Aggressive Repositioning is so much more than just keeping your baby off of the “flat area.” Effective aggressive repositioning takes advantage of combining 4 different strategies to help reshape your baby’s head: No Pressure, Reduced Pressure, Static Pressure, and Gravity. Here are some explanations, pros and cons, tips, and products to help you with customizing an aggressive repositioning program for your baby.

NO PRESSURE – NOTHING COMES IN CONTACT WITH THE BABY’S HEAD

Pros: Easily understood strategy Cons: Difficult to implement 24 hours a day

This strategy allows the entire head shape to grow outward all over, in addition to just the flattened area, so there is a risk of continued expansion of bulging, wide, or tall areas of the head instead of just correction of the flattened area.

Ideas to help:

Bouncy seat repo – if you must use this device occasionally, try cutting a rectangular piece of foam from a foam bath support and placing it behind your baby’s neck area. This tip can help suspend the back of the baby’s head above the seatback of the bouncy.

Nighttime repo – with ped’s approval, try cutting a square of foam, then cutting out a smaller square inside it, creating a square-shaped ring. This headrest will support baby’s head, but suspend the baby’s head up off of the mattress.

Products to help:

A Finer Thing Custom slings CARRY your baby rather than using your carrier/car seat while shopping, visiting, etc http://www.afinerthing.com.

Baby Bjorn Baby Carrier The Baby Bjorn Baby Carrier provides strong support for your baby's neck and back. As your baby gets older and his neck is strong enough to support his head, he can be carried facing outward. The head supports can then be folded down giving the baby a birds-eye-view of his surroundings. http://www.babybjorn.com

Babytrekker Baby Carrier Comfortable and easy baby carrier http://www.babytrekker.com

First Journey Baby Carrier The First Journey is the most comfortable and versatile baby carrier you'll ever wear, with five wearing positions, and padded shoulder straps and waistband. Baby can face in or out, front or back, and nurse as well. http://www.first-journey.com/page1pics/page1.html

The Hiphugger Baby Sling By helping distribute your child's weight across your torso, you can hold him longer and more comfortably. And with our patent-pending design, you can adjust the HipHugger to exactly fit your body and your child's size. It works for right- and left-handed parents, large or small. From when the child can sit upright without help (about six months) to 35 pounds. http://shop.store.yahoo.com/thehiphuggeronline/

Dex Comfy Strap Compact and convenient. Comfy Strap is easy to use and fits in your purse or diaper bag. It’s fully adjustable, so you can secure your child in shopping carts and chairs of many different sizes. Appears on "Slide 11" of the Products section of the Dex website. http://www.dexproducts.com/Pages/frame.htm

ExerSaucer Classic® Activity Center Rock, spin and bounce fun for babies four months to walking age. http://www.evenflo.com/pr/ac/prac_classic.phtml

ExerSaucer® Mega Active Learning Center™ by Evenflo A wide surrounding tray is landscaped to bring toys closer to baby and has a flat area for snacks. Baby gets plenty of exercise with bounce, rock and swivel/spin actions. Four months to walking age; maximum height 30." http://www.evenflo.com/pr/ac/prac_mega.phtml

Fisher-Price Deluxe Jumperoo Give your little jumping bean a safe and fun place to exercise his/her strong legs with this Fisher-Price Deluxe Jumperoo. Part doorway jumper, part play saucer, it features a wraparound suspended seat with a colorful, interactive play tray. http://www.target.com/gp/detail.html/601-2497913-9534501?asin=B0000A9XYV&reviewID=B0000A9XYV25001072153058&start%5Fcounter=0&sortOption=%2Bdate&Useful=no

The Bumbo Baby Sitter The Bumbo Baby Sitter is a revolutionary new concept with world wide patent rights, uniquely designed according to the baby’s posture to seat babies independently in an upright sitting position, from as young as six weeks, or as soon as they can support their own heads unaided, up to an age of approximately fourteen months. http://www.bumbobabyseat.com/

Boppy Tummy Play The smaller sized Boppy® shape makes it easy for babies to push up on their arms. The attached mat protects babies belly from hard or rough surfaces. http://www.boppy.com/playtime.asp?sts=5%2F20%2F2004+8%3A16%3A41+AM&mscssid=530VNELHT8638GKFK5HT6STRNEUR0N29

1-2-3 Discovery Lane Playmat by Tiny Love When configured into Stage 1, the Discovery Lane is circle shaped for babies 3 to 6 months, they play contentedly on their tummies. http://store.yahoo.com/dreamtimebaby/123dislanpla.html

1-2-3 Musical Mirror Tummy-Time Has Never Been So Much Fun. This unique specially designed musical mirror adapts to baby’s developmental stages. Baby won’t be able to resist trying to look at herself in the large colorful mirror, which will encourage her to lift her head -- an important developmental milestone. http://www.tinylove.com/pages/catalog.asp?PageID=273&prodID=84

