Bright Futures®

Well-baby visits are often planned at 2-5 days after birth, and at 1-, 2-, 4-, 6-, 9- and 12-months of age. During the first six months, it is important to educate and confirm the importance of both the Back to Sleep program and substantial amounts of supervised tummy time.

Physical examinations of baby’s head include evaluation of the neck muscle weakness/asymmetry/tightness, the cranial sutures and fontanelles, and the overall head shape development. Skull asymmetry and/or disproportion should be documented in the medical chart with additional education and discussion about repositioning and tummy time activities—both of which are most effective at potentially changing the overall head shape in the first three to four months.

Sustained asymmetry and disproportion should be referred to a pediatric physical therapist and/or STARband specialist for further assessments and treatment recommendations. Plagiocephaly has been identified as a marker of elevated risk for developmental delay, and limitations to head movement may further disrupt functional motor development.

Clinic documentation at well-baby visits of the head shape and the education on repositioning are both necessary to meet coverage criteria for most payers if the head deformity remains and a cranial remolding orthosis is prescribed.