https://www.thenoggindoctor.com/blog daily 0.75 2021-04-20 https://www.thenoggindoctor.com/blog/2021/1/30/perspective-is-everythingeven-with-plagiocephaly monthly 0.5 2021-03-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1612026906897-3NTP12L0BGPXCCUZVB36/garys+endo+pics+043.jpg Blog - Perspective is everything.....even with plagiocephaly. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1612026925907-O3PQDNZ1RS2Q7JZ2BUVL/garys+endo+pics+051.jpg Blog - Perspective is everything.....even with plagiocephaly. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1612026853929-X3M84U9015JMA5J72UGR/wendy%27s+242.jpg Blog - Perspective is everything.....even with plagiocephaly. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1612026887274-SRHMR6XQ986K32RYUWHW/wendy%27s+266.jpg Blog - Perspective is everything.....even with plagiocephaly. https://www.thenoggindoctor.com/blog/2020/11/1/what-do-plagiocephaly-and-pumpkins-have-in-common-a-lot monthly 0.5 2020-11-22 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1604242042749-X74QX2SZHD1U15K1LWI3/familypics1003+156.jpg Blog - What do plagiocephaly and pumpkins have in common? More than you might expect. https://www.thenoggindoctor.com/blog/2020/8/25/finally-the-arrival-of-the-perfectnoggin-infant-sleep-solution monthly 0.5 2020-08-26 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1598401752699-776E3357HERX44QLZRRC/UntitledPost.jpg.png Blog - Finally, the arrival of the PerfectNoggin Infant Sleep Solution..... https://www.thenoggindoctor.com/blog/2020/5/16/to-treat-or-not-to-treat-who-should-decide monthly 0.5 2020-05-17 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1589664273833-WYGFLZ5VAYYTK2AY7Y1Y/plasticpics102004+059.jpg Blog - To Treat or Not to Treat- Who Should Decide? Adult with persistent deformational plagiocephaly. It is not that uncommon….. https://www.thenoggindoctor.com/blog/2019/9/6/the-noggin-doctor-asms-visiting-professor-at-the-university-of-chicago monthly 0.5 2019-10-13 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1567810150347-STHZYCZULU2ZVEXXZBNN/Picture1.jpg Blog - The Noggin Doctor: Afterthoughts from my ASMS Visiting Professor Lecture at the University of Chicago Automated interfrontal divergence angle. is the most accurate measure of forehead shape and contour reported. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1567810246596-KYRQ9IP0RQRPCLOX8L70/Picture2.jpg Blog - The Noggin Doctor: Afterthoughts from my ASMS Visiting Professor Lecture at the University of Chicago The manual interferential divergence angle can be performed on a standard CT image and accurately determines if the forehead shape is overly acute (trigonocephalic) or not. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1567814752842-58VDM07M70F9FE821P7Y/image2.jpeg Blog - The Noggin Doctor: Afterthoughts from my ASMS Visiting Professor Lecture at the University of Chicago https://www.thenoggindoctor.com/blog/2019/3/3/helmet-companies-and-the-business-of-selling-helmets monthly 0.5 2026-02-26 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1555065404687-NTCBW0JUC8FVS3G8OWJK/image_6483441.JPG Blog - Helmet Companies, and the Business of Selling Helmets. https://www.thenoggindoctor.com/blog/2019/2/8/plagiocephaly-is-not-caused-by-a-soft-or-malleable-infant-head-debunking-another-incorrect-medical-myth monthly 0.5 2019-02-11 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549898735593-84QCUSHZ9H9LB2VMPZ44/baby5.JPG Blog - Plagiocephaly is NOT caused by a "soft" or malleable infant head. Debunking another medical myth. https://www.thenoggindoctor.com/blog/2019/2/3/torticollis-is-the-primary-cause-of-cranial-flattening-how-to-spot-and-manage-it-1 monthly 0.5 2022-01-08 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549591355609-4R1F26ERMGTNW6P3107U/thumb_IMG_20190203_223548_440_1024.jpg Blog - Torticollis is the primary cause of cranial flattening. How to spot and manage it. Get a coffee as this is a long one… https://www.thenoggindoctor.com/blog/2019/2/2/mothers-know-best monthly 0.5 2019-02-02 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549129113036-DH7UJVZZBCYGC1HE23N8/IMG_20190202_120656_307.jpg Blog - Mothers know best. https://www.thenoggindoctor.com/blog/2019/1/29/perspective monthly 0.5 2019-02-02 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549129495905-CMWWSKXEUCEOHPMPNX21/IMG_20190129_191023_981.jpg Blog - Perspective.... https://www.thenoggindoctor.com/blog/2019/1/21/buyer-beware-all-helmet-companies-are-not-the-same monthly 0.5 2019-04-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549129853415-6EIR5UNB2E8X5O7VL53Z/20190126_140743.jpg Blog - Buyer beware! All helmet companies are not the same. https://www.thenoggindoctor.com/blog/2019/1/20/there-is-no-evidence-that-craniosacral-therapy-improves-head-shape-in-patients-with-piagiocephaly monthly 0.5 2019-04-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1555290703914-BRZDGHISOQ7P07AS6O5H/DSC_0494.jpg Blog - There is no evidence