Specialized helmets are used to gently reshape a baby’s head, addressing head shape differences that can arise during infancy. While not exclusively used for all infants, there is a higher occurrence of helmet use within the Down syndrome population. This therapy aims to guide the natural growth of a baby’s skull, ensuring a more typical head contour.
Understanding Cranial Remolding Helmets
These specialized devices, known as cranial remolding orthoses or cranial helmets, are custom-fitted to a baby’s head. Their primary function is to gently guide head growth, addressing certain head shape abnormalities. The helmet works by providing a snug fit in prominent areas of the skull, while leaving space for growth in flattened regions. This allows the head to gradually round out as the baby develops.
Two common conditions treated with these helmets are positional plagiocephaly and brachycephaly. Positional plagiocephaly involves a flat spot on one side of the back of the head, leading to an asymmetrical appearance. Brachycephaly is characterized by an overall flattening across the entire back of the head, often making the head appear wider. These conditions are typically cosmetic concerns, not associated with brain development issues.
Several factors can contribute to these head shape differences. Prolonged time spent lying on the back is a frequent cause, especially since the “Back to Sleep” campaign encouraged supine sleeping positions to reduce the risk of Sudden Infant Death Syndrome (SIDS). Torticollis, a condition involving tight neck muscles, can also lead to positional flattening by restricting a baby’s ability to turn their head. Additionally, a baby’s position in the womb or pressures during birth can sometimes result in a misshapen head at birth.
Increased Incidence in Down Syndrome
Babies with Down syndrome often have a higher likelihood of needing helmet therapy due to several unique characteristics. One factor is generalized hypotonia, or low muscle tone, common in infants with Down syndrome. This reduced muscle tone can lead to less spontaneous head movement when a baby is lying down, increasing sustained pressure on one area. Consequently, they become more susceptible to developing flat spots.
Many babies with Down syndrome also exhibit a distinct skull shape, often described as brachycephaly, meaning the head is shorter and broader than average with a flattened back. This inherent skull morphology can predispose them to brachycephaly or make any existing flattening more pronounced. The craniofacial structure in Down syndrome includes a flatter facial profile and a smaller head size, further contributing to these unique proportions.
Developmental delays also play a role in the increased incidence of head shape issues. Babies with Down syndrome often reach motor milestones like rolling over or sitting up later than other children. This prolonged period spent on their backs or in positions that apply consistent pressure to the head can contribute to the development of plagiocephaly or brachycephaly.
While less common, some infants with Down syndrome may experience atlantoaxial instability (AAI), which is increased mobility between the first two vertebrae in the neck. Although symptomatic AAI is rare, affecting about 1% to 2% of individuals with Down syndrome, medical evaluation is important if concerns arise. These combined factors make head shape monitoring and potential intervention more frequent in this population.
The Process of Helmet Therapy
Helmet therapy begins with a thorough evaluation by a specialist, such as an orthotist or neurosurgeon. Precise measurements of the baby’s head are taken, often using 3D scanning technology. A custom helmet is then fabricated to fit the baby’s head precisely, guiding its growth over time.
Once fitted, the helmet is typically worn for approximately 23 hours a day, with short breaks for bathing and cleaning. Consistency in wearing the helmet is important for achieving desired results. Most babies adapt quickly to wearing the helmet, often within about a week.
The duration of helmet therapy varies, commonly lasting 3 to 6 months. The timeframe depends on the severity of the head shape difference and the baby’s growth rate. Regular follow-up appointments, often every 1-2 weeks, are scheduled to monitor progress and make necessary adjustments.
Proper hygiene is essential; the helmet should be cleaned daily with a mild soap or alcohol-based solution, and the baby’s head should be washed regularly. Skin checks are performed each time the helmet is removed to ensure no irritation. The goal of this therapy is to achieve a more symmetrical and rounded head shape, which can significantly improve the cosmetic appearance of the baby’s head.