Preventing Plagiocephaly: Flat Head Syndrome

If your child's head isn't alternating his head position enough, it could result in Plagiocephaly or flat head syndrome. What specific signs should you look for to determine if your child is developing this condition? What are some ways to treat it or prevent it from happening in the first place?

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Episode Transcript

Parent Savers
Preventing Plagiocephaly: Flat Head Syndrome

[Theme Music]

Ericka Craft Mizuta : Plagiocephaly, also known as flat head syndrome, is the misshaping of the head due to weight bearing forces on the soft cranium of the infant. This can be caused by pressures in circumstances intrauterine or can occur on conditions that happen after the baby is born. Luckly, there are a number of ways to treat plagiocephaly and also steps parents can take to prevent it. I'm Ericka Craft Mizuta, Physical Therapist, and this is Parent Savers, episode 67.

[Theme Music/Intro]

Johner Riehl : Welcome back everybody once again to Parent Savers, broadcasting from the Birth Education Center of San Diego. Parent Savers is your weekly online on the go support group for parents of newborns, infants and toddlers. I'm your host, Johner Riehl, and thanks again for all of our loyal listeners who joined the Parent Savers Club. Our members get all of our archived episodes, bonus content after each new show, where we do a special conversation with our expert, extending the show. And plus, we also have special giveaways and discounts that we offer to our members. You can subscribe for free to our monthly newsletter, if you're not already a member, and you can get a chance to win a membership to our club each month. Another way for you to stay connected is by downloading our free Parent Savers app, available on the Android and iTunes market place. You can also follow us on Facebook and Twitter and I highly suggest that you do, because we engage in great conversations there and you'll also be one of the first to know when new episodes are posted. You may hear that noise in the background, that is one of our special guests in the studio, we have parents, and we invite them to bring in their kid sometime, 'cause we don't mind because we're all parents and we're all kind of used to the noise in the background, so hopefully you guys don't mind as well. Let's go around and you guys can hear who's in the room and we can put a name and a face – well, not a face – we can put a name to all these sounds that you hear.

Scott Kilian : I'm Scott Kilian, I'm 36 years-old, I'm a certified financial planner, I've got one boy, he is 3, he's name is Alex.

Ericka Craft Mizuta : Hi, I am Dr. Ericka Craft Mizuta, I'm 34 years-old and I own Mizuta and Associates Physical Therapy. I have one daughter who is 21 months old and I'm about to deliver another one.

Johner Riehl : Hopefully not today though, congratulations! When's your due day?

Ericka Craft Mizuta : August 8th, but I'm probably going to do it earlier.

Johner Riehl : So there is a pretty good decent chance that she will be here when this episode airs, we're taping here in July but I think this episode is going to air in August, so congratulations, and who's that that we're hearing over there?

Chrissy Corrao : This is Dorothy. My name is Chrissy Corrao, I'm 35, I'm currently on a break from work, but I worked in education. I'm a single mother by choise to my daughter Dorothy, who is 11 months-old.

Johner Riehl : Hi Dorothy, we're so happy you could join us! And I'm your host, Johner Riehl, I have three boys, 6, 4 and 2, and also in the studio of course is producer Erin.

Erin Esteves : Hi, I'm Erin and I am the official geriatric, I have one boy, and he is going to be 2 in October.

Johner Riehl : Alright, well thanks so much everyone for joining us.

[Theme Music] [Featured Segments: News Headlines]

Johner Riehl : From time to time on this show we like to talk about news headlines, these are funny, entertaining, interesting stories that are in the news, that would be of interest to parents of young kids. And for today's news headlines we're talking about baby sized burritos and how they lead to unusual baby photos. There's a restaurant, this is from curtesy of yahoonews. America's problem with portion size has sparked a strange new photo trend, one in which parents set their new born babies alongside massive burritos on a restaurant table tops, and I got a picture on my phone so you guys can see it, we'll have this picture on the site too. According to Dailymail in UK a mexican restaurant in Seattle, Washington is saying that any diners who take photos of their babies next to one of their restaurant's big burrito grande plates get to eat for free. The child must be less than one month-old and they have to post it on their Facebook page. They have a 9 dollar burrito that they've marketed, it's the size of a newborn, so this is one of their marketing techniques to show that they have a big burrito, but also I guess to attract new customers and parents and publicity.