that craniosacral therapy improves head shape in patients with pIagiocephaly The exposed anterior cranium of an 8-month old infants undergoing cranial remodeling for craniosynostosis. The bones are not soft or malleable. They are, in fact, strong enough that they must be cut with a power tool and are very resistant to stress contouring. The proposition that one can “manipulate” these bones with hourly sessions using manual pressure is an absurdity and shows the disconnect between the musings of the those who propagate false or speculative ideas (usually for financial gain) and those who have experienced the objective truth. https://www.thenoggindoctor.com/blog/2019/1/15/test-post monthly 0.5 2019-04-15 https://www.thenoggindoctor.com/home daily 1.0 2025-04-04 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547271720554-3QNGK7GOJB1PKT353NZT/perfectnogginfullres.jpg Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549484583593-9JIRZKQYHCPCGIRALO2F/thumb_IMG_0198_1024.jpg Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547264946041-N1SYRV17IGNGKZ5U2C1Z/Picture2.png Home Typical right posterior deformational plagiocephaly; note anterior shifting of right forehead and ear. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265869822-1XXQ84LAWB2Y2378C12Z/Picture24.png Home Posterior views of infant with right lambdoid craniosynostosis (above) and left posterior deformational plagiocephaly (right). The height of the cranial vertex is lower on the affected side for the craniosynostosis patient but higher in the patient with deformational changes. The vertical position of the ears (level) is only significantly altered in the patient with craniosynostosis. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265864969-PI66925DQ1OWGS4KJ9A4/Picture23.png Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547264698059-5QNFG28TSKB92FZ2ULEK/Picture3.png Home Deformational brachycephaly; symmetrical flattening. There is no facial asymmetry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547326671121-QWDGR38573MFVDCBH4RJ/Picture4.png Home Asymmetric deformational brachycephaly; asymmetry with a broad head. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265875350-69F0WIQ44JM761A83XQF/Picture19.png Home Deformational scaphocephaly; this subtype, due to the very lateral area of flattening, has the most pronounced facial asymmetry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265701639-HEWL9OAUWXMHUQJJEUG7/Picture9.png Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547269554383-RY5LGG9VF1W7SD8YJYNE/Picture8.png Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265675288-4LYX05K2N0XT091399D5/Picture6.png Home Flattening occurs gradually as the infant cranium grows against a flat, unyielding resting surface. This only happens when the point of contact between the infant head and resting surface (mattress, car seat, etc.) is consistent through time, usually due to some factor that limits independent head mobility (e.g., torticollis) https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265754256-598GRHLNAXF3D3V8R2VZ/Picture10.png Home Active, not passive, range of motion is the most reliable test for torticollis in an infant. This can be assessed as early as a few weeks of age. The infant is induced to turn to each side by the parents. I use crumpled paper in the office, but the parent’s voice or a rattle works well. In this patient, head rotation to the left is excellent. This is, of course, the side that he “prefers” when sleeping and is also flattening. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265763630-JVZ5MBXLFN84Y01W2W84/Picture11.png Home Head rotation to the right is more limited. The infant tried to hold this position, but could not for long. Thus the “preference” is not volitional, but a result of imbalance of the cervical muscles, especially the sternocleidomastoid. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312859285-EI23QUNV34F9ASPZU96I/pict2000.png Home Head rotation discrepancy demonstrated in an older infant. Active head rotation reveals excellent head rotation to the left. Note the chin point is almost at the shoulder, indicating slight weakness or laxity in the left sternocleidomastoid muscle. This will result in a head tilt to the right side when the infant is fatigued or preoccupied. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312877498-W2JL4Z25HE8Q96PCLFD9/Picture1000.png Home Head rotation to the right side about 65 degrees, well off of the shoulder; this indicates modest residual tightness of the right sternocleidomastoid muscle. