The Growing Child: 1 to 3 Months

My Son, Chrissy Teigen’s, Wore a Corrective Helmet for a Flat Spot

The Growing Child: 1 to 3 Months | Johns Hopkins Medicine

The research that does exist on this is conflicting, although largely in favor of helmet use.

For instance, one randomized, controlled trial published in the BMJ in 2014 followed 84 babies between the ages of 5 months and 6 months with moderate to severe skull deformation for six months.

Babies were randomly assigned to receive either helmet therapy or to just let the skull deformation take its natural course. Their results showed no real differences in improvement between the groups, suggesting that the helmets really didn't do much.

However, the study has been criticized for having a low number of participants, a poor fit for helmets, and no assessment of how long babies who were assigned the helmets actually wore them each day.

“This trial was not well done and got a lot of criticism from those of us who have done this for a long time,” Jordan Steinberg, M.D., Ph.D., assistant professor of plastic and reconstructive surgery at Johns Hopkins Medicine, tells SELF.

“If you put a badly fitting helmet on a child that doesn’t need it, you’re not going to get a good result.”


Steinberg also led a study published in the journal Plastic and Reconstructive Surgery in 2015 that analyzed 4,378 patients with flat spots and assigned them either conservative therapy ( repositioning the babies while they slept or doing physical therapy) or helmet therapy. Babies’ heads were completely corrected in 95 percent of those who were given helmet therapy right off the bat, and in 96 percent of babies whose head shape didn’t improve with more conservative therapy.

The AAP has endorsed guidelines from the Congress of Neurological Surgeons that state there is “more significant and faster improvement” of a baby’s head shape when they’re treated with a helmet compared to more conservative therapy, especially if the deformity is severe and the helmet therapy is used when they’re still pretty young.

As a whole, doctors generally recommend this if a child's case seems severe enough.

A baby's head shape “generally improves over time even without helmeting,” Jesse Taylor, M.D., chief of the division of plastic and reconstructive surgery at Children’s Hospital of Philadelphia, tells SELF—which makes it difficult to prove that a helmet is responsible for improvement in any individual case. But, in general, “helmets work well,” he says.

If necessary, your doctor may recommend starting your baby with a helmet right away.

But depending on your exact circumstances and the severity of your baby's case, they may also recommend more conservative treatments counter-positioning (basically repositioning your child using a bolster or using other measures repositioning their crib relative to the door or hanging an interesting mobile) or more tummy time when your baby is awake, Jonathan Martin, M.D., a neurosurgeon at Connecticut Children’s Medical Center, tells SELF. “The goal is to achieve more time off of the ‘flat’ part of the head.”

In fact, Dr. Vander Kolk says he usually only recommends helmets in more severe cases. “If I think a case is mild, I don’t usually recommend helmets to families,” he says. “Wearing a helmet for 23 hours a day can be difficult for a child.”

And, at a certain point, babies age helmets. “The FDA does not approve helmet wear beyond 18 months of age, but practically speaking, most infants won’t keep the helmet on after a year,” Dr. Steinberg says. “They become handsy and will get it. I always strive to be done by age 12 months.”

If your child has a flat spot on their head, don't hesitate to flag it for their pediatrician. Helmet-molding therapy, if your doctor decides is a good way to go, works best when it's done at an earlier age, Dr. Steinberg says, so it's not something you want to sit on.



Infant Skull Fracture Symptoms

The Growing Child: 1 to 3 Months | Johns Hopkins Medicine
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Infant skull fracture symptoms may range from mild and not even noticeable to severe and debilitating. An infant may suffer such a fracture for a variety of reasons, but the most common cause is the use of instruments during childbirth.

Forceps, for instance, may be used by the doctor to grasp a baby’s head during delivery and this force can lead to a fracture and even subsequent brain damage and lasting disabilities and symptoms.

Noting the signs and symptoms of an infant skull fracture is important because the consequences of not treating this injury can be serious.

Both parents and the medical team need to be aware that a fracture may have occurred, look for the signs, and take any necessary steps to confirm a skull fracture diagnosis and to use appropriate treatments to prevent or correct any brain damage or physical damage.

How Infant Skull Fractures Occur

Infant skulls are flexible and made up of plates that are attached by soft tissue called sutures.

These harden eventually but allow the brain to grow into an expanding skull and allow the skull to survive the pressures of the womb and childbirth.

The latter does not always happen, and even without any kind of doctor error, an infant’s skull can fracture during delivery, simply due to the pressure. [1]

More often, though, the cause of an infant’s skull fracture can be due to medical malpractice. The number one cause of an infant skull fracture during delivery is from the force of instruments, typically forceps or a vacuum extractor. These instruments can help deliver a baby quickly if there are complications, but they can also fracture the skull.

A medical error may also be involved when the infant’s skull is fractured during natural delivery with no instrument use.

If the child is unusually large or presents in the breech position or if the delivery is long and difficult, the baby may be at a greater risk of suffering a fracture.

If the doctor failed to recognize there would be these complications and did not perform a Cesarean section, the result may be a fracture.

Types of Skull Fractures

The symptoms of an infant skull fracture depend on factors such as the severity of the fracture, but also on the type. [2] A linear fracture is a simple line fracture that is most often the least complicated and causes the fewest and mildest symptoms. The fracture does not cause the plates of the skull to move and often this type of fracture heals without any intervention.

Depressed skull fractures are much more ly to cause symptoms and to have serious complications. This kind of fracture is easy to spot and occurs when the skull is sunken down toward the brain. It should be readily visible.

