Dr Costa Clara, Head of the pediatric Neurosurgery

Sant Joan de Deu Hospital, Barcelona.

To infocefalia

Dear Mr Verde,

As you know, over the past ten years we have witnessed an alarming increase in the positional skull deformities in pediatric neurosurgery consultation. The lack of support from the Catalan health institute to tackle this problem has led to long patient's waiting lists (up to several months of waiting) and saturation of our medical staffs and resources in order to attend to all these patients according to the established protocol. Treatments to the urgent cases such as craniosynostosis are inevitably delayed as we review positional plagiocephaly cases which are less serious.

Prevention of cranial deformities can be easily done by following preventative guideline. We estimated that about 10% of the babies have some degree of deformity but this is ignored once the hair grows, although in many of the cases this deformity does not really resolve.

The babies' head shape should be systematically monitored and measured in the first 6 months of life in the same way as the current weight, height and head circumference check. In this way a quick and effective action can be taken directly by the pediatricians and the problem can be corrected easily and quickly.

After using your Craneometer for several months, I have confirmed that the proper measurement obtained is as good as the 3 dimensional scanner that we have in our hospital. I believe that this Craneometer would be very useful for pediatricians to take head measurement of all the babies between 0 to 6 months of age in order to detect and quantify the positional deformities early. These deformities can be treated easily by the primary care pediatricians with repositioning and the pillow that you promote and hence avoid the helmet therapy that is unnecessary in majority of the cases.

I wish you luck in your prevention campaign and hope all the pediatricians get involved in this prevention campaign and we can solve this problem together.

Dr Jose M. Costa Clara

Dra Ochotorena, Peadiatric plastic Surgeon and Craniofacial

San Rafael Hospital, Madrid.

Dear Mr. Verde:

Over the past 15 years we have seen an increase in positional craniofacial deformities.

In general, the more severe cases were operated to restore the symmetry.

Approximately 13 years ago I began treatment with helmets to avoid the surgery, having resolved hundreds of cases.

When the child comes to my office the asymmetry has already established.

It is very simple to avoid this asymmetry with a prevention guideline, especially if the issue is addressed in the early months of life.

I think it is perfect to continue the campaign on the prevention in pediatric offices in order to avoid the use of helmet when the asymmetry has already manifested.

I hope that the need for helmets will diminish and the only solution is through prevention.

Best regards,

Dra Ma Jesus Ochotorena Guindo