity. And gravity is going to make it very difficult for a baby to turn out of a preferred position, if they have one.

For example, if Susie likes to turn to her right and we have her on the floor, she may very well be able to turn to the left to look at you in the kitchen.

But if she’s in a Bjorn bouncer and she has a right turn preference, there is no way that she’s going to be able to pull out of that incline, pull against gravity, and turn to the opposite direction. So what does she do? She just sits there with her head to the right.

And then we put her in bed and she’s sleeping with her head to the right because her neck is tight.

That’s why I love when people have bassinet strollers, because again, that’s a flat surface. You can put Susie in that and walk around the neighborhood, rather than the Doona that you took to the grocery store and now out to lunch and now for a walk, keeping her in the same position each time.

Do plagiocephaly pillows help prevent a flat head?

No! It’s really bad marketing to parents because they’re kind of “getting you” and the pillows are cheap. So it’s the middle of the night, you’re worried about your baby’s head, and you find these plagio pillows on Amazon with great reviews.

But they’re not great! They restrict the head and neck movement, which again, we want to move freely; we don’t want our babies to be restricted in any regard (note that swaddling is different because that’s for sleep and it serves a purpose).

But when your baby is awake or sleeping on a pillow, first, it’s not safe. Second, it’s just going to keep them in that preferred position; they’re not going to pull out of that and go to the next side.

So we’ve now actually purchased something that can actually cause more challenges!

One of my favorite stories with the plagio pillows is from doing a new eval in a family’s home. I followed mom into one room because she was changing the baby’s diaper, and there was a plagio pillow on the changing table.

Then we went to the nursery and she had a plagio pillow in the crib. Then we went to the floor and she had a plagio pillow there. She had purchased four of them! She just thought that’s where she was supposed to put her son all the time to prevent his head from flattening.

I felt so bad for her because she was trying so hard. It’s not that she didn’t care, she was just misinformed.

At Baby Begin, we just want people to know the truth, and what works and what doesn’t.

This is not to say don’t buy any containers ever. But it is to say be cognizant about how much you’re using them and aim to do more floor time. If, however, your your baby has a flat head or a tight neck, containers should be used minimally.

There’s a prevention aspect of this conversation, and then there’s a treatment aspect. And if you’re trying to prevent plagiocephaly, one way to prevent it is from watching your container use. If you’re trying to treat it or keep it from worsening, then containers are not your best friend.

What does plagiocephaly treatment look like? When do babies need a helmet versus physical therapy?

Helmets provide an external force 23 hours a day to reshape your baby’s skull. When a baby is born, their skull is very maleable and susceptible to forces placed upon it. So a helmet is a good treatment if you’ve tried everything else and your baby’s head shape still bothers you.

The alternative to a helmet is if your baby is very young and treated early enough, we can work on their neck. We can also strategically (and safely!) position them for sleep on the other side, providing an external force just like a helmet does.

Our before and afters look just like a helmet before and after, and I think sometimes even better!

Even if a baby ends up needing a helmet, however, we still need to adjust their neck tightness. Something caused that baby to want to turn one direction – it’s not just because they like turning that way, there’s a physical reason.

If a parent has a newborn or young baby and they notice a head turn preference, or notice their baby’s head shape is a bit off, what should they do?

If you notice your baby has a head turn preference or their head looks a bit misshapen, reach out to a pediatric physical therapist or occupational therapist, and make sure they actually work with babies with torticollis.

To make sure the therapist will be a good fit, I recommend calling the clinic and asking how many babies with toricollis have they worked with. If someone has only worked with 5, 10, or 20 babies with torticollis, that’s likely not enough. You can even ask for the therapist who has seen the most babies with torticollis!

The therapist might say it’s mild and you have nothing to worry about, or they might start your baby on a treatment plan.

You can also reach out to your pediatrician, however don’t simply wait for your baby’s next scheduled appointment, because this is a time-sensitive issue. Also note that your pediatrician isn’t a PT or OT, so they might have a different opinion than a specialist, or they might have more of a “wait and see” mentality here.

But remember that time is of the essence with plagiocephaly and torticollis! The earlier you start, the better it’s going to be for everybody. For example, when we start working with babies at six months old, we’ll be with them for about one year. When we start working with babies at two months old, however, we’re with them for just a few months.

Also remember that it’s not just about head shape or a tight neck – this is about overall motor development! Everything works better when we’re symmetrical.

If a baby has started their life with one side of the neck that’s tight, their shoulder is likely tight, their trunk is likely tight, their hip is likely tight, and their leg might even be tight on that side. That baby might only be able to roll in one direction, they might struggle to crawl, to get in and out of sitting, and to use their hands equally for play. It could even impact their vision!

We’ve also found that babies who really struggle with tummy time often have some sort of tension going on, and we can help!

We want to give our babies the opportunity to function normally and not have to compensate for everything else going on.

Tell us about how Baby Begin supports families and how parents can reach out for help!

Baby Begin has physical locations in Dallas, Houston, and Austin, Texas. We also see patients virtually from all over the world!

At the top of our website there is a blue bar that says “Schedule a Consultation.” Whether families want to see us in person or virtually, that’s where to start! And our team responds quickly, because we know time is of the essence.

Is there anything else you’d like to share?

First of all, I want every parent reading this to know that if your baby has torticollis or plagiocephaly, it’s not your fault!

A lot of babies don’t move around very much in utero – maybe they drop early, are breach for a long time, maybe they’re big and mom is little, or there are multiples. Some babies are born with a misshapen head and tight neck, and that’s no one’s fault!

So give yourself grace.

I also want to remind parents that we live at a time of information overload and it can be so overwhelming. The parents we work with are so well educated and we’re proud of everything they’re doing for their babies, but it’s easy to get anxious with all of the information out there to sift through!

Please remember that you’re not a pediatric therapist and no one expects you to be – there are professionals everywhere who would love to work with your baby. Don’t put it on yourself as a new mom to be the professional!

Our team at Baby Begin would love to help be a calm in the storm. Whether that’s by following us on Instagram or scheduling a consultation, we’d love to give you solutions and take that worry off your list!

About Jennifer

Jennifer has been a pediatric Occupational Therapist for over 20 years and really, just loves babies. Always has. She is the owner of Baby Begin.

She thrives on making a small but significant difference in families’ lives and seeing the improvements in head shapes STILL makes her giddy. She loves to teach other professionals and is ready to build her army of therapists worldwide to change the way plagiocephaly is treated.

Her mission is to eradicate flat head syndrome worldwide. She has become an expert on treating torticollis and correcting flat heads without a helmet and trains passionate therapists all over the world to do the same.