2 in 1 Tummy Time Gym Traditional overhead gym easily converts to a toy babies can play with while on their tummies! http://www.hasbro.com/pl/page.viewproduct/product_id.13027/dn/playskool/default.cfm

Busy Boa Activity Playmat - Manhattan Toy This baby activity playmat has a detachable soft snake (90") that unzips from the mat. Activities on the mat include a mirror, hidden noise makers and a variety of textured, colored fabrics. http://www.geniusbabies.com/busboaplayne.html

Carter's Imagination Prop Up Play Mat Encompassing a jungle theme your little one will be entertained by all the fun animals including a giraffe, zebra and and lion. Each mat includes a removable pillow, five Fun Links, ring rattle, chewy tether and a plush lion that rattles. Packaged in a vinyl bag making it easy to store away. http://www.geniusbabies.com/caimprupplma.html

First Years Tummy Fun Farm Activity Blanket This Tummy-Time Play Set will encourage baby to enjoy tummy-time with fun activities and colorful characters. Open the barn door to see your favorite baby in the mirror, let baby chew on the teething discs or play with the farmer and his horse. A padded bolster is included for baby to lean on so tummy-time will be comfy too. http://www.babygenie.com/product_details.asp?pid=3925

Furniture-4kids Infant Activity Mats These 57" square, vinyl-covered 1" thick foam activity and crawly pads are designed for resting, nesting, bonding, or group activities. http://www.furniture-4kids.com/sofplayacmat.html

Hold-Me-Tite Adjustable No-Slip Tummy PlaySystem The Hold-Me-Tite tummy playtime system safely and effectively addresses the issue of enjoyable tummy time. http://www.tummyplaytime.com

I.Q. Baby Discovery Circle The two-sided, reversible play mat has over 15 activities that challenge and entertain children. Items include crinkles, rattles, squeaks, peek-a-boo pockets, fun textures, mirror and more. http://www.babygenie.com/product_details.asp?pid=953

Infantino Aqua Fun Water Filled Playmat Colorful fish swim around inside as baby pushes on mat. http://www.babygenie.com/product_details.asp?pid=9119

Musical Mirror Prop-Up Playmat Tummy time is more rewarding when your baby can wriggle around on this monkey, giraffe, and alligator playmat, prop up on the contoured pillow, and peer into the plump, squishy mirror. One jiggle of the mirror sets off stimulating music and an engaging flashing light display. http://store.babycenter.com/product/toys/by_type/arches_and_gyms/4997

Take-Along Hop 'n Pop by Fisher Price The Fisher-Price Take-Along Hop 'n Pop rewards Baby's bouncing with fun popping action, music, sound and lights. And 7 colorful toys surround Baby and provide tactile and auditory stimulation. Hop 'n Pop bouncer folds easily to go anywhere and features 5 songs, a volume control, a soft floor pad and 3-height adjustable seat. Maximum weight: 25 lbs. http://www.target.com/gp/detail.html/601-7660436-2495335?asin=B0000A9XYU

Tummi Time Cushion The Tummi Time Cushion enables baby to spend quality time on their tummy in a safe, hygienic and comfortable way which is beneficial for hand/eye coordination, strengthening back, neck and arm muscles, and motor skills required for crawling and walking. Available from Australia. http://www.tummitime.com/tt_frameset.html

Tummy Time Picture Show A musical light-up toy made especially for babies to enjoy while on their tummies! Moving light-up pictures and happy music encourage baby to lift head. http://www.babyzone.com/features/content/display.asp?ContentID=849

Wee Exercise Roll Scroll down the page of the Wee Exercise Store to see the 5" X 5" X 20" firm pillow roll. Ready, set, crawl! Wee build upper body strength and get lots of tummy time with the Wee Exercise roll. Baby learns to shift his body weight and develops hand strength, too. http://www.weeexercise.com/goshopping.htm

REDUCED PRESSURE – SOFTENED CONTACT WITH THE BABY’S FLATTENED AREA

Pros: Easily understood strategy

Easy option for nighttime repo

Potential to reduce regression of repo progress

Allows such devices as swings and bouncy seats to be incorporated into a repo program

Allows intermittent positioning of the baby on his/her back

Cons: Any continued pressure, however slight, has the potential to hinder rounding out of the flattened area

Not as effective in encouraging rounding of the flattened area as the rest of the strategies

Ideas to help:

Bouncy seat repo – if you must use this device occasionally, try placing a Boppy Noggin Nest or a square of memory foam behind the baby’s head to reduce pressure from the chair back

Swing repo – a notoriously bad device for repo since the baby’s positioning as well as the centrifugal force pulling the baby’s head into the seatback; if you must use this device, try placing a Boppy Noggin Nest or a square of memory foam behind the bay’s head to reduce pressure.