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547333453585-IEVFZ4LK7CL6W0KY3HD7/18533.jpg Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547333485331-VMSN61XD0DHLM47YN7X7/18509.jpg Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547332516743-NP1IA2WQSNHE2BW6NNU7/thumb_18598_1024.jpg Home The PerfectNoggin Infant Mattress (formerly marketed as the PlagioCradle) provides an anatomically-contoured head rest that, unlike other resting surfaces or torso support systems, is upsized as the infant grows. Because the head rests against a contoured surface during the critical first 4 months of life, it is extremely difficult for flattening to develop when used consistently. In addition, the head rest aligns the neck and torso to reduce airway-restricting neck flexion during sleep. Zechariah is the fourth child (of six) in his family to successfully use this same device. His two older brothers were born before the creation of this and have significant residual posterior flattening. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547661968429-DMXXMLOV815WGIYO0F1M/Figure+6.jpg Home Cephalic index- maximum width divided by maximum length (W/L) x 100. Normal pre-1993 was an average of 0.75. Current estimates in back-slept infants is modestly higher (average 0.8-0.85). This reflects the wider variation in head shape in a back-sleeping population. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265969975-9WKVZ2OGKDD4MGT3HLHV/Figure+7.JPG Home Approximate landmarks to measure absolute transcranial difference (long oblique-short oblique). https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265907015-9ESEVMRHPDQUO7WY0306/Picture15.png Home Finger estimation of transcranial difference. Not precise, but a reasonable proxy for most patients. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265889390-MJNC9ICTH0LBQS9YT3FL/Picture14.png Home Head caliper for direct anthropometry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547266027325-WQ8WSUCFOBHLS95TZEAO/Figure+9.JPG Home A well-designed molding helmet modeled by my fourth child, Ava. Note that the helmet has a large foam layer to allow gradual contouring and remodeling without the need for multiple helmets. I am not a fan of see-through plastic helmets as they offer less flexibility and often need to be replaced during treatment. In my experience, all but the most severe head shape differences can be sufficiently treated with a single, well made helmet. Beware of orthotic companies who suggest otherwise. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265775093-IV637EBN5TZYWGQJRURS/Picture17.png Home The mechanism by which helmet therapy induces gradual cranial shape change. This is a passive function wherein the helmet holds certain areas that are overgrown and allows disproportionate growth in the flatter areas. The claim of “active”helmet therapy, or treatment that moves or remodels bone segments, is largely marketing hype as undue pressure on the cranium would create progressive skin breakdown. Skin breakdown is occasionally seen on poorly fitted or over-tight helmets. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547266006451-K7I4L1868JJ5I1CI1L2X/figure+11.jpg Home Surface laser scan of patient with left posterior deformational plagiocephaly before (left) and after (right) 4 month of helmet therapy. It is imperative to note that any patient’s result will depend on the quality of the helmet design, the age treatment starts (younger is better), duration of treatment, and compliance with wearing the device (-20+ hours/day minimum). Failure to properly control for these variables, coupled with the misguided use of cranial ratios to evaluate improvement, are the major weakness of most studies suggesting that helmets are not effective. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547336412665-OPXWOQL9YMFWOUORMWO8/Figure8a.JPG Home The mitigating effect of perspective. This young man, a family friend, has persistent severe right occipital flattening that does not affect his ability to wear glasses and helmets. Although the asymmetry is extremely visible on the vertex view, it is almost imperceptible from a posterior view even with short hair. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312820918-BYNNS53BJ64J8DIA1ZTN/Figure8b.JPG Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547329654972-05ZZZAX62P7L24SLRU52/thumb_IMG_20180514_094822118_1024.jpg Home Significant residual right occipital flattening in a 12 year-old. The patient’s mother was aware of his head asymmetry, although he was not. Many providers incorrectly counsel parents that the flattening “goes away” with growth. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547329676077-FKFZLR4P0FSEEDEISKIW/thumb_IMG_20180514_094802263_1024.jpg Home Instead, flattening that is established at 6-8 months of age often persists but is mitigated by cranial growth, hair coverage, and a shift in perspective from top-down in early childhood to posterior-side in older kids and adult. This patient’s asymmetry is very hard to appreciate when viewed from the posterior perspective. