Cranial orthosis, commonly known as helmet therapy, is a non-invasive medical treatment used to gently reshape the heads of infants. These custom-fitted devices are prescribed for conditions grouped under the term “flat head syndrome.” The two most common forms are deformational plagiocephaly (a flat spot on one side of the back of the head) and deformational brachycephaly (symmetrical flattening across the entire back of the skull). This therapy works by applying mild pressure to prominent areas while allowing growth in the flattened regions. It is a time-sensitive intervention that capitalizes on a baby’s rapid head growth to achieve correction.
Understanding Positional Head Flattening
Positional head flattening occurs because an infant’s skull bones are soft and pliable in the first months of life. The condition is primarily caused by prolonged external pressure on one area of the head, often due to the recommended practice of placing infants on their backs to sleep. Other causes include restrictive intrauterine positioning or congenital muscular torticollis, where tight neck muscles cause a head-turning preference.
Positional flattening is distinct from craniosynostosis, a much rarer condition where the skull plates prematurely fuse together. In positional flattening, the skull sutures remain open, meaning the condition does not affect brain growth or development. Craniosynostosis restricts brain growth and typically requires surgical intervention, sometimes followed by a helmet. A typical sign of positional plagiocephaly is the presence of an ear displaced forward on the flattened side.
Initial Steps Before Orthotic Treatment
Upon noticing a flat spot, parents should first implement conservative management strategies, often before the baby reaches four to six months of age. A primary intervention is repositioning, which involves actively alternating the baby’s head position while they are placed on their back to sleep.
Increased supervised tummy time while the baby is awake is also a fundamental strategy, as it relieves pressure from the back of the head. If the head flattening is associated with torticollis, physical therapy is highly recommended to stretch and strengthen the neck muscles. Conservative treatments like repositioning and physical therapy are effective in a large percentage of infants, sometimes preventing the need for a helmet entirely.
When a Helmet Becomes Necessary
A corrective helmet becomes the recommended treatment when conservative efforts fail or when the degree of flattening is moderate to severe. Intervention is based on specific measurement indices, such as a Cranial Vault Asymmetry Index (CVAI) of 11% or greater, or an asymmetry of 12 millimeters or more. These measurements are obtained through a non-contact 3D scan of the infant’s head by an orthotic specialist.
The timing of treatment is crucial because it aligns with the period of an infant’s most rapid head growth, when the skull bones are most pliable. The optimal age window to begin helmet therapy is between four and six months of life, as starting earlier results in a shorter duration and a better outcome. Delaying treatment significantly reduces its effectiveness, as the skull’s malleability decreases substantially after nine months, and treatment is rarely successful after 12 to 18 months of age.
What to Expect During Helmet Therapy
The process begins with a referral to a certified orthotist who uses a 3D scanner to create a precise, customized mold of the baby’s skull. The helmet is a lightweight, rigid outer shell designed to apply gentle pressure to the prominent areas. This redirects the natural growth of the head into the flattened areas left open within the device.
The standard wear schedule requires the baby to wear the helmet for approximately 23 hours per day, removing it only for bathing and cleaning. Treatment duration is variable, lasting between two to six months, depending on the infant’s age, severity of flattening, and consistency of use. Frequent follow-up appointments, often every two to four weeks, are necessary for the orthotist to monitor head growth, track progress, and make adjustments to ensure continued correction.