Erin Esteves : I would've totally done that.

Ericka Craft Mizuta : So would we.

Johner Riehl : I think it touches a lot of interesting things, from the fact that people share pictures of food and their babies, and this is combining them, and portion size. But would do that, Scott?

Scott Kilian : Without a doubt.

Erin Esteves : Would you dress your baby up so he would look like a different kid? Then you can get multiple burritos.

Scott Kilian : I like your thinking.

Johner Riehl : The burrito is indeed massive, it does say that it is literally the size of a newborn, because it weighs about 4 pounds.

Erin Esteves : It sounds amazing!

Johner Riehl : So I guess everyone needs to tweet us or send us Facebook pictures of your baby, and we'll even let you go to a couple of months older than that, next to the plate of food, but hopefully, your babies are bigger than the food.

[Theme Music]

Johner Riehl : Today's topic is plagiocephaly, also known as flat head syndrome, we're talking with Dr. Ericka Craft Mizuta, she's going to tell us about what it is, what can we do about, and even what we can do to prevent it, so thanks for joining us Dr. Mizuta.

Ericka Craft Mizuta : You're welcome.

Johner Riehl : Alright, let's start with the easy question: what is plagiocephaly?

Ericka Craft Mizuta : Basically, plagiocephaly is a misshaping of the head, when the child is born, their head starts to look like a parallelogram when you look at it from the top. And a lot of times there's a interior bulge of the cranium in the front, that's basically what it looks like. And it can be due to torticollis, or other conditions in the utero, basically there's an asymmetric weight barrier on one side of the head that causes it to be misshapen.

Johner Riehl : It doesn't have to be flat, just misshapen?

Ericka Craft Mizuta : Exactly, yeah. It's really flat if it's a severe case, but you can see some cases where it's not completely flat, it's just kind of round, but the head is not symmetrical when you look at it from the back.

Johner Riehl : Does it have to be when the baby is born?

Ericka Craft Mizuta : No.

Johner Riehl : This can happen at any time in the first months?

Ericka Craft Mizuta : A lot of times what happens is that the child will actually be born with torticollis, which is another condition where the baby can move their head on one side, and then when they are put on their back to sleep, that pressure from the torticollis will actually cause the plagiocephaly.

Johner Riehl : Why can't they move their head with torticollis?

Ericka Craft Mizuta : It depends. Torticollis is of several different types, sometimes children are born with a congenital shortening of the ACM, which is a muscle in the front of the neck, that can be seen because there is a mass or a bulge there, it's shortened in utero.

Johner Riehl : Because they're so compacted?

Ericka Craft Mizuta : Exactly. It can be because they're compacted, it can be because there is not amniotic fluid, it can be because of multiple birth causes that obviously cause compaction, but basically that's one of the things that can cause it. There can be another problem with the ACM where it's weak on the opposite side and that's one that shows off more later on, wich is around one or two months old, when the doctor finally notices it, and the baby is not moving the head to the opposite side, so basically they're going to get the plagiocephaly from that.

Johner Riehl : I know we're talking about torticollis off the topic, but they seem pretty related.

Ericka Craft Mizuta : They are related.

Johner Riehl : And so it's so hard to know, because right when babies are born, even a healthy baby doesn't really move their neck too much.

Ericka Craft Mizuta : Correct, and because the doctor's assessment is usually very quick, five minutes or so, a lot of times they won't notice that, it's the parent that notices it later on, because they think, oh, my kid's head is always tilted to the right or tilted to the left.

Johner Riehl : This happens in a baby, and baby's head is soft and such, so they grow and they grow, is this something they grow out of or is it something that it stays with them?

Ericka Craft Mizuta : It depends on the child. If it's not very severe, they can grow out of it. But if it is a more severe form, they won't grow out of it, and they need treatment. So they need physical therapy and sometimes they need a helmet.

Johner Riehl : So the structure of the skull is shapen differently?

Ericka Craft Mizuta : It's because of undue forces on one side of the head, so you have to actually correct the problem that's causing the force outside of the head.

Johner Riehl : But then you have to correct the head?

Ericka Craft Mizuta : Exactly, you have to correct two problems.