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549891106186-QDVQK3IHR76YSTUNU73C/received_1181164582045765.jpeg Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1581246421446-7KTRHJ6DNM9VAR9BI3X3/LOGO%2Bphoto.jpg Home https://www.thenoggindoctor.com/social-media-mobile daily 0.75 2019-01-28 https://www.thenoggindoctor.com/about-dr-gary-rogers-mobile daily 0.75 2019-01-28 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547332331931-Q7Y6W8M3GHBOWNXKQD3K/19405.jpeg About Dr. Gary Rogers Mobile https://www.thenoggindoctor.com/home-mobile daily 0.75 2019-02-06 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549413566550-0YO6K8MVCZY4V336A6BM/image_6483441.jpg Home Mobile https://www.thenoggindoctor.com/the-noggin-doctor-blog-mobile daily 0.75 2019-02-06 https://www.thenoggindoctor.com/the-science-mobile daily 0.75 2022-03-19 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547264946041-N1SYRV17IGNGKZ5U2C1Z/Picture2.png The Science Mobile Typical right posterior deformational plagiocephaly; note anterior shifting of right forehead and ear. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265869822-1XXQ84LAWB2Y2378C12Z/Picture24.png The Science Mobile Posterior views of infant with right lambdoid craniosynostosis (above) and left posterior deformational plagiocephaly (right). The height of the cranial vertex is lower on the affected side for the craniosynostosis patient but higher in the patient with deformational changes. The vertical position of the ears (level) is only significantly altered in the patient with craniosynostosis. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265864969-PI66925DQ1OWGS4KJ9A4/Picture23.png The Science Mobile https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547264698059-5QNFG28TSKB92FZ2ULEK/Picture3.png The Science Mobile Deformational brachycephaly; symmetrical flattening. There is no facial asymmetry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547326671121-QWDGR38573MFVDCBH4RJ/Picture4.png The Science Mobile Asymmetric deformational brachycephaly; asymmetry with a broad head. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265875350-69F0WIQ44JM761A83XQF/Picture19.png The Science Mobile Deformational scaphocephaly; this subtype, due to the very lateral area of flattening, has the most pronounced facial asymmetry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265701639-HEWL9OAUWXMHUQJJEUG7/Picture9.png The Science Mobile https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547269554383-RY5LGG9VF1W7SD8YJYNE/Picture8.png The Science Mobile https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265675288-4LYX05K2N0XT091399D5/Picture6.png The Science Mobile Flattening occurs gradually as the infant cranium grows against a flat, unyielding resting surface. This only happens when the point of contact between the infant head and resting surface (mattress, car seat, etc.) is consistent through time, usually due to some factor that limits independent head mobility (e.g., torticollis) https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265754256-598GRHLNAXF3D3V8R2VZ/Picture10.png The Science Mobile Active, not passive, range of motion is the most reliable test for torticollis in an infant. This can be assessed as early as a few weeks of age. The infant is induced to turn to each side by the parents. I use crumpled paper in the office, but the parent’s voice or a rattle works well. In this patient, head rotation to the left is excellent. This is, of course, the side that he “prefers” when sleeping and is also flattening. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265763630-JVZ5MBXLFN84Y01W2W84/Picture11.png The Science Mobile Head rotation to the right is more limited. The infant tried to hold this position, but could not for long. Thus the “preference” is not volitional, but a result of imbalance of the cervical muscles, especially the sternocleidomastoid. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312859285-EI23QUNV34F9ASPZU96I/pict2000.png The Science Mobile Head rotation discrepancy demonstrated in an older infant. Active head rotation reveals excellent head rotation to the left. Note the chin point is almost at the shoulder, indicating slight weakness or laxity in the left sternocleidomastoid muscle. This will result in a head tilt to the right side when the infant is fatigued or preoccupied. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312877498-W2JL4Z25HE8Q96PCLFD9/Picture1000.png The Science Mobile Head rotation to the right side about 65 degrees, well off of the shoulder; this indicates modest residual tightness of the right sternocleidomastoid muscle. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547333453585-IEVFZ4LK7CL6W0KY3HD7/18533.jpg The Science Mobile https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547333485331-VMSN61XD0DHLM47YN7X7/18509.jpg The Science Mobile https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547332516743-NP1IA2WQSNHE2BW6NNU7/thumb_18598_1024.jpg The Science Mobile The PerfectNoggin Infant Mattress (formerly marketed as the PlagioCradle) provides an anatomically-contoured head rest that, unlike other resting surfaces or torso support systems, is upsized as the infant grows. Because the head rests against a contoured surface during the critical first 4 months of life, it is extremely difficult for flattening to develop when used consistently. In addition, the head rest aligns the neck and torso to reduce airway-restricting neck flexion during sleep. Zechariah is the fourth child (of six) in his family to successfully use this same device. His two older brothers were born before the creation of this and have significant residual posterior flattening. