Baby Helmet Therapy: What Parents Can Expect

The first time Jessica Sanchez-Gomez and her husband, Ray, heard the words cranial therapy was six years ago, at their son Matthew's four-month appointment with his pediatrician. "They measured the circumference of his head, said it was misaligned, and suggested we see a cranial specialist for a baby helmet," she says. 

After meeting with the specialist, it was confirmed that Matthew needed to be fitted for a baby helmet to treat a condition called plagiocephaly, which is sometimes referred to as "flat head syndrome."

It is estimated that up to 50% of 6-month-olds have plagiocephaly to some degree. It can be treated with repositioning methods, physical therapy, and helmet therapy, says Matthew D. Smyth, MD, chief of pediatric neurosurgery at Johns Hopkins All Children's Hospital in St. Petersburg, Florida.

It may sound scary, but fear not! First, it's important to note that most cases of plagiocephaly do not cause any long-term effects on your baby's neurological development. Also, baby helmets can not only be successful in reshaping your infant’s head, but they are also harmless. Here's all you need to know about baby helmet therapy, also called cranial orthosis.

Why Do Babies Wear Helmets?

Helmets, also called cranial bands, are used to correct the shape of an infant’s skull that has developed a flat spot or uneven appearance. 

The bones of a newborn's skull are soft and flexible, and the individual pieces of the skull are not yet fused together. This allows their head to pass through the birth canal. It also allows for their brains to grow, which happens rapidly in the first year of life. But the pliable nature of their skull bones makes it possible to develop a condition called deformational, or positional, plagiocephaly. That's where helmet therapy comes in.

"Helmet therapy is the application of a helmet that is created custom for a patient from a 3D image," says Caitlin Hoffman, MD, a board-certified neurosurgeon who specializes in pediatric neurosurgery at Weill Cornell Medicine in New York City. It should only be pursued after seeking an evaluation by a craniofacial specialist, typically a neurosurgeon or craniofacial plastic surgeon. “The cause of a patient's positional plagiocephaly or flattening can therefore be specifically assessed, and alternate methods of treatment discussed,” adds Dr. Hoffman. 

According to Cranial Technologies, improving plagiocephaly might be possible with supervised tummy time, repositioning techniques, and limiting the use of car seats, infant carriers, and swings. But when conservative measures like these are unlikely to work “helmet therapy will be recommended,” says Dr. Hoffman. 

A baby may also need helmet therapy for craniosynostosis, a congenital abnormality in which the bones in a baby's skull join together too early. This is a more serious condition that causes an abnormal shape of the head and may impact brain growth. Craniosynostosis often requires surgery.

Plagiocephaly Causes

Parents should know they are not at fault for their child’s flat head. Plagiocephaly, to some degree, is fairly common. There are several possible causes including: 

• Birth. Tight space in the uterus can lead to a baby being born with a flat spot. The chances increase when a person is carrying multiples. Additionally, interventions like the use of forceps or a vacuum during delivery may alter a baby's head shape.
• Prematurity. Premature babies have softer bones, and they are more likely to spend a lot of time in the hospital with their heads in the same position.
• Too much time on their backs. Sleeping on their backs is the safest position for babies, but back sleeping or being in a car seat where they don’t change their head position for a long time can lead to head flattening.
• Muscular torticollis. A baby can be born with one or more tight muscles in the neck making it hard for them to reposition their head.

How Does Helmet Therapy Work?

After it’s confirmed that your child is a candidate for a helmet, an orthotic specialist will take 3D scans (usually laser photo scans) of the baby’s head. Then, they will create a plastic helmet with inner foam padding that is customized to the current head shape and size of the infant. 

“The helmet shape provides for growth in the preferred direction, so with gentle compression from the helmet and ongoing head growth, the head can adopt the preferred overall shape," says Dr. Smyth.

So even if your child continues to lay their head on one side, the rounded helmet prevents more flattening because of the cushioning. 

Adjustments to the helmet are made as your child’s head grows. “Typically, a child will require a minimum of two helmets, and sometimes three helmets, to accommodate their growth during the helmet process,” says Dr. Hoffman.

Checking in with the orthotists frequently to ensure no issues with scalp breakdown, poor fit, or growth restriction is essential. "The appropriate fit of the helmet, scanning, and fabrication of new helmets based on growth occurs every couple of weeks,” says Dr. Hoffman.

Sanchez-Gomez regularly took Matthew for helmet adjusting. “They'd shave off parts of the helmet to continue to help shape it,” she says, adding they didn’t need to use another helmet in her son’s case.

How Long Do Babies Have To Wear the Helmet?

"Your child will be required to wear the helmet for 23 hours a day for approximately four to six months, which can seem like a tall order for an infant—and their parents,” says Dr. Hoffman. That includes feeding and sleep time. The helmet should be removed when your baby bathes. 

When Is It Too Late for Helmet Therapy?

Typically, an infant's skull will become less malleable and therefore less responsive to helmet therapy around 10-12 months of age. This is different for every patient, however, depending on gestational age and other factors related to constitutional growth and bone thickness, says Dr. Hoffman.

Are Helmets Safe for Babies?

Helmet therapy is safe for your baby, but it may take some getting used to. “At times the helmet was uncomfortable for him because his head was hot,” says Sanchez-Gomez of her child. 

And it’s important to keep the helmet clean. “We had to clean it once a day to make sure he didn't get rashes, which he did early on,” says Sanchez-Gomez. Parents can clean the helmet with soap and water as needed. Allow it to fully dry before putting it back on your baby’s head. 

Thankfully for Sanchez-Gomez, life with the baby helmet quickly became easier for Matthew and as a first-time mom, she got used to it after a few days. "It didn't hamper my feeding or holding him,” she says. “I also made sure I didn't stop him from doing the normal things that any kid his age would do. It actually served as protective gear if he fell.”

She also noted there were no development delays and the helmet didn't impede his movements. "He slept with it well and he played just fine."

Helmet Therapy Costs

Helmet therapy can be pricey, typically costing families anywhere from $1500 to $3000. It can sometimes cost even more.

“Luckily, we only used one band because it's expensive and insurance didn't pay for it. It cost us like $3000,” says Sanchez-Gomez. “I did engage with other families that we'd see at the doctor's office and they were on their second helmet. I don't know how we would have afforded it." 

Is Helmet Therapy Successful?

Research has found both conservative measures and helmet therapy can be successful for babies with plagiocephaly. But one study found helmet therapy had a higher success rate than conservative measures.

While helmet therapy should be closely monitored to ensure the helmet is properly fitting and is not worsening the head shape, applying pressure on the head, causing scalp sores, or restricting growth due to lack of sizing up at the necessary time points, the benefit of improved symmetry in head shape is a welcome result. 

After wearing the baby helmet for four months, the difference in the shape of Matthew's head was striking. "I'm so glad we did it,” says Sanchez-Gomez. “It worked well for us."