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Re: More is not necessarily better

In the review of plagiocephaly Gill and Walsh say “physiotherapy may help and certainly will not harm”. Really? What evidence do they have for that comment?

There are numerous side effects to supposedly harmless interventions such as this: • Time off work to take the child to physiotherapy. • Cost of getting to appointments and parking at the hospital. • Medicalisation or professionalisation of the child and family. • Creation of a dependency relationship. • Time taken to do the exercises in between appointments. • Guilt and anxiety if the exercises or appointments are missed. • Guilt and anxiety that the child must have a serious problem because he is under a professional. • Perpetuation of the myth that ‘more must be better’. • Desire for future interventions, which may be unnecessary, when the child has other difficulties. . Whilst the physiotherapist is giving treatmetn to this child they are not giving treatmetn to anohter child. • Lastly, physiotherapy was responsible for brain damage of babies on the neonatal unit at the National Women’s Hospital in Auckland several years ago [ref 1].

Neither the authors nor physiotherapists know that there are no side effects from this intervention for plagiocephaly.

Gill and Walsh are falling into the trap of so many professionals in thinking that ‘more must be better’, and that non-invasive treatments have no side effects. Such pointless and unproven treatments go unchallenged because they are below the radar of so many professionals' thinking yet are costing the NHS millions if not billions of pounds.

Dr Charles Essex Consultant Neurodevelopmental Paediatrician