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547661968429-DMXXMLOV815WGIYO0F1M/Figure+6.jpg The Science Mobile Cephalic index- maximum width divided by maximum length (W/L) x 100. Normal pre-1993 was an average of 0.75. Current estimates in back-slept infants is modestly higher (average 0.8-0.85). This reflects the wider variation in head shape in a back-sleeping population. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265969975-9WKVZ2OGKDD4MGT3HLHV/Figure+7.JPG The Science Mobile Approximate landmarks to measure absolute transcranial difference (long oblique-short oblique). https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265907015-9ESEVMRHPDQUO7WY0306/Picture15.png The Science Mobile Finger estimation of transcranial difference. Not precise, but a reasonable proxy for most patients. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265889390-MJNC9ICTH0LBQS9YT3FL/Picture14.png The Science Mobile Head caliper for direct anthropometry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547266027325-WQ8WSUCFOBHLS95TZEAO/Figure+9.JPG The Science Mobile A well-designed molding helmet modeled by my fourth child, Ava. Note that the helmet has a large foam layer to allow gradual contouring and remodeling without the need for multiple helmets. I am not a fan of see-through plastic helmets as they offer less flexibility and often need to be replaced during treatment. In my experience, all but the most severe head shape differences can be sufficiently treated with a single, well made helmet. Beware of orthotic companies who suggest otherwise. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265775093-IV637EBN5TZYWGQJRURS/Picture17.png The Science Mobile The mechanism by which helmet therapy induces gradual cranial shape change. This is a passive function wherein the helmet holds certain areas that are overgrown and allows disproportionate growth in the flatter areas. The claim of “active”helmet therapy, or treatment that moves or remodels bone segments, is largely marketing hype as undue pressure on the cranium would create progressive skin breakdown. Skin breakdown is occasionally seen on poorly fitted or over-tight helmets. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547266006451-K7I4L1868JJ5I1CI1L2X/figure+11.jpg The Science Mobile Surface laser scan of patient with left posterior deformational plagiocephaly before (left) and after (right) 4 month of helmet therapy. It is imperative to note that any patient’s result will depend on the quality of the helmet design, the age treatment starts (younger is better), duration of treatment, and compliance with wearing the device (-20+ hours/day minimum). Failure to properly control for these variables, coupled with the misguided use of cranial ratios to evaluate improvement, are the major weakness of most studies suggesting that helmets are not effective. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547336412665-OPXWOQL9YMFWOUORMWO8/Figure8a.JPG The Science Mobile The mitigating effect of perspective. This young man, a family friend, has persistent severe right occipital flattening that affects his ability to wear glasses and helmets. Although the asymmetry is extremely visible on the vertex view, it is almost imperceptible from a posterior view even with short hair. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312820918-BYNNS53BJ64J8DIA1ZTN/Figure8b.JPG The Science Mobile https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547329654972-05ZZZAX62P7L24SLRU52/thumb_IMG_20180514_094822118_1024.jpg The Science Mobile Significant residual right occipital flattening in a 12 year-old. The patient’s mother was aware of his head asymmetry, although he was not. Many providers incorrectly counsel parents that the flattening “goes away” with growth. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547329676077-FKFZLR4P0FSEEDEISKIW/thumb_IMG_20180514_094802263_1024.jpg The Science Mobile Instead, flattening that is established at 6-8 months of age often persists but is mitigated by cranial growth, hair coverage, and a shift in perspective from top-down in early childhood to posterior-side in older kids and adult. This patient’s asymmetry is very hard to appreciate when viewed from the posterior perspective. https://www.thenoggindoctor.com/contact-the-noggin-doctor-mobile daily 0.75 2021-02-13 https://www.thenoggindoctor.com/dr-rogers-peer-reviewed-publications-mobile daily 0.75 2019-10-12 https://www.thenoggindoctor.com/dr-rogers-peer-reviewed-publications-espanol daily 0.75 2019-02-15 https://www.thenoggindoctor.com/the-science-espanol daily 0.75 2019-02-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547264946041-N1SYRV17IGNGKZ5U2C1Z/Picture2.png The Science Typical right posterior deformational plagiocephaly; note anterior shifting of right forehead and ear. