![]() ![]() The study, however, focused only on babies with mild plagiocephaly, not torticollis, prematurity, or other associated conditions. In a brand new study out of the Netherlands this month, researchers found that helmet therapy alone yields similar results to natural cranial growth. While the literature is still young and long-term research is still in the works, untreated cranial asymmetries have been linked to visual defects, ear infections, middle ear malfunction, jaw bone changes, developmental delay, learning difficulties, and other psychomotor delays. There has been research over the last two decades on whether helmets alone prevent long-term asymmetries, if cranial asymmetries lead to other medical issues, or if neurodevelopmental delays occur in school-aged children with plagiocephaly. Parents and practitioners alike question the association between deformational plagiocephaly and long-term functional delay in kids. The biggest push-back from some insurance companies and doctors against cranial helmets is that asymmetrical head shape in babies appears to be a cosmetic complaint that hardly justifies a costly and bulky orthosis. In its early years, the infant helmet received a bit of scrutiny. Do helmets actually help? Aren’t all of our heads a little bit asymmetrical? What happens if my child doesn’t get one? Of course, every baby develops differently and other factors may be taken into consideration, such as if his abnormal head shape is keeping him from achieving gross motor milestones (rolling, head control, etc). What facial asymmetries do we look for as an indication of moderate to severe cranial change? A smaller chin on the affected side, a smaller ear or an ear that’s shifted forward, and a smaller or droopy eye on one side are examples. Usually, helmets are not expected to be effective for kids over 18 months. As physical therapists, we usually recommend a helmet evaluation if 1) A baby has been repositioned off his flat spot and participating in physical therapy for 1-2 months without any significant changes noted to his head shape, 2) A baby has spent 1-2 months sitting independently with good head control and playing easily in tummy time, and moderate to severe plagiocephaly is still present, or 3) A baby is over 6 months of age and facial asymmetries are still obvious. The earlier a child with torticollis and plagiocephaly starts a repositioning and physical therapy program, the less likely he will need a skull reshaping orthosis. Certain hospitals, orthotics companies, and plastic surgeon’s offices design their own version of the helmets, but the concept is still the same. They are meant to be worn for 8-12 weeks for at least 23 hours a day, during sleep and play. Plagiocephaly helmets are cranial orthoses made out of a hard plastic shell with foam lining, custom made to each child, and designed to keep pressure off the flat spots to help the head naturally round itself out. How do plagiocephaly helmets work and what’s the best time to get one? Often times, the asymmetries are resolved with simple repositioning and stretching exercises to encourage the child to look to both sides, physical therapy, as well as nap and play time on the tummy, all with supervision of course. Plagiocephaly and brachycephaly can be associated with many conditions, from prematurity and twin births, to torticollis (asymmetrically tight neck muscle), to developmental delay. Any prolonged external force leads to some skull shape changes. While most parents think they were partially responsible for the flat spot developing in their newborn, an infant’s head is extremely malleable before it reaches cranial maturity. Plagiocephaly and brachycephaly are two terms used to describe the abnormal head shape, depending on the degree of distortion and location of the flatness. Since the beginning of the “Back to Sleep” program in the 1990s, which kept babies off their tummies to prevent Sudden Infant Death Syndrome, many babies started to develop flat spots on the back of their heads. The first questions they ask are “could I have prevented this?” and “will he need a corrective helmet?” What is plagiocephaly and what causes it? These babies are often accompanied by bewildered first-time parents with worried looks, scared by those big diagnostic words. ![]() A majority of the babies I see in the clinic are those diagnosed with torticollis and plagiocephaly. ![]()
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