4 Things to Consider Before Using a Cranial Molding Helmet

Cranial molding helmets, also known as orthotic helmets or cranial reshaping helmets, have become increasingly more common in recent years. This is due to an increase in head shape changes among infants due to the Safe to Sleep campaign. This campaign encourages parents to place their babies on their back to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS). This campaign was formed in 1992 and at this time 1 in 400 babies dealt with flattening of the head. Now, in 2023, 1 in 4 babies deal with head shape changes. Cranial molding helmets are primarily used to treat infants with positional plagiocephaly or brachycephaly, conditions where the baby's head develops an asymmetrical or flattened shape due to constant pressure on one area of the head. While cranial remolding helmets can be effective in reshaping a baby's head, there are several important considerations to keep in mind before using one. In this blog post, we'll explore 4 Things to Consider Before Using a Cranial Remolding Helmet with your baby.

#1: Consider the severity of the head shape

The severity of the head shape change should be considered before deciding to use a cranial molding helmet. Based on recent research, some flattening of the side or back of the head is normal. As a parent, we have to remember that there is no perfect head shape and as long as the head shape is not significantly flat our babies will be just fine. The standard of severity is based on many things including parent opinion, helmet company standards, insurance reimbursement standards, and research on the topic. As a licensed occupational therapist and mom to a baby who dealt with positional plagiocephaly, I base my standards of severity on 2 things: parent opinion and evidenced based research. Based on current studies, plagiocephaly severity ratings, are as follows: normal is 3.5 CVAI, mild is between 3.5 and 6.25 CVAI, moderate asymmetry is between the CVAI of 6.25 and 8.75 and severe asymmetry is greater than 8.75 CVAI. This CVAI measurement is often taken at a helmet scan and you can usually find this number on the document sent after the assessment.

When discussing brachycephaly, which is flattening on the back of the head, the cephalic index (CI) is often used to rate the severity. The CI measures the differences in length compared to width of our babies head and a CI of 90 or below is considered normal. Based on research, mild flattening on the back of the head is between 91 and 93 CI, moderate severity is between 94 and 97 CI, and severe flattening is indicated by a CI of 98 or above. Although these are the values that current research supports, the normal head shape is changing and becoming less “almond” shaped due to changes in sleeping position. New research is emerging to develop new normal measurements in infant head shape, which I predict will change this rating scale. At the end of the day, the values do not determine the clinical presentation and if the parent opinion does not align with the severity rating, then ultimately the parent’s view should be prioritized.

Now that we have discussed the numerical rating of head shape severity, what does the evidence say about when to use a cranial molding helmet. Based on research, before 4 months, postural change should be completed in the treatment of positional plagiocephaly and brachycephaly. After the 4 month mark, if the baby has mild to moderate positional plagiocephaly, positional changes can be used to treat the flattening of the head. If repositioning strategies are continuing to be effective, cranial molding helmets are not required in the treatment of head shape changes in infants of all ages. If repositioning changes cease to be effective in rounding the head, then cranial molding helmets should be considered. In severe cases, after 4 months of age, usage of a cranial molding helmet should be used.

#2: Consult with a licensed physical or occupational therapist specializing in head shape

Before pursuing a cranial molding helmet for your child, it is imperative to seek a consultation with a licensed physical or occupational therapist with experience in head shape correction. This professional will be able to discuss options in treating your baby’s head shape changes and addressing underlying issues relating to the flattening. During the consultation, the specialist will assess your child's head shape, measure any cranial deformities (if meeting in person), and discuss the potential causes of the condition. They will also evaluate other potential treatment options, such as repositioning techniques and therapy, to determine the most appropriate course of action. Remember that cranial molding helmets are not a one-size-fits-all solution, and an evaluation by an experienced medical expert is crucial.