Johner Riehl : Got it. So how common is plagiocephaly?

Ericka Craft Mizuta : About 20% of kids have it, it's more common now too because of the back to sleep campaign that happened in the early 90s. With that, they found that putting children on their back to sleep actually prevented SIDS, and we had about a 50% decrease in SIDS, but because of that, if children are not able to move their head or if they have the torticollis, then if they are lain down and sleep 10 to 12 hours a day, or 14 which is what newborns do, it causes the plagiocephaly.

Chrissy Corrao : I think that is kind of where it came from with my daughter, from the time she was two weeks old, she slept really long at night, she slept almost 10 hours every night, so at two weeks old, I would just swirl her up and she would lay her head and face it to the left, every night, and she slept like a log so I wasn't going to do anything about it, I didn't know there was anything wrong with that. And then it was around I think two or four months, four months when I kind of started to notice it, but everybody kept saying that her face is so round, and I'm like, “Really? 'Cause I feel like her head's got a flat on the back”. To me it seemed... I noticed it, but no one else was, so it didn't really seem like it was a problem. And that was when we did her four month checkup. At the time I was seeing two different pediatricians, which seems kind of crazy but in retrospect I'm really glad I did, because I had two people's opinions, one doctor is the one that referred me, because he felt it was mild to moderate, and he felt that she needed a helmet, and the other one didn't even notice it until it was a problem. So I ended up kind of both pursuing and not pursuing it, because I had two very different opinions about whether or not it was a problem.

Ericka Craft Mizuta : That's actually pretty common when you have it, my daughter had the same thing, she slept a lot and she was very big when she was born, so I knew she had torticollis, but if you don't treat it, you'll start to see the back of her head, she had a lot of hair there and once I took that aside she had a bold spot, so you start to see that where they're putting on a weight on there.

Johner Riehl : And then what did you do?

Ericka Craft Mizuta : To treat it?

Johner Riehl : Yeah.

Ericka Craft Mizuta : Same thing I do with all my parents. And the thing too is that there are a lot of other conditions that can lead to problems and can make the torticollis worse. One of my problems with her was breastfeeding, she could only feed on one side, and so I was holding her that way all the time.

Johner Riehl : Was that because of the torticollis?

Ericka Craft Mizuta : No, it's because she'd like that side better.

Johner Riehl : Because she's an independent baby.

Ericka Craft Mizuta : Right, and that was unfortunately the wrong side to be holding her on, because it was actually making the torticollis worse. We do a lot of education with parents on position when they're feeding, position in the car seat, in bed, so if you don't know those things at the time you are doing things like that, you are making it worse, so you have to correct those things. That's what we do in physical therapy as well, we teach them all those tricks.

Johner Riehl : Yeah, we'll talk about that definitely a little bit more at the break, but what are some of the things parents can look for to see if they think they have it?

Ericka Craft Mizuta : Basically what you see first is a lot of times the baby won't turn the head on the other side, even if you are clapping on that side of their head, you want them to turn their head on the left, they just won't do it. But obviously the biggest thing is to look at the shape of your child's head, and look at what they look like in the car seat, because if they're always tilting to one side, or putting the pressure on one side of the head, that's going to cause it.

Johner Riehl : After the break we'll talk a little bit more about Chrissy, what you did when you followed your gut as well as the treatment options that folks have, physical therapy and other devices that can help.

[Theme Music]


Johner Riehl : We're talking about plagiocephaly, or flat head syndrome, with Dr. Ericka Craft Mizuta. So as a physical therapist, how do you help patients and parents with plagiocephaly? Let's talk about some of the specific treatment options and what you do as a physical therapist.

Ericka Craft Mizuta : The biggest thing is to really educate the parents, because obviously the infant is not going to do exercises and a lot of the time are not going to let you just lay them down and stretch their neck. We go through everything that the parent does, look at positioning techniques, how they are holding the baby when they're feeding, how they're sleeping, how they're putting the baby on the kitchen table, what hey look like when they're in the swing, or car seat.

Johner Riehl : Do you go to their house and do that? Or do you have them show you?