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265869822-1XXQ84LAWB2Y2378C12Z/Picture24.png The Science Posterior views of infant with right lambdoid craniosynostosis (above) and left posterior deformational plagiocephaly (right). The height of the cranial vertex is lower on the affected side for the craniosynostosis patient but higher in the patient with deformational changes. The vertical position of the ears (level) is only significantly altered in the patient with craniosynostosis. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265864969-PI66925DQ1OWGS4KJ9A4/Picture23.png The Science https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547264698059-5QNFG28TSKB92FZ2ULEK/Picture3.png The Science Deformational brachycephaly; symmetrical flattening. There is no facial asymmetry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547326671121-QWDGR38573MFVDCBH4RJ/Picture4.png The Science Asymmetric deformational brachycephaly; asymmetry with a broad head. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265875350-69F0WIQ44JM761A83XQF/Picture19.png The Science Deformational scaphocephaly; this subtype, due to the very lateral area of flattening, has the most pronounced facial asymmetry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265701639-HEWL9OAUWXMHUQJJEUG7/Picture9.png The Science https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547269554383-RY5LGG9VF1W7SD8YJYNE/Picture8.png The Science https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265675288-4LYX05K2N0XT091399D5/Picture6.png The Science Flattening occurs gradually as the infant cranium grows against a flat, unyielding resting surface. This only happens when the point of contact between the infant head and resting surface (mattress, car seat, etc.) is consistent through time, usually due to some factor that limits independent head mobility (e.g., torticollis) https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265754256-598GRHLNAXF3D3V8R2VZ/Picture10.png The Science Active, not passive, range of motion is the most reliable test for torticollis in an infant. This can be assessed as early as a few weeks of age. The infant is induced to turn to each side by the parents. I use crumpled paper in the office, but the parent’s voice or a rattle works well. In this patient, head rotation to the left is excellent. This is, of course, the side that he “prefers” when sleeping and is also flattening. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265763630-JVZ5MBXLFN84Y01W2W84/Picture11.png The Science Head rotation to the right is more limited. The infant tried to hold this position, but could not for long. Thus the “preference” is not volitional, but a result of imbalance of the cervical muscles, especially the sternocleidomastoid. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312859285-EI23QUNV34F9ASPZU96I/pict2000.png The Science Head rotation discrepancy demonstrated in an older infant. Active head rotation reveals excellent head rotation to the left. Note the chin point is almost at the shoulder, indicating slight weakness or laxity in the left sternocleidomastoid muscle. This will result in a head tilt to the right side when the infant is fatigued or preoccupied. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312877498-W2JL4Z25HE8Q96PCLFD9/Picture1000.png The Science Head rotation to the right side about 65 degrees, well off of the shoulder; this indicates modest residual tightness of the right sternocleidomastoid muscle. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547333453585-IEVFZ4LK7CL6W0KY3HD7/18533.jpg The Science https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547333485331-VMSN61XD0DHLM47YN7X7/18509.jpg The Science https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547332516743-NP1IA2WQSNHE2BW6NNU7/thumb_18598_1024.jpg The Science The PerfectNoggin Infant Mattress (formerly marketed as the PlagioCradle) provides an anatomically-contoured head rest that, unlike other resting surfaces or torso support systems, is upsized as the infant grows. Because the head rests against a contoured surface during the critical first 4 months of life, it is extremely difficult for flattening to develop when used consistently. In addition, the head rest aligns the neck and torso to reduce airway-restricting neck flexion during sleep. Zechariah is the fourth child (of six) in his family to successfully use this same device. His two older brothers were born before the creation of this and have significant residual posterior flattening. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547661968429-DMXXMLOV815WGIYO0F1M/Figure+6.jpg The Science Cephalic index- maximum width divided by maximum length (W/L) x 100. Normal pre-1993 was an average of 0.75. Current estimates in back-slept infants is modestly higher (average 0.8-0.85). This reflects the wider variation in head shape in a back-sleeping population. