Page last updated at 00:02 GMT, Sunday, 18 September 2005 01:02 UK

'We put our baby into a helmet'

By Jane Elliott
BBC News health reporter

William Barker
William Barker wore the helmet 23 hours a day

Looking at William Barker now it is hard to see any blemishes. He is a beautiful bouncing baby.

But just six months ago his face looked strangely misshapen.

His forehead and cheeks had became more prominent on the right side, his right eye looked larger than the left, his ears look misaligned and he had a flat spot on the right side of the back of his head, from where he had been lying.

His parents had to make the difficult decision to take action on what was largely a cosmetic problem and encase his head in a plastic helmet 23 hours a day to correct the asymmetry.

Empathy

His mother, a London GP, now says the decision was the right one and that William's problems are now completely resolved.

And she said that the experience had made her deal more compassionately and with greater understanding for patients with similar problems.

I felt that he would have wanted us to do this
Dr Harriet Fraser

Like most parents, Dr Harriet Fraser and husband Greg Barker followed cot death prevention guidelines and put William down to sleep on his back.

But soon Dr Fraser noticed William was developing a flat spot on the back of his head.

She tried repositioning him in his cot and encouraging him onto his stomach, during the day, but William preferred lying in the same position. He was slow to roll and crawl and gradually the flatness grew.

By the time he was six months old, Dr Fraser became convinced that William had positional plagiocephaly, a partial flattening of the back of the head which gives a distorted look to the head shape and which can cause a misalignment of the ears, although it causes no problem with the brain's development.

She thought this would resolve itself and tried putting him in different positions in his cot and encouraging him onto his tummy, but it soon became clear the problem was getting worse.

Advice

Dr Fraser and her husband went to see a paediatric neurologist who confirmed her diagnosis and suggested they consider treatment.

"He said it was a moderate to severe case of positional plagiocephaly, but that he would not leave it if it was his child. He recommended that we go to see a German doctor who comes to England regularly to treat children with this problem."

Within weeks, William had seen the specialist and was fitted for the special helmet, which was made to his specifications.

Some people thought it was a kind of crash helmet for children and said where could they get one
Dr Harriet Fraser
The helmet was made from a plastic casing with a foam inner layer.

This was left flush with the head on the normally rounded side, and was filed away to create a gap where the flat area was.

As his head grew it would fill up the space therefore 'rounding out'.

"He would have the helmet off for an hour, while he had his bath and we would clean the helmet. He was very good about wearing it and did not object at all, even when we first put it on.

"The hardest bit though was making the plaster cast mould used to make his helmet," said Dr Fraser.

The cost of the helmet and the consultations was 1,200.

Relatives and friends were supportive of their decision, but Dr Fraser said she felt the stares from strangers irritating.

"Some people thought it was a kind of crash helmet for children and said where could they get one.

"Other people thought that he had been in a car crash or that he had epilepsy or had brain surgery.

"A lot of people would ask me and I preferred them to do that than to just stare."

Decision

Dr Fraser said that deciding to use the helmet, which is not generally funded by the NHS, had been a difficult decision as plagiocephaly was unlikely to cause William any physical problems.

But she said this had to be weighed against the considerable psychological problems he might face, such as bullying and low self-esteem, if his head was seen as misshapen.

"I felt that he would have wanted us to do this."

She said plagiocephaly can cause jaw and dental problems in later life. It has also been linked to migraine and astigmatism (when the eye is abnormally shaped, which can cause problems focusing), although this has not been proven.

Dr Fraser is now back at work and says she has already seen a couple of parents whose children have the same problem as William.

And that the biggest lesson she had learnt was to offer parents a sympathetic ear when they came for help.

"I would not dismiss anybody by saying that it will get better on its own, even though some mild cases will, if parents are advised early enough on repositioning techniques.

The helmet therapy can only work up to the age of 10 to 12 months of age
Joerg Christoph Blecher
"I advise them about repositioning their babies in the cot and keeping their babies off their flat spot and keeping them where possible sat up and encouraging them onto their tummies. All these are things that are free for parents to do."

She said she also carefully examines children with this problem to see whether they have torticollis (where their neck muscles are tight on one side). She says if this is the case she encourages simple neck stretching exercises.

Joerg Christoph Blecher, a craniofacial and maxillofacial surgeon, working at the University of Giessen in Germany and in the UK and Switzerland, who advised Dr Fraser said: "The helmets can treat the positional head deformities, caused by positioning babies on their back to sleep.

"With the helmets we take advantage of the baby's own head growth and direct it into the flattened parts. Because of this the helmet therapy can only work up to the age of 10 to 12 months of age."



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