4 Things to Consider Before Using a Cranial Molding Helmet

Cranial molding helmets, also known as orthotic helmets or cranial reshaping helmets, have become more common in recent years. This increase is largely due to a rise in head shape changes among infants following the launch of the Safe to Sleep campaign. This campaign, formed in 1992 to reduce the risk of Sudden Infant Death Syndrome (SIDS), encourages parents to place their babies on their backs to sleep. At the time of its introduction, only 1 in 400 babies experienced head flattening. By 2023, this figure has risen to almost 50%. 

Cranial molding helmets are primarily used to treat positional plagiocephaly or brachycephaly - conditions where a baby’s head develops an asymmetrical or flattened shape due to constant pressure on one area. While these helmets can effectively reshape a baby’s head, there are key factors to consider before using one. Here are four things you should keep in mind.

#1: Consider the Severity of the Head Shape

The severity of head shape changes is a critical factor when deciding whether to use a cranial molding helmet. Some flattening on the side or back of the head is normal. Remember, there is no "perfect" head shape, and mild flattening is often not a cause for concern.

Severity is typically assessed based on parent opinion, helmet company standards, insurance criteria, and research findings. As a licensed occupational therapist and a mom whose baby experienced positional plagiocephaly, I prioritize both parent opinion and evidence-based research.

Based on current studies, here are the severity ratings for plagiocephaly:

• Normal: 3.5 CVAI (Cranial Vault Asymmetry Index)

• Mild: 3.5 to 6.25 CVAI

• Moderate: 6.25 to 8.75 CVAI

• Severe: Greater than 8.75 CVAI

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231243/

For brachycephaly (flattening on the back of the head), the cephalic index (CI) is used:

• Normal: CI of 90 or below

• Mild: 91 to 93 CI

• Moderate: 94 to 97 CI

• Severe: 98 or above CI

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231243/

While these numbers are useful, it’s important to remember that the "normal" head shape is evolving due to sleeping position changes. Ultimately, parent perspective should take priority when making decisions.

Current research suggests that before four months of age, repositioning strategies should be the primary approach for addressing head shape concerns. After four months, if the flattening is mild to moderate and repositioning remains effective, a helmet may not be necessary. Helmets are generally recommended for severe cases when repositioning is no longer effective. See image below for evidence-based practice when navigating head shape treatments.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206465/

#2: Consult with a Licensed Physical or Occupational Therapist

Before pursuing a cranial molding helmet, consult a licensed physical or occupational therapist specializing in head shape correction. They can assess your baby’s head shape, measure any deformities, and discuss possible causes and treatment options, including repositioning techniques.

With a team of therapists specializing in "flat head", Infant Insights is passionate about non-helmet approaches to head shape correction. Our program focuses on repositioning techniques and holistic interventions to address underlying issues. Our program has helped 2000+ families since 2022 and continues to help parents all over the world. 

If you’re interested in a holistic approach to "flat head" correction, please book a free call with one of our specialists here.

#3: Consider the Commitment and Cost

Cranial helmet therapy requires a significant commitment. The helmet must be worn for 23 hours a day, often for several months. Parents should prepare for frequent adjustments, cleaning, and consistent wear to achieve results. Appointments to monitor progress and fit are also necessary.

Emotionally, parents may feel guilt or anxiety about their child wearing a helmet. Connecting with support groups or medical professionals can help. It’s also important to remember that head shape changes are incredibly common - almost 50% of babies experience them, and this number may continue to rise.

Cost is another consideration. In the U.S. and Canada, insurance may cover the cost if the baby’s head shape falls within moderate to severe categories. Families outside these regions may face higher costs or limited availability. If a helmet isn’t practical, programs like our "Flat Head Correction" program provide affordable alternatives.

#4: Consider Long-Term Factors

Think about how your baby’s head will look as they grow. If your baby has mild flattening with no facial asymmetry or significant ear shift, hair growth may make it unnoticeable over time. Keep in mind that most people have some asymmetry in their head shape.

Cranial molding helmets can be a valuable tool for addressing head shape concerns, but the decision to use one should be thoughtful. By considering severity, consulting a specialist, evaluating the commitment and cost, and thinking long-term, you can make an informed decision that supports your baby’s development and well-being.