When a worried parent or public health nurse notices a baby’s head is growing in an odd shape, the Stollery Children’s Hospital’s Pediatric Head Shape Clinic team helps parents take corrective action.
Carolyn Shinbine, a surgery registered nurse (RN), and Wendy Beaudoin, a nurse practitioner (NP) for pediatric neurosurgery, lead a group of RNs, occupational therapists and physiotherapists who manage cases from a flat back of the head to premature fusing of the bones of the skull.
Every Monday, patients visit the clinic for screening. Carolyn triages, examining the babies and identifying surgical cases that Wendy or a neurosurgeon must see.
Most patients have a flattening of the head due to positioning, a matter that can be corrected with crib adjustments and repositioning strategies such as “tummy time” -- placing babies on their abdomen for exercise periods.
“Empowering parents with information helps those babies recover and grow out of the deformity,” Carolyn says.
However, some babies requires surgical correction. When the skull prematurely fuses (craniosynostosis), a surgeon can operate to prevent misshaping. Uncorrected, the condition can worsen as the child grows. In a small number of uncorrected cases, children will develop an increase in the pressure on their brain, leading to severe headaches and visual impairment.
The earlier Wendy identifies surgery candidates, the better.
If the problem is detected in the first three months of life, babies may be candidates for a less invasive procedure called endoscopic synostosis repair. Rather than performing major surgery that requires a peeling back of the scalp, the surgeon can make two incisions about two centimeters each and then use an endoscope and scissors to cut the prematurely fused bone, which is the thickness of cardboard in infants this young.
“Kids younger than 18 months regrow their own bone,” Wendy says. “So, we can take bone out and allow them to refill it on their own.”
Parents anguish over any surgery involving a newborn, but a minimally invasive surgery is far less worrisome.
“Afterwards,” Wendy says, “They often say, ‘If I had known how easy this was going to be, I wouldn’t have spent so many hours lying awake worrying.’”
Families often express deep gratitude after their child has gone through any of the head shape treatments once the head has returned to its naturally-intended shape.
Wendy says, “They’re almost like, ‘Oh, there you are. That’s what you should’ve looked like.’”
Although the screening occurs on Mondays, the clinic can be flexible.
One Northern Alberta couple drove five hours to the Stollery
Children’s Hospital’s emergency department on a different day of the
week. Carolyn was working in another clinic when the emergency
department called her about the couple. The staff had discharged the
baby, and the parents started home, hoping to get an appointment on
another day. Carolyn phoned them and told them to return, saving them
another 10-hour round-trip.
She and Wendy examined the child that day, and she then paged the neurosurgeons. They arranged for corrective surgery within days.
“Always at the forefront for me is: What is in the best interest of that child, and what is in the best interest for that family?” Carolyn says.
The two nurses are bound by mutual respect.
“Wendy provides her contact information to parents so they can reach her with questions and for reassurance. She is such a kind and empathetic nurse, and her patients always smile when they see her or run up and hug her,” Carolyn says.
Wendy praises Carolyn’s professionalism and skill in “educating both
patients and other health care professionals about the importance of
early intervention in head shape-related issues.”