How often will my infant need to see the orthotist for follow-up and/or adjustments?
Frequency of follow-up visits usually depends on the severity of the initial head shape, age of the infant, and individual treatment protocols of the local orthotist. Typically, the infant is seen a week after the initial fitting and approximately every 2 to 3 weeks thereafter, throughout the course of the treatment program. Younger infants may require more frequent follow up appointments since their heads are growing so rapidly.
What kind of adjustments can we expect throughout the course of the treatment program?
Cranial remolding orthoses are designed to make contact over the “high” spots, and leave voids over the “low” spots. This provides “directed growth” of the head. Throughout the course of the treatment program, material (liners) may be removed to allow more growth in targeted areas. Pads may also be added in specific areas to further enhance the symmetrical or proportional growth of the infant’s head. In addition, the plastic material may be heated and recontoured as the shape of the head changes. After each adjustment, it will be important to closely monitor your infant’s head to make sure that it’s adapting well to the adjustments.
How do I clean Orthomerica Cranial Remolding Orthoses?
The cranial orthoses manufactured by Orthomerica can all be cleaned with 78-99% rubbing alcohol. Wet a soft cloth with the alcohol and vigorously wipe out the entire inside of the orthosis once a day when you remove the orthosis for your baby’s bath. This will help prevent bacteria from building up on the inner liner and will reduce the odor that is sometimes present. Make sure the alcohol is completely dry before placing the orthosis back on the baby’s head. If you live in a sunny climate, place the band in the sun after cleaning it to help it dry. The baby’s head should be washed daily with a mild baby shampoo that will not hurt the eyes. Aveeno shampoo, or Tea tree oil shampoo made by a company called Jason can soothe some scalp irritations that can occasionally occur because of heat buildup and perspiration inside the orthosis.
How should Orthomerica orthoses fit on my baby’s head?
During the first two weeks of orthotic treatment, the cranial orthosis may shift around on your baby’s head, especially if your baby has a head shape that is asymmetrical. While this may require the caregivers to frequently reposition the band, rotation is not unusual during this early treatment time as the asymmetrical head adjusts to the more symmetrical shape of the cranial orthosis. The orthosis may require an adjustment earlier than your scheduled appointment if the band rotates and blocks vision, rubs against either ear of if you notice skin problems. Contact your orthotist with any questions or concerns any time during the treatment process. After two weeks of 23 hour wearing time, any rotation should be minimal.
The Clarren Helmet fits loosely when it is initially fit. Depending on the cast modification process, your child’s age, and type of cranial deformity, other types of cranial orthoses may also fit loosely. The orthosis may tip forward while the baby is lying on the back, but it should not impede vision. There is a tendency for orthoses to tip forward more in babies with brachycephalic (very wide and short heads), but this tends to diminish as the head develops more contour in the back. Discuss any concerns about fit with your orthotist.
Growth spurts can affect the fit of the orthosis between the casting and fitting appointments and at different times during the treatment process. This is particularly true of babies between the ages of 4-7 months since the head is growing about 1 centimeter a month during this period. If this occurs, the orthosis may fit quite snugly at the fitting, and the orthotist may remove material at this appointment to ensure there is adequate room for growth to occur. The orthosis should still fit around the baby’s head, allowing one person to apply and remove the orthosis. The child’s skin may be pink or even dark pink when you remove the orthosis during the break in period, but any marks should disappear in 30 minutes. At no time should the skin appear tender or blistered. If this occurs, remove the orthosis and schedule an appointment with your orthotist as soon as possible.
If I have questions regarding my infant’s orthosis and/or treatment program, whom should I contact?
You should always contact your orthotist immediately with any questions or concerns you have regarding the orthosis or treatment program. Your practitioner is the only one in a position to answer these types of questions because they have seen and evaluated your infant in person. It is very difficult to assess the fit and function of an orthosis from a photograph, and opinions solicited from other sources cannot be as accurate as those from the health care professional providing treatment.
How long will the cranial remolding orthosis treatment program last?
The average treatment program lasts between three and four months, with younger infants typically completing treatment sooner than older infants. Other factors such as severity of head shape, consistency of wear, and individual growth patterns of the infant affect the length of time for treatment. Your orthotist can best estimate the length of time necessary for completing the treatment program.
Will my child need more than one cranial remolding orthosis during treatment?
Most cranial remolding treatment programs are completed with a single STARband, STARlight or Clarren Helmet. Only rare and severe circumstances should require a second orthosis. Orthomerica specifically designs and modifies our cranial designs to complete a majority of the treatment programs with a single orthosis. Credentialed orthotists and prosthetists are experienced at adding and removing material to increase the longevity of the orthosis and reduce costs for the caregivers.
When will treatment be discontinued?
Generally, treatment is discontinued when any remaining asymmetry is so mild that it would not require treatment with a cranial remolding orthosis and you are happy with your infant’s overall head shape. The orthotist will be taking specific measurements throughout the treatment process that will track the changes of the head shape. If your orthotist has a STARscanner, the orthotist will scan the patient during follow-up visits. The follow-up scans will be compared to the initial scan, and the STARscanner software will measure the changes, as well as, symmetry. Once you and your orthotist agree on the amount of improvement seen, you will return to your referring physician before treatment is discontinued.
How often should I see my referring physician?
Your physician will advise you as to when he/she wants to see the patient during treatment. Many physicians prefer to see the infant after receiving the cranial orthosis, and at the middle and end of the orthotic treatment program.
Will my insurance cover Orthomerica’s cranial remolding orthoses?
Insurance companies and state plans have different criteria for coverage depending on the type of plan and premiums paid. All of these plans require extensive documentation to process the claims including the prescription, letter of medical necessity from the referring physician, proof that repositioning techniques were not successful in correcting the infant’s head shape. Additional information, such as, specific measurements and clinical photographs may also be required. You should contact your insurance company prior to your first visit with the orthotist for evaluation and/or casting/scanning for a cranial remolding orthosis. Ask your insurance company if they cover DME (Durable Medical Equipment) and/or cranial remolding orthoses. Cranial remolding orthoses are custom molded devices and carry a specific billing code of S1040 or an undifferentiated code of L1499 or E1399. If your insurance company says that it covers billing code L0100, tell them that the L0100 code is for a protective helmet, not a remolding orthosis. If your insurance company tells you that “orthotics” are excluded in your policy, ask what type of “orthotics” the policy refers to. Many insurance companies exclude orthotics worn in the shoes to prevent a variety of foot problems and inaccurately generalize the term to include cranial remolding and other types of orthoses.
Where can I find more information about deformational Plagiocephaly and cranial remolding orthoses?
Your orthotist can provide you with different types of written information that explains deformational Plagiocephaly and the orthotic treatment program. You may also find helpful resources online – keeping in mind that many internet sites are sponsored by manufacturers of different brands of cranial remolding orthoses and are heavily biased towards their own products. The most accurate information regarding the STARband, STARlight and Clarren orthoses will come from your orthotist and Orthomerica’s website.