Cranial remolding helmets are specialized orthotic devices prescribed for infants with skull flattening after birth. These custom-fitted devices gently redirect the natural growth of a baby’s head toward a more typical, rounded shape. The helmets work by providing constant, mild pressure on the more prominent areas of the skull while leaving space for flattened areas to expand as the brain grows. This non-invasive treatment is reserved for moderate to severe head shape deformities when repositioning efforts have failed.
Understanding Positional Head Shape Deformities
The medical terms for a flattened head shape are positional plagiocephaly and brachycephaly, both falling under deformational flat head syndrome. These conditions occur because an infant’s soft, malleable skull bones are susceptible to external pressures in the first few months of life. Positional plagiocephaly describes an asymmetrical flattening on one side of the back of the head, which can cause the ear on that side to shift forward and may lead to facial asymmetry.
Brachycephaly involves a symmetrical flattening across the entire back of the head, causing the head to look disproportionately wide and sometimes resulting in a high, sloping forehead. The most common cause for both conditions is placing babies on their backs to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS). Other contributing factors include Torticollis, a tight neck muscle condition causing a head position preference, or excessive time spent in car seats and swings where the head rests against a flat surface.
Criteria and Optimal Timing for Helmet Therapy
A helmet is recommended only when conservative repositioning efforts have failed and the deformity is classified as moderate to severe. The severity of the head shape is determined by precise measurements taken by a specialist, often using a three-dimensional scanner. For asymmetrical flattening, the Cranial Vault Asymmetry Index (CVAI) is used; a measurement greater than 6% to 10% often indicates a need for intervention.
The timing of helmet therapy is a factor in achieving the best outcome because correction relies on the infant’s rapid head growth. The optimal window for starting treatment is generally between four and six months of age. This period coincides with the most significant phase of head growth, allowing for a shorter treatment duration and better results.
Treatment can still be effective for infants up to 18 months, but head growth slows significantly after about six to eight months. Starting therapy later means less growth while wearing the helmet, resulting in a diminished degree of correction and a longer time in the device. If a moderate to severe deformity persists beyond four months despite repositioning, an evaluation for a helmet is recommended to utilize the most responsive growth period.
The Mechanics and Duration of Cranial Remolding
The cranial remolding orthosis is a custom-made plastic shell, often lined with foam, that acts as a mold for the baby’s skull. The mechanism is passive; it does not squeeze the head but holds the existing, more rounded areas firm. The helmet leaves strategically placed open spaces over the flattened regions, guiding new growth into these voids.
To be effective, the helmet must be worn consistently for nearly the entire day, typically 23 hours daily. Short breaks are only for bathing, cleaning the helmet, and skin checks to ensure no irritation. The typical duration of treatment ranges from three to six months, depending on the infant’s age, initial severity, and consistency of wear.
Regular follow-up appointments with the orthotist are necessary, usually every two to four weeks, to monitor progress and make adjustments. As the baby’s head grows and reshapes, the orthotist removes material from the helmet’s interior to maintain the gentle redirection of growth. This process ensures the helmet continues to fit properly and guides the skull toward a corrected shape throughout treatment.
Repositioning Techniques and Prevention
For mild flattening or prevention, repositioning techniques are the first line of defense. These methods aim to relieve pressure on the flattened spot by encouraging the baby to rest their head in a different orientation. A simple strategy is increasing supervised “Tummy Time” during waking hours, which keeps the back of the head free from pressure and helps develop neck and upper body muscles.
Parents can alternate the direction the baby is placed in the crib at night, encouraging the infant to turn their head toward the room’s activity or light source. During feeding and carrying, switching the side the baby is held on helps distribute pressure evenly across the skull. Reducing the time the baby spends in static, reclined devices like car seats, swings, and bouncy seats is also recommended.
If a positional preference is caused by Torticollis, physical therapy is initiated early to stretch the tightened neck muscles. Addressing this underlying muscle imbalance helps the baby comfortably turn their head in both directions, allowing the flattened area to heal naturally. These conservative strategies are often successful if started early, typically before four months of age, and should be attempted before considering helmet therapy.