Whatever Ian Likes...

...Ian gets.

But he also gets plenty of stuff he doesn't like. Such is life!

Here's a little update on Ian's sojourn into the land of solid foods.

Ian seems to think that green beans are yucky. Sweet potatoes are okay. Mommy milk with a bit of prune juice will work when he needs to get things going, if you know what I mean. Rice cereal is boring and tends to stop things up. Pears are yummy. Mix pears and oatmeal, and he just might finish the bowl.

Next up to try? Peas, perhaps.

Ian's first several food experiences consisted of a lot of pushing food out of his mouth with his tongue, contorting his face into grimaces and smearing food all over everything. He seems to have gotten the hang of swallowing it now, when he wants to do so.

Ian has two teeth. The first to arrive is growing in quite nicely. The second tooth has broken through the surface and will shortly be just as lengthy and present as the first.

Speaking of Ian, we are off to see a third specialist today about his flat noggin. The results so far are mixed:

Opinion 1 - Cranial Tech
This company specializes in cranial remolding and has its own proprietary "active" helmet. The therapist we saw said Ian is "definitely" a candidate for a helmet and predicted a 2-3 month treatment time if we start right away. They found that Ian has brachycephaly (widening of skull front to back) and plagiocephaly (flattening of one side of the skull) with mild torticollis (neck tightening). They did a photo study and took manual measurements, but most of the opinion we received was based on one person's interpretation of the situation by simply looking at his head. Their sales pitch is formidable and they make no bones about being the best option. In fact, if it didn't cost huge sums of money we don't have, their sales pitch would have been effective, despite the lack of scientific data, because they manage to make treatment seem quite urgent and almost cool.
Pros:
- they have the best reputation among parents of the major helmet-providers when it comes to results
- because of aggressive treatment, they tend to get the results faster, which means less time for skin problems and other complications of treatment to develop
- their helmets are lighter and less bulky than the other active helmets on the market
- they make a cute calendar of their patients and otherwise make it seem "cool" to have a DOCband (their product)
- our pediatrician recommended them
Cons:
- the evaluation is a one-time deal -- the next visit would be the beginning of the treatment process
- they don't contract with insurance companies, in general, because insurers prefer to work with companies that can provide other orthotic devices, not just helmets
- they don't want to tell you who the competition is so that you can make an informed choice, only that Cranial Tech is better
- their helmets are expensive, and...
- kids tend to outgrow their helmets and need new ones more often because the reduced bulk means less foam to shave away as a child's head grows. This means that parents have to pay twice for the treatment process, once for each helmet
- their closest location is in Charlotte, and he will initially need to make weekly visits

Opinion 2 - Level 4 Orthotics
This company makes all kinds of orthotic devices, hires experienced orthotists and uses the STAR line of products from Orthomerica, which includes both active and passive bands (more on this later). They said that Ian's condition warrants treatment on the basis of 4 measures (placing him on a severity scale of 3/moderate in each category), but on the fifth, which is the most critical, he just barely misses falling in the normal range. In fact, the data showed that my subjective feeling about his severity (I said he fell between moderate severity, unacceptable and moderate severity, acceptable) was supported by the scientific data she got from the scan. This orthotist also disagreed with the torticollis finding, saying that she did not detect any serious muscle tightness or limitations in his range of motion.

This particular evaluation suggests that we genuinely have choices to make, including choices about treating him or not, and much could depend on what natural growth does for him over the next few weeks. The one variable that is hard to control for is what will happen if the child is left untreated. The condition can cause neurological and functional problems, but there is no guarantee that the condition will worsen without treatment. In fact, some research I read last night suggests that there is a 70% chance that his condition would improve or stay the same even without an orthotic, as long as we are diligent about repositioning, especially because an unexpected finding of this particular bit of research is that growth was greater front-to-back than expected, which is good news for brachycephalic babies, since that is the major problem area for them. With Cranial Tech, we were not encouraged to wait and see, but at Level 4, that is exactly what they suggested. One major consideration is that he has little "facial involvement," which means that the flattening in the back has not disfigured his face much. This was all based on data I could see and compare to studies I later found online, which makes it easier to make an informed, rational decision over an emotional one.

Pros:
- they have contracts with all but one insurance company, which means they work with ours
- they use a laser scanner to make a 3-d model of the cranium and to take measurements/ratios, which are then compared to a variety of severity scales (in other words, it is much less subjective)
- they are not all sales pitch, in fact, they told us more about our other options, including the local politics of cranial banding
- they were low-pressure, and encouraged us to have a second free scan after 2-4 weeks to see what natural growth is doing to his head without intervention
- they were very honest about all of the options, and did not want to make a recommendation until they are sure of his need
- kids are less likely to need a second helmet, because the first one is bulky enough to allow for significant growth
Cons:
- this company is also far away - they have offices in Charlotte and Cary that I can take him to, but it is a 1.5 hour drive, at least, either way
- their helmets are bulkier than Cranial Tech's, making them more unsightly and obvious
- some of their staff specialize in cranial remolding alone, others, including the one we met with in Cary, is also a general orthotist, so we'd have to go to Charlotte if we wanted Ian to see someone who only does helmets
- the cost is high for the sort of helmet that is appropriate for Ian's condition

Passive Helmets vs. Active Helmets (Bands)
Passive helmets are mass-produced in set sizes and are shaped like an "ideal" skull with the idea that the natural growth of the skull will cause it to fill in the helmet, helping the skull to take a more normal shape. The cost savings are clear, but the treatment is much less effective. Often babies with passive helmets end up having active helmets later on when the passive helmets do not work.
Active helmets work by placing constant gentle pressure on areas of overgrowth, while relieving pressure on depressions where more growth is desired. In order to achieve this kind of fit, each helmet is custom made to fit the contours of the child. As a result, treatment tends to go more quickly and effectively, but it costs more.

Each type of orthotic is indicated for different conditions. Nobody has suggested that a passive helmet would be appropriate for Ian. If they suggest treatment, they suggest the custom orthotic.

What's next?
We're off to Hanger Orthopedic Group today, so I can add their analysis to this once I know what it is.

Also, I am debating taking him to see a cranio-facial specialist (plastic surgeon) in Winston-Salem who is all the rage in the area. His philosophy is contrary to that of all of the other major orthotic providers, and, from reading the background information on the helmet he has patented, I find his reasoning fairly compelling. His approach is less forceful than the typical "active" band, making the correction more physiologically natural, but it is more effective at addressing root causes than the typical "passive" helmet. He also made his device with the idea that it needed to be more reasonably priced than the custom orthotics that we have been considering. I think if we decide to treat Ian, it would be a good move to have him evaluated by this doctor as well so that we know what his option might cost us, in addition to saving us some time, since he's closer than two of the other options.