Flat Head & Twisted Neck: Words of Advice from an Occupational Therapist

Recently I head the pleasure to speak with Jennifer Todd-Barnard of Baby Begin, LLC. Jennifer is a pediatric occupational therapist who specializes in working with infants with Plagiocephaly (flat head) and Torticollis (twisted neck) as well as infants with reflux and other conditions. Jennifer offers some great advice for new parents!

1. Tell me about you. I am a pediatric Occupational Therapist with a passion for babies!

2. What is "flat head" and "twisted neck"? Plagiocephaly (flat head) is a very common condition that newborns are getting, mainly because they are sleeping on their backs. It can be mild or severe and often affects even the face. You only have a short window of opportunity to improve it (up to 18 months of age) and then it is permanent. But the good thing is- it is preventable! Torticollis (twisted neck) is a tightness on one side of the neck that causes a baby to tilt their head and prefer to rotate in one direction. It should be addressed immediately by a qualified Occupational or Physical Therapist. It is usually caused from in-utero crowding/constraint. If left untreated, it can cause skull/facial deformities and developmental delays.

3. How can a parent recognize them? When the baby is born, you really need to watch for a turn preference. If the baby always turns in the same direction and resists turning the other way, one side of the neck is probably tighter than the other. You should also monitor the shape of the baby's head by looking at it from above, watching for any flattening or asymmetries. Some babies are even born with a misshapen skull.

4. What can a parent do to prevent or help them?  Encourage lots and lots of tummy time (from day 1) when the baby is awake and supervised. Limit time in containers (swings, bouncy seats, car seats) to 3 hrs or less a day. Reposition the baby frequently - hold her on both sides, burp her on both shoulders, switch sides of the crib, etc. Be conscious of repetitive positions. And don't forget to address any concerns with your pediatrician and ask for assistance from a therapist.

5. How do you help parents and babies in your therapy? We know that with just a few minor changes in a baby's day, a parent can prevent Plagiocephaly. We do a lot of educating the community. We go to the baby's home and work with the parents on repositioning strategies and effectively treating the Torticollis with experienced therapists. We also work on reshaping the skull so the baby can avoid a helmet or further skull deformities. We are seeing a 70% success rate if the baby is referred to us before 3 months of age. That means lots of round heads, which, of course we love!

6. How do you use Baby Stay Asleep in our therapy? We are encouraged by the ways we can use the Baby Stay Asleep. It offers a safe way to reposition the baby off of the flattened area of the skull, thus improving the head shape very quickly. All other positioners have been taken off the market, which made our job a lot more difficult!  This specific positioner has made a world of difference for our patients. We also have a lot of babies with reflux. Being able to put the baby in the crib (not a container) AND being able to position their head at the same time is so nice. It really works and our families are so excited to have a viable option for both. Great design and easy to use.


"Controlled Crying" - Is it an Effective Technique?

Recently I had the pleasure to meet with Marsha Podd, R.N., C.L.E. author of Secrets of a Baby Nurse. We met up because of a mutual interest in infant sleep and well being. During our conversation we discussed sleep training. Marsha works with parents of newborns on sleep training. She and I discussed our personal belief in infants learning to sleep on their own. Learning to self-soothe and self-regulate is an important skill that can be learned as early as 6 months old.

Marsha also mentioned a study that was done that followed up with children at six years of age that participated in sleep training. What they found is that 'controlled crying' and other sleep training methods had no adverse behavioral or emotional affects as compared to those who had sleep problems, but received no training. In fact, the study comments' "without intervention, sleep problems are more likely to persist into childhood, potentially leading to behavioral and cognitive problems including aggression, anxiety and attention and learning difficulties". You can read more from Murdoch Children's Research Institute here. 




Do any of these terms sound familiar: Night Nanny, Baby Nurse or Newborn Care Specialist?  Each of these terms has been used interchangeably in the past, but in reality there is vast difference in their duties. A Night Nanny is simply a person who comes into your home at night and gets up with your newborn when he/she awakens. She is not educated in newborn issues and will do only what the client instructs her. At times it can be like the blind leading the blind.

A Baby Nurse is a registered RN or LPN who comes into your home and cares for your newborn’s medical issues. So what is a Newborn Care Specialist?


Newborn Care Specialist (NCS) is an extensively educated, skilled person who has a well-rounded knowledge in formula and breastfeeding, understands how to effectively set up a routine that fits the family’s lifestyle, is able to interpret and adequately respond to a baby’s needs, establish healthy sleep habits, knows about diaper rashes, circumcision care, reflux, colic, swaddling, soothing techniques and how to effectively set up the family for success. She will be experienced in preemies, multiples and special needs babies.  She will generally come in for one week to three months relieving the parents at night and educating them while she is there. Most Newborn Care Specialists are also available for day duty or round the clock duty. Her goal is to work herself "out" of a job by the time the baby is 3 months old and typically sleeping from 7 PM to 7 AM without waking.


Once a baby reaches 12 weeks or 12 pounds he/she should be sleeping all night without waking. A Newborn Care Specialist is trained to help a baby accomplish this using gentle no cry methods.


A great schedule is the key to a happy baby.  Implementing a good sleep, feed, and wake schedule can be the key to a peaceful home and baby.  A baby with a good schedule will also sleep better at night.   A Newborn Care Specialist can help set that up.


A trained Newborn Care Specialist is an expert in swaddling and can show new parents how to become experts also.  Many new parents do not realize that when proper swaddling techniques are used, the benefits will be a baby who sleeps longer and more peaceful.