As an occupational therapist, I am very passionate about treating head shape changes in infants without a cranial molding helmet. I have developed a very specific and practical program in which repositioning techniques are the main focus. We also take a holistic approach in assessing the baby’s whole body to ensure we have addressed not only the head shape, but the underlying issues as well. At this time, I have helped over 450 babies and 97% of them have avoided a cranial molding helmet. In my approaches we have also encouraged milestones and movement symmetry so milestones are met in a timely manner. See many progress photos of babies I have helped all across the world here, and submit a free head shape assessment here if you are interested in my services!

When speaking with parents, I also inform them of the pros and cons to cranial molding helmets and instruct them to do whatever is best for their family. I have spoken with many parents that want to avoid a cranial molding helmet, and that’s when my services are most beneficial. But, in some cases a cranial molding helmet is the best option for the baby and family. In those situations I always respect that decision. When clients do choose to use a cranial molding helmet, it’s imperative that the baby also gets additional therapy or consulting services to address the underlying issues of the flattening. Please email me at [email protected] if you are interested in more information about this!

#3: Consider the commitment and cost

Cranial helmet therapy requires a significant commitment from both parents and the child. The helmet must be worn for 23 hours a day, typically for several months. Consistency is key to achieving the desired results. Parents should be prepared for the challenges that come with cranial molding helmets, such as frequent adjustments, cleaning, and ensuring that the helmet is worn consistently. The parent should also account for recurrent appointments and checks to ensure the helmet fits well and progress is being made.

It's also crucial to understand that the process can be emotionally challenging for parents, as they may feel guilty or anxious about their child wearing the helmet. Seeking support from medical professionals, support groups, or other parents who have gone through the same experience can be immensely helpful during this time. It’s also important to understand that head shape changes, as discussed above, as SO COMMON these days. 1 in 4 babies deal with this and I can predict this number will only continue to rise with the suggestions of back to sleep. Additionally, tons of baby items are available to parents, like the Snoo, weighted swaddled, swings, and bouncers, that encourage time spent on the back. Just know, if your baby has a flattening on their head, you are not alone. Definitely seek help if your baby’s head is affecting your mental health.

Lastly, cost can be something to consider when deciding on cranial molding helmet usage. Your insurance may cover this option if you are inside the United States or Canada and your baby’s severity rating falls within a certain standard. If your baby does not fall within the moderate or severe category, then insurance will not cover the cost of the helmet. If the out of pocket cost is not practical for you and your family, services like those through Infant Insights, are available to you at an affordable cost. If you are outside of the US or Canada, helmets may be very expensive, or not available at all. That’s when seeking services like my “Flat Head” Correction program should be considered. I am happy to offer flexibility in my prices because at the end of the day, my job is to provide you with the tools and information you and your baby need.

#4: Consider things long term

Lastly, when considering the usage of a cranial molding helmet, you want to consider the long term. If your baby currently has mild flattening on their head and they have no hair, consider how their head will appear once they have hair. Also, consider your head shape. Can you tell if there are slight changes in your head shape as an adult? There is no perfect head, so I can assure you we all have some asymmetry or flattening in the back if we really feel around. If your baby’s head shape is not severe and there is no facial asymmetries or significant ear shift involved, you may consider skipping the cranial helmet all together and correcting through repositioning. Once your baby is older you will most likely not be able to tell flattening was present. In contrast, if your baby’s head shape changes are causing their ears to change shape or one side of their ear and/or face to appear larger, I would suggest a cranial molding helmet. This will ensure their face and appearance from the front is symmetrical as they grow. There are so many things to consider when setting your baby up for success, and their head shape severity and appearance is one of them!

In conclusion, cranial molding helmets can be a valuable tool for treating infants with positional plagiocephaly or brachycephaly, but the decision to use one should not be taken lightly. Considering severity, consulting a licensed therapist, considering commitment & cost, and considering things long term are all essential factors to consider before pursuing usage of a cranial molding helmet. Ultimately, the goal is to ensure the best outcome for your child's future, and these considerations will help you make an informed decision. I am so glad you are here with me! I am so thankful helping parents and babies is my job!

Thanks for reading,

Brooke, OTR/L