Daytime repo – incidental positioning of the baby on his/her back may be necessary for diaper changes or other activity. Keep a square of memory foam handy to place under the baby’s head whenever you need baby on his/her back!

Nighttime repo – Try a sleep positioner with memory foam under the head area, or make one of your own by ordering custom-sized memory foam.

Products to help:

Amby Baby Motion Bed The Amby Baby Motion Hammock is helping babies across America and around the world enjoy a peaceful night's rest. While many babies sleep safely and soundly cuddled up with mom and dad in bed or sleeping in a crib, some babies have special nighttime needs that require a more creative approach. The Amby meets these needs. In the early months, babies are prone to developing a flat area in the back of the head due to the disproportionate weight of baby’s head on a flat surface. Because the Amby allows baby to sleep in a slightly upright position, much of the baby’s head weight is more evenly distributed to the rest of the body. The short answer to this is YES, the hammock will go a long way in addressing this problem. http://www.ambybaby.com

Boppy Noggin Nest The Boppy Noggin Nest by Camp Kazoo is a soft head support that reduces pressure on the back of a baby's head and keeps it from getting flat. The nest can be strapped into a stroller, car seat, bouncer or swing. http://www.boppy.com/newproduct.asp?sts=5%2F20%2F2004+8%3A15%3A28+AM&mscssid=Q8ELKQRL9W3U8M1QNB0VQLLPWXPK3BR0

Dex Secure Sleeper Sleep Positioner A sleep positioner designed to cradle a baby on its back as recommended by the American Academy of Pediatrics and the Surgeon General. The head support is made of Visco-Elastic material specifically designed to prevent Flat Head Syndrome. Appears on "Slide 2" of the Products section of the Dex website. http://www.dexproducts.com/Pages/frame.htm

Dex Secure Sleeper Ultra 3 in 1 Sleep Positioner A 3 in 1 sleep positioner. 1. Designed to position baby on back as recommended by the American Academy of Pediatrics and the Surgeon General. 2. Elevates the head & chest to help prevent Acid Reflux and 3. The head support is made of Visco-Elastic material specifically designed to prevent Flat Head Syndrome. Appears on "Slide 2" of the Products section of the Dex website. http://www.dexproducts.com/Pages/frame.htm

Foam Products for the Home Foam products for the home, including memory foam, which could also be used for repositioning. http://www.foamorder.com/

Head & Body Support System™by DEX products in the UK Available in the UK from KITSILANO LTD, the Head & Body Support System™ is a head supporter and sleep positioner designed to prevent Flat Head Syndrome (Plagiocephaly) and position baby as recommended by the U.S. Surgeon General and the American Academy of Paediatrics. http://www.kitsilano.co.uk/

OccBlock Infant Mattress Innovative Mattress for Safe Infant Sleep. Pillow shaped to spread pressure on Occiput and Parietal bones to assist in reducing head flattening (Occipital Plagiocephaly). Available from New Zealand. http://www.kiddy-worth.co.nz/occblock.htm

Safety Ride "N" Rest The Safety Ride "N" Rest is a “one of a kind” patented, cushy, head support designed to attach to infant and children’s car seats. This "Mom Invented" pillow eases the strain on baby’s delicate neck muscles and supports them comfortably while they sleep. http://shop.store.yahoo.com/shopsourceone/colinsafridn.html

Snuglbuds Butterfly Pillow Use the Butterfly to position an infant for feeding, bathing or playing. Cradles and supports the head and upper body. http://www.snuglbuds.com/butterfly.htm

STATIC PRESSURE – INTENTIONALLY CHOOSING A POINT OF CONTACT ON THE BABY’S HEAD TO ENCOURAGE REDIRECTING OF GROWTH TO THE FLATTENED AREA Pros: Most effective strategy of all the strategies

Mimics the philosophy of helmeting/banding, in that part of the head shape is held, and growth is redirected to the flattened area

Cons: Labor intensive – required accumulative time spent using this strategy to yield results

More complex strategy to understand and implement

Repo can only provide one point of static pressure at a time, unlike the 3D capability of helmets/bands

Must use caution and rotate points of contact to ensure that this strategy doesn’t cause flattening on the non-flat side of the baby’s head.

Must use caution and prevent head height increases by using this strategy only occasionally in bouncy seats, swings, car seats, high chairs, strollers, etc.

Ideas to help:

Think of the top of your baby’s head as a clock face with his/her nose at 12 o-clock – is your baby’s flattened area at the 4,5, and 6 o’clock positions? Then try rotating your points of contact with surfaces at the 7,8, and 9 o’clock positions.