Ericka Craft Mizuta : They come into the clinic and show us, and then we go through a whole treatment program that's a lot of positioning that educates the parents so that everything they do basically is going to promote to get rid of that plagiocephaly, or if they have torticollis, also get rid of that at the same time. The other thing we do depends on the ages of the child, if we get one that is four, six months old, obviously there is developmental milestones that they should have met, so we do a whole developmental assessment, and make sure they are meeting the milestones. If they are not , then we show the parents ways, exercises, different activities to do with a child to meet those milestones. Like rolling, sitting, starting to crawl when they're older.

Johner Riehl : I'm just curious, for torticollis does any sort of massage work?

Ericka Craft Mizuta : It can, and it depends on the child, because some children have a lot of tightness in the neck muscle, and it needs to be massaged. Others don't, it's more of a weakness issue, so it depends on what the actual diagnosis is for the torticollis. But yes, if it's tight, then massage will help.

Johner Riehl : One thing I'm learning is that plagiocephaly in itself is almost a symptom. Right? It's not it's own thing.

Ericka Craft Mizuta : Right.

Johner Riehl : It's kind of a symptom that's a result of torticollis.

Ericka Craft Mizuta : Very few children are born with just having a plagiocephaly.

Johner Riehl : But it can happen, but again, it's because something else happens.

Ericka Craft Mizuta : Correct.

Johner Riehl : Chrissy, I want to hear more about your story. Because when you went down the path, you went with some different treatment methods.

Chrissy Corrao : Right, I thought it was really interesting, one pediatrician did send me for referral to a place here in San Diego called Cranial Tech. And you go there and they'll do an assessment, and they take all kinds of pictures of your child, and they'll take different pictures of their head. They can get down to the very last degree of any sort of distortion. Almost every baby looks like there's something wrong with him, so it could really upon your fears, “Oh my gush, my baby's head is totally crooked!” For me, I came away from it and they said it was in the mild category. The therapist there did recommend stretching, and she also recommended a helmet. I looked into having the helmet that they suggested to put on her head, it would have only been for six weeks, but it would have been 23 hours a day, only taking off to bath. And they have told me originally that it would be covered by my insurance, and it wasn't. And they're about 2,000 dollars. That was really a huge barrier for me, because I just thought to myself, “This is insane! Are we going to pay 2,000 dollars for something she's going to wear six weeks?” What I ended up doing was looking into some alternative therapies, and I have seen that a chiropractor might be an option, as well as cranial sacral therapy. I've been seeing a chiropractor throughout my pregnancy, so I brought her in, and he did a few minor adjustments, it's very simple, it's very delicate and very gentle, and I noticed that her neck was a little stiff, and he said that this may be just a packaging issue. I carried her very low, and so she may have been squished a little bit. And for the very first time he had just seen her that day, I put her down for a nap and I turned her head to the right side, she always favored her left, and she left it there. It was immediate that I noticed a difference. I have taken her back maybe two or three times over the time to have her adjusted again, and it's gotten nothing but better. And at the same time she was growing and she was starting to sit up, and roll over, and all those other things, and perhaps unthankfully for me, waking up at the night. So she was no longer sleeping those huge 10 hour stretches like she used to. She was, all of the sudden, a new person, sleeping only for hours in a row. So I think it was a combination of those all things that really helped us even it out.

Johner Riehl : It's interesting, because I know, for me personally, but I think others too, when you hear plagiocephaly you do think that they have to wear a helmet. And that's not the case.

Chrissy Corrao : Right, it's not. I also took a class by a physical therapist, and she tought me some other ways of doing tummy time that didn't result in absolute screaming. Because she didn't really loved tummy time, she was not a superfan of it, so when I did go to the class, I learned just some reminders of other things I could do, sitting her on my knees facing out, or holding her and walking around the room, and wearing her, I was doing anyways, but I didn't really realize that all counts as something.

Johner Riehl : Do you talk about that a lot in your classes, in your therapy at tummy time?

Ericka Craft Mizuta : We do, and the other thing we talk about a lot to is early intervention, because it's been proven that if you get treatment before the age of three months, about 70 to 75% of children will never have to wear a helmet. So you just either intervene early, and then they don't get severe plagiocephaly.

Johner Riehl : So really looking at it early.