Diastatic skull fractures are fractures along a suture. a linear fracture, these may not cause symptoms right away, but they may be more serious. As the child’s brain grows the fracture may grow as well and cause problems.

Signs of Mild Fractures

Mild infant skull fracture symptoms may be nonexistent. Some signs may include irritability, sensitivity to light and sounds,  abnormal eye movement, seizures, lethargy, listlessness, crying, difficulty sleeping, and difficulty in nursing.

Fortunately for most mild fractures, there are no lasting consequences or symptoms. Sometimes the immediate signs are so insignificant that the fracture is not detected.

Signs of Moderate to Severe Skull Fractures

Physical signs of a more severe skull fracture in a newborn may include swelling, a lump, or a depression on the head. There may be bruising around the eyes or fluid or blood coming the baby’s ears or nose.

A more serious skull fracture may cause brain damage or a traumatic brain injury. Signs include difficulty in nursing, crying for no apparent reason and being difficult to console, listlessness and lethargy, unexplained irritability, and difficulty focusing on anything. Seizures may also be a sign of brain damage associated with a skull fracture.

If a skull fracture is suspected because of some of these signs, doctors may use imaging scans, a CT scan or MRI to confirm the fracture’s location and the extent and to find out if it has caused a hematoma or bleeding on the brain. [3]

A hematoma may be associated with symptoms irritability, seizures, crying, and difficulty sleeping or nursing. Bleeding on the brain can put damaging pressure on it and depending on the severity, may or may not need to be drained surgically. In severe cases, this bleeding may cause lasting brain damage or even death.

Long-Term Brain Damage

Over the long-term, skull fracture may cause a wide variety of symptoms depending on the severity of the brain damage and how it was treated after the skull fracture was discovered. These long-term symptoms may include cognitive, developmental, perceptual, physical, and behavioral complications.

Cognitive symptoms may include memory problems, a lower than average IQ, difficulty paying attention or focusing, a short attention span, learning disabilities, difficulty understanding the abstract, and difficulty making decisions. Perceptual symptoms include impaired vision and hearing, trouble with balance or coordination, sensitivity to pain, and spatial disorientation. [4]

Physical signs of brain damage include seizure disorders, fatigue, headaches, difficulty speaking, difficulty sleeping, loss of consciousness, tremors, and paralysis varying from partial and mild to severe.

Children with brain damage may also have behavioral and emotional challenges that include impatience, difficulty coping with stress, irritability, either heightened or flattened emotions, aggression and lethargy.

Infant skull fracture symptoms are varied, ranging from immediate and either mild or severe to long-lasting. If you suspect your child was injured during childbirth, don’t hesitate to ask your doctor about imaging to check for a fracture.

Any sign of a fracture should be taken seriously as the consequences of ignoring it could be serious. If you think the fracture was caused by negligence, you may want to take steps to start a lawsuit to seek compensation for your child.


The Johns Hopkins Neurosciences Intensive Care Nursery Tenth Anniversary (2009-2019): A Historical Reflection and Vision for the Future

The Growing Child: 1 to 3 Months | Johns Hopkins Medicine

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The Growing Child: 1 to 3 Months

The Growing Child: 1 to 3 Months | Johns Hopkins Medicine

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While all babies may grow at a different rate, the following indicates the average for boys and girls 1 to 3 months of age:

  • Weight: average gain of about 1½ to 2 pounds each month
  • Height: average growth of over 1 inch each month
  • Head size: average growth of about ½ inch each month

As your baby begins to grow, you will notice new and exciting abilities that develop. Babies at this age begin to relax the tight muscle tone of newborns and begin extending their arms and legs more. While babies may progress at different rates, the following are some of the common milestones your baby may reach in this age group:

  • Some of the newborn protective reflexes begin to disappear
  • Neck muscles become stronger, head bobs then is held erect
  • Turns head from side to side when placed on belly
  • Brings hands or objects to mouth
  • Looks at hands
  • Follows light, faces, objects
  • Listens to sounds
  • Opens and closes hands
  • Holds, then drops a rattle or other object
  • Active leg movements
  • At the end of 3 months:
  • Raises head and chest when placed on belly
    • Beginning to reach hands to objects, may bat at hanging object with hands
    • What can my baby say?

It is very exciting for parents to watch their babies become social beings that can interact with others. While every baby develops speech at his or her own rate, the following are some of the common milestones in this age group:

  • Begins to imitate some sounds (coos, vowel sounds)
  • Cries become more purposeful and are different for hunger, fatigue, and other needs

What does my baby understand?

A baby's understanding and awareness of the world around him or her increases during this time. While babies may progress at different rates, the following are some of the common milestones in this age group:

  • Knows familiar voices, especially of mother and father
  • Smiles in response to others
  • Responds to social contact, may coo
  • Moves arms, legs, body in rhythm with other's voice

How to help increase your baby's development and emotional security

Young babies need the security of a parent's arms, and they understand the reassurance and comfort of your voice, tone, and emotions. Consider the following as ways to foster emotional security of your newborn:

  • Hold your baby face to face and make eye contact.
  • Talk to your baby with a soothing, animated voice throughout the day while dressing, bathing, feeding, or playing with your baby.
  • Sing to your baby.
  • Give your baby rattles and soft toys with different sounds.
  • Let your baby hear different sounds (for example, wind chime, ticking clock, soft music, or music box).
  • Show your baby bright pictures of black and white images.
  • Hang a mobile with bright objects above your baby.
  • Call your baby by name.
  • Hold your baby during feedings and provide comfort when he or she is distressed and cuddling when happy.