Bottle Feeding – position your baby so that the target point of contact rests on your breastbone or arm

Napping – if you are open to your baby napping while in your arms, position your baby so that the target point of contact rests on your breastbone or arm

Cuddling – at every opportunity, place your baby’s head so that your target point of contact touches your breastbone, arm or body in general.

Stroller – place a rolled up washcloth or wedge to one side of your baby’s head to prop it off of the flat area.

High Chair – turn the high chair to one side, so that your baby has to turn his/her head to see you, thus the target point of contact and not the flattened area makes contact with the seat back

Car Seat – place all object of interest (toys, portable DVD player, brother/sister, etc.) to one side of the car seat, encouraging your baby to turn his/her head to one side, so that the target point of contact touches the seatback of the car seat.

Bouncy Seat – if you have to use this device intermittently, use a rolled up towel to prop your baby’s head over. There is a special watch out with repo’ing in this device, in that there is a risk of increasing head height on the non-flat side, so repo with caution!

Nighttime repo – with ped’s approval, place your baby’s head in such a way that the target point of contact touches the mattress or sleep positioner surface under the head. Get creative by sewing a bag of rice or very small pillow to one side of the back of your baby’s sleeper to tip the baby up off of the flattened area

Products to help:

AngelCare Movement Sensor with Sound Monitor Stop worrying while your baby sleeps! The under-the-mattress Sensor Pad detects your baby's slightest movements, and the Nursery Unit receives the signal and sounds a "no-movement" alarm that is picked up by the portable Parents Unit. If absolutely no movement is detected for 20 seconds, the alarm will sound. http://www.bebewing.com/saftey-monitors.shtml

Baby Shop Baby Neck Support Baby neck support while in carseat, stroller, or bouncy seat from Ireland's Online Baby Shop. http://www.babyshop.ie/asp/product.asp?product=162

Childrens Medical Ventures - Repositioning Aids This page has a number of interesting looking repositioning aids. They are geared towards preemies and babies who are in NICU, but they look like they could be good for plagio prevention. http://www.childmed.com/search/product_searchresults.cfm?keywords=&selTarget=1&x=7&y=8

Foam Products for the Home Foam products for the home, including memory foam, which could also be used for repositioning. http://www.foamorder.com/

Full of Fun Newborn Neck Support - Duck Allows child to sleep in comfort in carseat or stroller. Available at Babies R Us in the U.K. http://www.toysrus.co.uk/Product.aspx/bruorfindusing/bruazofbrands/bruexclusivesfulloffun/087890

Kindershop Infant Neck Support This adorable neck support helps your infant's head stay in place and lets them sleep restfully away from home. European toys and products. http://www.kindershop.com/0-9/0-9%20list%20frame.htm

New Visions Crescent Neck Pillow Use the Crescent Neck Pillow to provide added neck support for infants. The positioning products that this company uses for feeding and swallowing therapy can also be used for infant head repositioning. http://www.new-vis.com/cat/p-pos.htm

One-Stop Baby Neck Napper Rests lightly on the baby's chest to give adequate neck support. A must have for traveling in the car or for the infant swing. http://www.onestopbaby.com/naturalnurse5.asp

Safe T Sleep™ Sleepwrap® Safe T Sleep™ - It's an ingeniously designed wrap which keeps your baby sleeping in a comfortable and safe position. A New Zealand product. http://www.safetsleep.com

Sassy Infant Sleep Positioning Wedge & Support Provides firm support, while allowing you to alternate your baby's head position, as recommended by American Academy of Pediatrics to help reduce the risk of "Flat Head Syndrome. The head position wedge can be alternated from left facing to right facing. http://www.greatbabyproducts.com/sassysleepbackrightbaby.htm

XCam2 Wireless Video Camera Monitor your baby's head position in the crib from your living room or computer desk. This wireless camera system delivers live color video to your TV or PC. http://www.x10.com/products/x10_vk45ac.htm

GRAVITY – KNOWING THAT THE HEAD WILL GROW IN THE PATH OF LEAST RESISTANCE – IN OTHER WORDS, GROW IN THE DIRECTION OF GRAVITY Pros: No props required

Helpful with nighttime repo

Cons: More complex strategy to understand and implement

Slow to yield results

Ideas to help:

Nighttime repo – with your ped’s approval, place your baby to sleep on his/her side with his/her ear directly onto the mattress, so that the flattened area is nearest the mattress. Ensure that the flattened area in no way makes contact with the mattress. This way, the flattened area is not making contact with the mattress, but is oriented downward. Gravity makes it easier for the head to grow downward in the direction of the flattened area in an effort to round it out, then upward on the other side of the head.