Babies undergoing treatment for head shape irregularities often wear specialized helmets, known medically as a cranial orthosis. This prescribed medical device is not a standard item for general infant sleep. The helmet is worn most of the day and night to gently correct the shape of a baby’s skull. Consistent use, including while sleeping, is necessary to effectively guide the infant’s rapid head growth.
Understanding Flat Head Syndrome
Flat head syndrome encompasses deformational plagiocephaly and brachycephaly. Positional plagiocephaly involves asymmetric flattening on one side of the back of the head, sometimes causing slight ear misalignment or a forward appearance of the forehead. Brachycephaly describes a central, symmetrical flattening across the back of the skull, often resulting in a wider head shape. Both conditions are considered cosmetic and do not affect brain development, though they can cause noticeable facial and head asymmetry.
These head shape changes are acquired after birth because a baby’s skull bones are soft and malleable during the first few months of life. The primary cause is prolonged pressure on the same area of the head from infants spending extended periods lying on their backs. The incidence of these positional flattenings increased after the recommendation to place babies on their backs to reduce the risk of SIDS. Other contributing factors include a preference for turning the head due to tight neck muscles (torticollis), or extended time spent in devices like car seats and swings.
Cranial Orthosis Therapy
A cranial orthosis is a custom-made helmet designed to reshape the infant’s skull by redirecting natural growth. This therapy is considered for moderate to severe cases of head flattening that have not improved with repositioning and physical therapy. The helmet is fabricated after a detailed three-dimensional scan of the baby’s head to ensure a precise fit. The device works by applying gentle, sustained holding pressure to the prominent or rounded areas of the skull.
The orthosis simultaneously leaves space over the flattened regions, allowing the rapidly growing brain to push the skull outward into the open area. This mechanism guides the growth toward a more symmetrical shape rather than applying active force to compress the skull. The optimal age for beginning treatment is typically between four and six months, when the baby’s skull is still growing quickly and is responsive to molding. Treatment commonly lasts between three and six months, varying based on the condition’s severity and the infant’s age.
Safe Sleep Protocols While Using a Helmet
Cranial orthosis therapy relies on maximum wear time, so the device is prescribed for approximately 23 hours per day, including all sleep periods. Standard safe sleep guidelines remain paramount: the baby must always be placed on their back for sleep on a firm mattress free of loose bedding. The helmet must be removed daily for a few hours to perform thorough skin checks for excessive redness or irritation. Regular cleaning is required to prevent odor and maintain hygiene.
The helmet can affect the baby’s ability to regulate temperature, requiring careful management to prevent overheating. Since the orthosis increases heat around the head, parents should dress the baby lightly in breathable clothing and ensure the sleep environment remains cool. The ideal room temperature is between 68 and 72 degrees Fahrenheit. If a baby can roll from back to stomach while wearing the helmet, it is safe to allow them to remain in that position, but they must always be placed to sleep initially on their back.
Repositioning and Prevention Strategies
In mild cases, or before orthosis treatment is considered, parents should implement active repositioning strategies to alleviate pressure on the flat spot. The most effective preventative measure is “Tummy Time,” which involves placing the baby on their stomach while awake and supervised. This activity removes pressure from the back of the head and strengthens the neck, shoulder, and upper body muscles necessary for milestones like rolling and crawling. Tummy Time should begin shortly after birth and gradually increase to 15 to 30 minutes daily by about seven weeks of age, broken up into short, frequent sessions.
Parents can employ supervised repositioning by intentionally alternating the direction the baby faces in the crib each night. Since babies naturally turn their head toward visual stimulation, switching the crib’s orientation encourages turning both left and right. Reducing the time the baby spends in static positions, such as in car seats, swings, or bouncers when not traveling, is another strategy to decrease pressure on the skull. Varying how the baby is held and carried, including switching arms during feeding, promotes balanced head movement and prevents a positional preference from developing.