Cranial remolding helmets are custom-fitted medical devices that guide the natural growth of an infant’s skull to correct abnormal head shapes and address conditions leading to head flattening. The process involves a careful assessment of the infant’s head shape and a tailored approach to facilitate proper development.
Understanding Head Shape Conditions
Infant head shape abnormalities stem from external pressures on the pliable skull. The most common condition is deformational plagiocephaly, characterized by a flattening on one side of the back of the head, often making the ears appear misaligned and the head asymmetrical. Brachycephaly involves a uniform flattening across the entire back of the head, causing the head to appear wider than typical. A less frequent condition, scaphocephaly, presents as an elongated and narrow head shape, often observed in premature infants who may spend extended periods lying on their side.
Factors contributing to these flattenings include prolonged time spent in a single sleep position, such as on the back, or extended use of car seats and swings that restrict head movement. Torticollis, a condition involving tightness in the neck muscles, can also lead to head flattening by causing a baby to favor turning their head to one side. In-utero positioning or prematurity can also predispose an infant to these head shape variations.
How Helmets Reshape Heads
Cranial remolding helmets operate on the principle of guided growth, effectively redirecting natural skull expansion. These devices are designed as passive orthoses; they do not apply active force to reshape the head. Instead, the helmet is custom-made to apply gentle, consistent pressure to the prominent areas of the skull while leaving open spaces for the flattened regions to grow into.
The effectiveness of this method relies on an infant’s skull being soft and pliable, with unfused plates, allowing for reshaping during rapid brain growth. For example, in cases of plagiocephaly, the helmet provides space on the flattened side for growth while gently containing the more prominent areas. Similarly, for brachycephaly, the helmet allows for expansion at the back of the head while limiting growth in the width. This process ensures that the skull grows into a more symmetrical and rounded shape over time, without applying intense pressure or causing discomfort to the infant.
The Helmet Treatment Journey
Cranial helmet treatment typically begins with a pediatrician’s referral if a head shape abnormality is noted. This leads to a consultation with a specialist, like an orthotist, for an evaluation. The evaluation often includes a 3D scan of the infant’s head to create a precise model, informing the custom design of the helmet. The helmet is then fabricated, often from a hard outer shell with a soft foam lining, and a fitting appointment is scheduled.
Once fitted, infants typically wear the helmet for approximately 23 hours a day, removing it only for bathing and brief breaks. The initial wearing schedule is gradually increased over a few days to allow the baby to adapt and to monitor for any skin irritation. Treatment duration commonly ranges from three to six months, with some severe cases requiring up to a year. Regular follow-up appointments, often every one to two weeks, are scheduled for adjustments as the baby grows and to track progress through repeat scans. Helmet therapy is highly effective, especially when initiated before six to nine months of age, with studies showing significant improvement in head symmetry.
Beyond Helmets: Prevention and Non-Helmet Approaches
Parents can implement strategies to prevent head flattening or manage mild head shape abnormalities without a helmet. A primary recommendation is “tummy time,” where infants spend supervised time on their stomachs. Tummy time not only helps prevent flat spots by relieving pressure on the back of the head but also strengthens neck and shoulder muscles important for development. It is suggested to start with short periods, a few minutes at a time, several times a day, gradually increasing duration as the baby tolerates it.
Frequent repositioning of the baby’s head is another effective measure. This includes alternating the direction the baby’s head faces in the crib each day, varying feeding positions, and holding the baby in different ways. Limiting the time a baby spends in devices like car seats, swings, and bouncy seats, which can put consistent pressure on the back of the head, is also advised. If a baby has torticollis, physical therapy can help address neck muscle tightness, which in turn reduces the likelihood of head flattening. Early intervention with these non-helmet approaches is often effective for mild cases.