A small, custom-fitted helmet, medically known as a cranial orthosis, is a common and effective treatment for infants. These helmets are designed to gently correct the shape of a baby’s skull when abnormal flattening has occurred. Because a newborn’s skull is still soft and pliable, external forces can easily alter its shape, leading to conditions that require intervention. The purpose of the orthosis is to guide the rapid natural growth of the infant’s head into a more symmetrical and rounded form.
Understanding Cranial Deformities
The conditions most frequently treated with a cranial orthosis are positional plagiocephaly and positional brachycephaly, which are types of deformational head shape abnormalities. Positional plagiocephaly involves an asymmetrical flattening on one side of the back of the head, often causing the ear on the flattened side to appear pushed forward and the forehead to bulge slightly. Brachycephaly, by contrast, is characterized by a symmetrical, broad flattening across the entire back of the skull, which can make the head appear wider than normal.
These deformities are classified as “positional” because they result from persistent external pressure on the soft skull bones, rather than from craniosynostosis, which is the premature fusion of the skull plates. Early intervention is recommended due to the rapid rate of head growth during infancy. Approximately 85% of an infant’s head development occurs within the first year of life, making the period between four and eight months the most effective window for corrective treatment.
Primary Causes and Risk Factors
The rise in positional head deformities is strongly linked to the “Back to Sleep” campaign. While this supine positioning is necessary for safe sleep, it means infants spend extended periods with the back of their head resting on a firm surface, which can lead to flattening.
Other factors can contribute to the development of flat spots, including the baby’s positioning before birth, especially in cases of multiple births or reduced amniotic fluid. A significant risk factor is congenital muscular Torticollis, a condition where the neck muscles are tight or shortened on one side. This tightness causes a preferential head turn, meaning the infant consistently rests their head on the same side, greatly increasing the likelihood of developing positional plagiocephaly.
The Mechanism of Helmet Therapy
The cranial orthosis works on the principle of passive redirection of growth. It does not squeeze the skull or actively push the head into a new shape, but rather provides a contained space for the head to grow into. The orthotist designs the helmet to hold the skull shape in the prominent areas while leaving a slight gap over the flat regions.
As the infant’s brain naturally grows, the skull expands into the open space provided by the helmet, allowing the flattened areas to round out. To achieve the best results, the helmet is typically worn for 23 hours per day, only being removed for bathing and brief skin checks. The process begins with a precise 3D scan of the infant’s head, which allows for the creation of a mold that guides the correction.
Frequent monitoring and adjustments are a standard part of the treatment process, usually occurring every two to four weeks. These appointments ensure the helmet is fitting properly and providing the correct points of pressure and space for growth. Parents are also instructed on careful skin integrity checks, as the constant wear requires monitoring for redness or irritation that might indicate the need for an immediate adjustment.
Life After Helmet Treatment
The typical duration of helmet therapy ranges from three to six months. Starting treatment earlier, around four to six months of age, often results in a shorter overall treatment time due to the faster rate of head growth during that period. For more severe cases, treatment may extend beyond six months.
Treatment is considered complete when the orthotist determines that the correction goals have been met, or when the infant’s head growth begins to slow significantly, making further correction unlikely. The outcomes of cranial orthosis treatment are generally permanent, as the head shape is corrected during the period of rapid bone development. Once the helmet is removed, follow-up care often involves a final cosmetic assessment to confirm the desired symmetry has been achieved.