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Being a guardian of the interface between illness and disease is a challenging and active process. What do the stories of babies Toby, Tyla, and their 20 or so friends, all of whom have been treated for skull asymmetry, tell us about this?1
According to their parents, they were all born ‘beautiful’ with a lovely rounded head but at the age of a few weeks this became misshapen. The parents consulted health professionals and were reassured that the head shape would get better and was simply related to the baby being put ‘back to sleep’. The evidence of the parents eyes however, was that things were getting worse with time. The treatment for skull asymmetry with orthotic devices, according to the narratives, does produce results. Treatment for what is usually regarded as a selfcorrecting condition is not available on the NHS and parents often go to huge lengths to fund raise.
There is a lack of evidence that helmet moulding for positional skull asymmetry does work and is better than simple positioning measures or doing nothing at all. Equally there is a lack of evidence that helmet moulding does not work.2
There are some important things we should be doing in primary care. There are preventative measures. There are also occasional children where the condition does herald significant pathology; not all skull asymmetry is positional and benign, so a thorough assessment is needed. Perhaps most of all what we need to be doing is offering parents an explanation, including an honest account of the evidence, and of course, taking the parent's concerns seriously.