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Sleep Problems Come To A Head


An Auckland plastic surgeon is proposing hospital trials of a sleepwrap to help combat a dramatic increase in head deformities since the "back to sleep" campaign was introduced.

A craniofacial specialist based at Middlemore Hospital, Dr Tristan de Chalain said the "back is best" message was important in helping to reduce the number of cot deaths and he was reluctant to contradict it, however, it had also resulted in a worldwide surge in the condition called occipital deformational (or positional) plagiocephaly (flat head).

"Basically it appears that babies who always sleep with their head in the same position dramatically increase the risk of developing head deformation.," said Dr de Chalain.

Dr de Chalain is proposing to trial Safe T Sleep Sleepwraps on neonates in the Special Care Baby Unit and on older babies aged up to 12 months in paediatric and surgical wards, to see whether varied head positions can be selected and maintained during sleep.

Safe T Sleeps have been used by New Zealand families for the past eight years as a means to ensure a safe sleeping position by helping to prevent babies climbing and falling, "creeping" up or down in their beds, or rolling onto their tummies.

Dr de Chalain said the seriousness of the head problem should not be underestimated. The number of skull deformities had dramatically risen internationally and in Auckland referrals for positional plagiocephaly had increased by more than 300% over the past three to four years.

"Something that starts as a deformation can persist, and asymmetry of the shape of a child's head may well affect quality of life. While the great majority improve with treatment, and in many, the residual deformation is masked by hair growth, not all will resolve completely and a small percentage may be severe enough to require corrective surgery," he said.

"Awareness and prevention are the keys to reducing the increasing number of problem cases," said Dr de Chalain.

Options for prevention include turning babies' heads to alternate sides when putting them to bed on their backs, in order to prevent prolonged pressure on the same spot.

Putting the baby to bed at alternate ends of the cot or placing a safe toy to one side may encourage the child to keep its head in a particular direction. However, many parents found this difficult to achieve and some babies were resistant to efforts to correct their sleeping position, said Dr de Chalain.

"If we can find a way to reliably and safely control the position of babies' heads during sleep, I would hope we can use it to help prevent the problem of skull deformities from occurring and to assist treatment of those who have already developed the condition," he said.

The study has to be approved by the Auckland Region Ethics Committee before it can proceed and babies would only be included in the trial with their parents' informed consent.


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