Flat head syndrome, medically known as positional plagiocephaly or brachycephaly, is a common condition where an infant’s head flattens. This occurs due to consistent external pressure on the soft, developing skull. While often a cosmetic concern, helmet therapy is a recognized method for correcting the head shape in some cases.
Understanding Positional Head Flattening
Babies’ skulls are soft and pliable, susceptible to shape changes from prolonged pressure. A primary cause of head flattening is the back-sleeping position, recommended to reduce the risk of Sudden Infant Death Syndrome (SIDS). Spending extensive time in car seats, carriers, swings, and bouncy seats can also contribute to this pressure.
Other factors influencing head flattening include limited head movement, often due to torticollis, a neck muscle condition. Premature babies are more prone to developing flat spots because their skulls are softer and they spend more time lying down. Head flattening can even begin before birth from pressure in the womb, such as in multiple pregnancies.
Positional plagiocephaly involves flattening on one side of the back of the head, making it asymmetrical, sometimes with a forward-pushed ear. Brachycephaly refers to an overall flattening across the back of the head, which can cause the head to widen.
Identifying the Need for Helmet Therapy
Helmet therapy is considered when repositioning efforts do not adequately improve head shape. It is most effective when initiated between 4 and 8 months of age, during rapid skull growth. Starting treatment earlier in this window can lead to better results and potentially shorter treatment times.
Parents may notice signs like a visibly flattened area on one side or the back of the head, less hair in that spot, or an ear that appears misaligned. A pediatrician or specialist assesses flattening severity using measurements like diagonal calipers or 3D scans. The severity of asymmetry helps determine if a helmet is recommended, particularly for moderate to severe cases.
The Helmet Therapy Process
A cranial orthosis, commonly known as a helmet, is a custom-made device designed to gently guide the baby’s skull growth. It works by applying gentle pressure to prominent areas of the head while allowing space for the flattened areas to grow and round out. This redirects the natural growth of the skull.
Once recommended, a 3D scan of the baby’s head is taken to create a custom-fitted helmet. Babies wear the helmet for 23 hours a day, removing it only for bathing and cleaning. The total duration of treatment varies but ranges from three to six months, depending on the baby’s age and the severity of the condition. Regular follow-up appointments, every two weeks, are necessary for adjustments to accommodate the baby’s growth and ensure effective reshaping.
Prevention and Early Interventions
Proactive measures and early interventions can help in preventing or improving mild cases of head flattening. “Tummy time” is an important activity that encourages babies to lift their heads, strengthening neck and shoulder muscles and relieving pressure on the back of the head. It can be started shortly after birth, with short, frequent sessions building up to 15-30 minutes daily by two months of age.
Repositioning techniques during awake and sleep times are also effective. While babies should always sleep on their backs to reduce SIDS risk, parents can alternate the direction the baby’s head faces in the crib or change the crib’s position to encourage head turning. Limiting prolonged time in car seats, swings, and bouncers can reduce consistent pressure on the skull. For babies with torticollis, physical therapy involving neck stretches can help improve head movement and reduce the risk of flattening.