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265969975-9WKVZ2OGKDD4MGT3HLHV/Figure+7.JPG The Science Approximate landmarks to measure absolute transcranial difference (long oblique-short oblique). https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265907015-9ESEVMRHPDQUO7WY0306/Picture15.png The Science Finger estimation of transcranial difference. Not precise, but a reasonable proxy for most patients. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265889390-MJNC9ICTH0LBQS9YT3FL/Picture14.png The Science Head caliper for direct anthropometry. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547266027325-WQ8WSUCFOBHLS95TZEAO/Figure+9.JPG The Science A well-designed molding helmet modeled by my fourth child, Ava. Note that the helmet has a large foam layer to allow gradual contouring and remodeling without the need for multiple helmets. I am not a fan of see-through plastic helmets as they offer less flexibility and often need to be replaced during treatment. In my experience, all but the most severe head shape differences can be sufficiently treated with a single, well made helmet. Beware of orthotic companies who suggest otherwise. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547265775093-IV637EBN5TZYWGQJRURS/Picture17.png The Science The mechanism by which helmet therapy induces gradual cranial shape change. This is a passive function wherein the helmet holds certain areas that are overgrown and allows disproportionate growth in the flatter areas. The claim of “active”helmet therapy, or treatment that moves or remodels bone segments, is largely marketing hype as undue pressure on the cranium would create progressive skin breakdown. Skin breakdown is occasionally seen on poorly fitted or over-tight helmets. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547266006451-K7I4L1868JJ5I1CI1L2X/figure+11.jpg The Science Surface laser scan of patient with left posterior deformational plagiocephaly before (left) and after (right) 4 month of helmet therapy. It is imperative to note that any patient’s result will depend on the quality of the helmet design, the age treatment starts (younger is better), duration of treatment, and compliance with wearing the device (-20+ hours/day minimum). Failure to properly control for these variables, coupled with the misguided use of cranial ratios to evaluate improvement, are the major weakness of most studies suggesting that helmets are not effective. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547336412665-OPXWOQL9YMFWOUORMWO8/Figure8a.JPG The Science The mitigating effect of perspective. This young man, a family friend, has persistent severe right occipital flattening that affects his ability to wear glasses and helmets. Although the asymmetry is extremely visible on the vertex view, it is almost imperceptible from a posterior view even with short hair. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547312820918-BYNNS53BJ64J8DIA1ZTN/Figure8b.JPG The Science https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547329654972-05ZZZAX62P7L24SLRU52/thumb_IMG_20180514_094822118_1024.jpg The Science Significant residual right occipital flattening in a 12 year-old. The patient’s mother was aware of his head asymmetry, although he was not. Many providers incorrectly counsel parents that the flattening “goes away” with growth. https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547329676077-FKFZLR4P0FSEEDEISKIW/thumb_IMG_20180514_094802263_1024.jpg The Science Instead, flattening that is established at 6-8 months of age often persists but is mitigated by cranial growth, hair coverage, and a shift in perspective from top-down in early childhood to posterior-side in older kids and adult. This patient’s asymmetry is very hard to appreciate when viewed from the posterior perspective. https://www.thenoggindoctor.com/social-media-espanol daily 0.75 2019-02-15 https://www.thenoggindoctor.com/home-espanol daily 0.75 2019-02-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1547271720554-3QNGK7GOJB1PKT353NZT/perfectnogginfullres.jpg Home https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549484583593-9JIRZKQYHCPCGIRALO2F/thumb_IMG_0198_1024.jpg Home https://www.thenoggindoctor.com/the-noggin-doctor-blog-espanol daily 0.75 2019-02-15 https://www.thenoggindoctor.com/contact-the-noggin-doctor-espanol daily 0.75 2019-02-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1548451084585-XSTJALEP33TPYPKCRLW1/Perfect+Noggin+Logo-size.jpg Contact For more information about the PerfectNoggin Infant Mattress, visit www.perfectnoggin.com https://www.thenoggindoctor.com/about-dr-gary-rogers-espanol daily 0.75 2019-02-15 https://images.squarespace-cdn.com/content/v1/5b6c99a1da02bc98907db53d/1549891106186-QDVQK3IHR76YSTUNU73C/received_1181164582045765.jpeg About