Ericka Craft Mizuta : That's the biggest thing I can tell parents, to really just watch your child's habits, because like I said, when you go to a doctor's checkup they don't see the kid very long, it might be five minutes, and it's not abnormal if they had their head to one side for five minutes, but if you notice that hours throughout the day, that is abnormal, so just tell your doctor that and they can give you a referral.

Johner Riehl : But doctors are checking for that at the appointments, right?

Ericka Craft Mizuta : They should be, they should be looking at the head, they should also be assessing the neck, just to make sure that the range and motion is good, that they can flex the head to the other side, they can rotate the head fully to both sides. Even if they don't assess that, just ask them to check your child, if you have a concern, check your child's head and neck, and they can tell you.

Johner Riehl : How does the helmet recommendation come in though when you need to make that decision?

Ericka Craft Mizuta : It depends on age, but it also depends on severity, sometimes you will see a child that's three months-old that has a severely flat head, if you look at it from the side, it's completely flat, they definitely would be helmeted, because that can cause restriction in brain growth, wich can lead to neurological problems and things later on. It depends more on the severity of the actual plagiocephaly.

Chrissy Corrao : One of the things I thought was really interesting, and I've since told other people, that one of the doctors told me when I went to have her measurements taken, that nowadays, because children's heads are differently shaped than they used to be, highschool football helmets have actually changed, the sizing of them has changed, because children's heads, since the back to sleep campaign, are different, they are flatter. So the highschool football helmets need to sort of account for that, which I thought was really interesting.

Johner Riehl : It is fascinating.

Chrissy Corrao : Yeah. I was also going to say that the other reason I chose not to helmet her, and I think this is different for every parent, but because she is a girl, I really never felt that the shape of her head would be exposed over time, I think that maybe if I had a son, I would maybe have made a different choice, because his hair will be short, his had shape would be exposed, people would notice that much more. But as a girl, I have a feeling, I'm thinking, she'll probably always have longer hair or hairstyle that doesn't necessarily expose the shape of her head, like a young boy's would. And so that was another reason, maybe I don't really need to do this this way, I can look for an alternative.

Johner Riehl : I don't know what hairstyles are going to be like in ten or 15 years, but I'm pretty sure that I'm going to hate them. I think I remember my wife saying – she's worked with kids in foster care before - sometimes seeing plagiocephaly would be a red flag for them somehow, but that doesn't mean that parents are doing anything wrong, I mean it's interesting that it's a red flag, have you heard about this?

Ericka Craft Mizuta : Yeah, and we always investigate that, because if you get a child that has a severe flat head but that's also developmentally delayed, sometimes is just because they're not getting the attention that they need and they've been left on their back too much, on a car seat or a carrier, we look for those things, but most times it's not the issue.

Johner Riehl : It's usually not because of parent neglect that they get plagiocephaly.

Ericka Craft Mizuta : No, sometimes it is just the parents not knowing, and it's a cultural thing too, I've noticed in different cultures that I've treated they had different ways of raising their children, and some cultures will carry their baby in a carrier all the time, whereas other cultures tend to leave them more in a car seat or car carrier. Sometimes it's just educating the parents to what they have to do, because they don't really realize that there is an issue.

Johner Riehl : Do you ever watch Breaking Bad? They're always carrying that baby around in a carrier. I bet that baby has plagiocephaly.

Ericka Craft Mizuta : Some of them don't, if they're carried in a carrier, what happens is that they get delayed a lot of the times, because they don't put them down on the floor and let him crawl around.

Johner Riehl : And that's important to tummy time, too. Exploring. Do you have any other tips for tummy time?

Ericka Craft Mizuta : For tummy time I would say to start right away. And the thing that a lot of people I think have a misconception is that they thing they have to put the baby on the floor, or on a bed and that's tummy time, it's not. There are so many different ways you can do it, when you're breastfeeding, if you have your child on your chest, that's considered tummy time. If you have him in a carrier and they're not on their back, that's tummy time. There are different holding techniques, so it's basically anytime they're not on their back, I would consider that more of a tummy time. If your child doesn't like being directly on their stomach, you can use a ball, you can use a breastfeeding pillow, you can use a lot of different thins in order to help out. But it seems like the earlier you start, the more the child will actually tolerate it, so don't wait to long.