Bring home baby is not as simple as it is cracked up to be. You can read the books and go to the classes but when that sweet little bundle arrives in your home, all your learning can go out the window. There is so much to know about babies and a Newborn Care Specialist is a person who is ‘in the know’.


While doing your search for a newborn care, we would strongly suggest that you make sure the Newborn Care Specialist you hire is certified by a qualified agent.  The Newborn Care Specialist Association is the certifying agent for the Newborn Care Specialist and can be researched at . Certified individuals  carry the initials CNCS (Certified Newborn Care Specialists) behind their name. Many individuals call themselves Newborn Care Specialists but not all are qualified to be doing that job, causing countless problems you will be calling a certified NCS to fix.



Arriving home with your newborn, a Newborn Care Specialist can be a wonderful asset to your family and to Mom’s recovery. Her services are priceless when she leaves 12 weeks later. Your baby should be sleeping through the night, and your evenings are yours to share with your other children or your spouse. You will feel more confident in your newborn care skills and you will be well on your way to a well- integrated family structure. Even if you decide to gift yourself with only a couple of weeks of help, the education you will receive and the rest you will get for those two weeks will have your friends envious.


Nancy Hamm is a Certified Newborn Care Specialist with over 35,000 hours of on-the-job experience.  She owns Exclusively Baby Nurses  a professional placement agency, The Baby Nurse Directory  a free referral network for new parents; she does sleep consulting, and is available for night-time work.  She can be reached at 800-337-0650.


What is a Newborn Care Specialist?

I recently had the pleasure to talk to Natalie Akpele of Cuddlebuggs, newborn care and nanny education company. I was interested to find out what a newborn care specialist is and how do they help families with newborns. Natalie works in the home with families to help them transition from hospital to home. She mostly works overnight to care for the newborn, while the parents get some much needed rest! Wow, I could really have used Natalie's services when my son was born, nobody in our house got sleep for months!

Natalie went on to tell me that there is much more to it than that. In addition to feeding, changing and keeping watch over baby, she provides parent education, including sleep training. Natalie starts with swaddling, a pacifier and a sound machine. She may also recommend positioning, including elevating the crib for infants with reflux. (See Natalie's review of Baby Stay Asleep).

What is her infant sleep training philosophy? She uses bits and pieces from different sleep training methods. She feels that sleep is essential for newborns - "it is the center of who they are". Therefore, it is important to develop healthy sleep habits. She believes babies should sleep in a familiar surrounding. The sounds from the sound machine are similar to the sounds in the womb and therefore familiar to the baby. She also believes they should sleep in their own crib - to learn that this is their "sleep space" – and is not opposed to some crying. Waiting too long to have baby sleep in their own space can make it difficult to transition later on.

Natalie's services are invaluable to new parents! The combination of getting some sound advice and sound sleep can make for one happy family!


The What, When and How of Swaddling

I recently had the chance to catch up with Tamara from Pea Wee Baby to ask her about the ins and outs of swaddling.She had some great insight and advice! Thanks Tamara!

Me: What are the benefits of swaddling?

Tamara: Swaddling has several benefits.
- keeps them warm
- helps them sleep longer
- provides relief from colic and fussiness
- helps baby sleep on his back, which reduces the risk of SIDS
- keeps the startle reflex in check.  babies that sleep on their backs
tend to startle themselves awake.
- it's soothing and reminds them of the closeness, comfort and warmth of
the womb.

Me: When would you swaddle?

Tamara: It all depends on the baby.  Personally, I swaddled my two youngest at the
hospital and for probably their first few days.  I didnt swaddle either of
them much until around the age of 5-6 weeks old when their startle reflexes
really kicked in.  At that point they had to be swaddled to stay asleep for
more than a few minutes at a time.  I would swaddle for naps and nighttime.
I continued to swaddle them for naps and bedtime until they were old
enough that I began to worry they might roll over while swaddled.

I'd also swaddle any time they seemed especially fussy.  A crying baby
with arms flailing can be calmed by wrapping them up and holding them

Me: How do you swaddle?

Tamara: Again, it depends on the baby.  Some are perfectly content wrapped up in a
blanket.  Some are little houdini's that can break out a traditional
swaddle in 2 seconds flat.  The preferred position according to Dr. Harvey
Karp in "Happiest Baby on the Block" is to have their arms at their sides.
If you watch the nurses in the hospital, you'll see them put baby on the
blanket, pull the arm down to the side, wrap that half of the body and tuck
the blanket around the back. Then the pull the next arm down to the side
and wrap the rest of the blanket around the entire body.  This method works
great until baby can get their arm bent and their hand up near their face.
At that point it becomes a wrestling match with the blanket, trying to get
that arm out and that's when the grunting and fussing starts.

Me: How does your product work?

Tamara: My products work by wrapping baby's arms to keep them at their sides.  I
use a knit fabric, which stretches, so their arms aren't completely
immobilized.  They can move their arms, but they aren't able to get that
elbow bent all the way to a 90 degree angle, which would allow them to
break out of the top.  I have three different designs.  One is an accessory
piece makes any ready-made swaddle or just an ordinary receiving blanket a
bust-proof swaddle.  Another is designed so that baby can be safely buckled
into a swing or bouncy seat while swaddled.  It would also work perfectly
with your sleep positioner!  The last one is like a traditional ready-made
swaddle, but it's design makes the leg pouch is impossible to kick out of.