Chrissy Corrao : Yeah, one of the things they've told me too is that whenever I sat her down, we set her tummy first. This was when she was really little, now she's all over the place, but just set her tummy first, and if she fusses, then obviously, you can put her on to her back, but it's just a good reminder for you, as a parent, just tummy first, and then if the fuss, you can roll them back onto their back. It was a good reminder. A lot of those things were just reminders.

Ericka Craft Mizuta : The other thing that helps too is that, because babies don't like, especially if they don't move their head very well, they don't want their face to be down on to a bed or an floor, so if you bring their arms up underneath them, so their face isn't totally down, they will tolerate it more easy.

Chrissy Corrao : She showed me that too, kind of keeping her hands in little fists, chucked up under her shoulders, just setting her that way. And shee took to that right away.

Ericka Craft Mizuta : Sometimes we use a position where you can put the baby on a wedge so that their head, if it went down, it wouldn't touch the ground, and that also is good, because it promotes neck range motion as well as strength, they have torticollis because of strength, that's going to correct it.

Johner Riehl : Do most patients come to you from a referral from the doctor, or are there parents who come in on their own?

Ericka Craft Mizuta : Both. We get probably 50% from doctors and the other 50% online. If the patient wants to use their insurance though, on the state of California they have to get a prescription from their doctor. So if they find us online and they don't have a prescription, than they still end up having to go to the doctor to see us.

Johner Riehl : I think that we did cover a lot, it finally crystalized for me that plagiocephaly is a symptom, and not necessarily a thing in itself. So thanks so much Dr. Mizuta, for joining us, thanks also to the panelists, and thanks for listening. For more information about plagiocephaly or torticollis, or more information about any of our panelists, visit the episode page on our website. We're actually going to continue the conversation for members of the Parent Savers Club. After the show, we're going to talk a little bit about craniostenosis, which actually is a disease, not just a symptom, but something that does happen to cause a misshape in head as well. For more information about Parent Savers Club, please visit our website,

[Theme Music] [Featured Segments: Ask the Experts]

Johner Riehl : Here's a comment from one of our listeners on our Facebook page, Jenny from Oregon asks, “About a month ago, my 2 month-old daughter began having nasal congestions, and diarrhea. We were told to put nasal drops in her nose, since there is no medicine for infants that young. It's been about a month and the diarrhea is gone, but the congestion is still a constant thing. She sounds clear sometimes, and wheezy at other times, any advice?”

Tara Zandvliet : Hi Jenny, this is Dr. Tara Zandvliet. She may be reacting to something in her diet. If she's breastfed, that means your diet. And if she's on formula, you can consider switching formulas. It's pretty unusual for infants to have environmental allergies affecting their noses, so it's often food related. You can experiment with eliminating a certain food class, like dairy or wheat, and see if it clears up. And then you add the food back into your diet, and see if the congestion comes back. Consider taking probiotics. After diarrhea, if she had a little bug, they often have a different good bacteria versus bad bacteria in their gut, and so either the baby can take probiotic, baby formula, or you could take probiotics, then the baby would get some in the birth milk and it helps colonize their guts. Another possibility is reflux. Even if she rarely spits up. If she has a little stomach bug causing that diarrhea, it may have caused worse reflux . The reflux can go all the way up into her nose, and cause the congestion, and it can flood the lungs, causing wheezing. Medicines for reflux don't actually change this, so I wouldn't recommend them. Try having her sleep at an angle though, her head up a little higher than her feet. So putting a few books under the leg of the cradle, or under your bed if she is in bed with you. Keep her more upright than horizontal while eating, and then burp her on your shoulder for about 15 minutes after feeding. If she breastfeeds while you're both lying in bed, you'll have to sit up for some of those feeds. Luckly, reflux is improved by 4 to 5 months of age, so there is hope on the horizon. And one last cause is a mirror nostril. If everything else fails and she keeps having congestions, have her see a pediatric ear, nose, throat doctor, to take a look at those nostrils and make sure they are open.

[Theme Music]

Johner Riehl : Well that wraps ups our show for today, we appreciate you listening to Parent Savers, don't forget to check out our sister shows, Preggie Palls for expecting parents and our show the Boob Group for moms who breastfeed their babies. This is Parent Savers, empowering new parents!


This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.


[End Of Audio]

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