The Truth About Helmets for Infant Head Shaping
There is a lot of debate and anxiety among parents around the topic of “flat head”, or flat spots, and helmets for infant head shaping.
As a pediatric occupational therapist, I dealt with “flat head” with my first born and have first hand experience around the education provided and given to parents around this topic.
Second, I have worked with over 2000+ babies in the area of “flat head” in 18 months, so I have significant experience in the area of head shape. I’ve gathered lots of information from my experience talking to parents, plundering through the research on this topic over the past 2 years, and talking to other professionals both therapists and pediatricians alike.
So, I am ready to possibly step on a few toes, and reveal the truth about helmets for infant head shaping.
To start - what is a helmet?
Helmets, like mentioned above, are orthotic devices (think splint or cast) for a baby’s head when they have a diagnosis of plagiocephaly (side flattening on the soft skull), brachycephaly (back flattening on the soft skull) or scaphocephaly (flattening on each side of the head).
These helmets are often recommended by a pediatrician, healthcare provider, physical or occupational therapist, &/or chiropractor among other professionals.
Helmets have been around for years, with the first helmet being used in 1979. Since the Back to Sleep campaign emerged in 1994, the prevalence of “flat head”, or flat spots, and the usage of cranial helmets has increased significantly because now babies sleep on their soft skulls.
So, now that we know what a helmet is and why it’s used - let’s reveal the truth about helmets.
First, helmets are NOT bad. Although I specialize in conservative correction, I will never deny that helmets help a lot of babies. Though helmets are helpful, helmets are considered a more invasive option when treating head shape abnormalities. This is due to the amount of monetary costs associated with the device and frequent visits to have the helmet sized and altered with cranial growth. On top of that, your baby has to wear a device 23 hours per day. These factors, among others, make this type of intervention a more invasive option because more medical attention is needed.
Helmet therapy is very common in the US and Canada, but not so common in other countries. In fact, a research study conducted in the Netherlands in 2014 found that helmet therapy was no more effective than conservative repositioning and allowing the head shape to round naturally, so this country no longer prescribes or uses cranial helmets with infants. Another research study conducted in the Netherlands in 2017 also found that back flattening was within normal range by age 5 and less than 1% of infants had severe side flattening after age 2.
Helmets in the US are often (but not always) used as the first line of treatment in correcting head shape.
Parents that have an infant with “flat head” are often told (myself included) to do more tummy time to address the flattened head shape. The parents are also likely given a series of stretches (myself included) to complete with their baby to encourage the baby to turn the head to other sides opposite of the flattening, and / or recommended to visit a physical therapist, chiropractor, or other provider that is well versed in head shape and body tension.
The parents then, after being given the diagnosis of “flat head” are often told to wait and see, do the stretches, and prioritize tummy time if they are not referred to another healthcare provider.
That baby then may return to the pediatrician, or health care provider, and be given the all clear because the head shape has improved, be referred to a helmet clinic, or referred to another provider skilled in treating infants with head shape abnormalities, and/or torticollis.
Typically at physical or occupational therapy, the baby is encouraged to complete milestones like tummy time and rolling, as well as exercises to address neck and body tension. At the chiropractor, the baby may be adjusted to reduce neck and body tension which may lead to more movement and less pressure on the flattened areas of the head.
When being referred to another health care provider educated on head shape and body tension, the baby may be able to avoid a helmet if correction strategies have been given and the parents are able to complete.
But, the baby may also end up in a helmet if the parents were only given strategies to prevent the head shape from becoming worse (encourage tummy time, keep baby off the head, etc) in comparison a repositioning program to correct the head shape (prop baby towards opposite side, get the baby on the bulging areas of the head as much as possible, etc).
The important thing to note here is that a helmet may still be indicated, even after conservative correction strategies have been performed, but the parents are set up for success from the beginning with proper information. Because prevention and correction are different. Prevention, like stated above, is commonly the course which is prescribed to parents, but correction information, like repositioning on opposite sides of the head, propping baby up towards non-preferred sides, etc may be skimmed over quickly or missed totally. When in reality, this information is the most important in helping parents avoid the need for the more invasive helmet treatment later in infancy.
Not to mention, typically insurance does not reimburse as much (if any) for parent education in comparison to the other codes billed in a medical setting (sorry insurance / medical talk), so therapists are not able or motivated to spend time educating the parents thoroughly on what they can be doing at home with their baby to round their head shape easily. Plus, if we spend all of the allotted time (possibly 30-60 minutes) educating the parents, then we never touch and work with the baby...
I actually just looked at a list of Current Procedural Terminology (CPT) codes that occupational therapists can bill through Babies Can’t Wait, which is a state-run early intervention service in Georgia, and the parent education code can’t even be billed. Plus, pediatricians are on a back to back patient basis a lot of times and aren’t able to spend a ton of time with each parent going over every single detail of an individualized plan.
I am not a conspiracist, nor am I against insurance / healthcare, but as a parent and therapist that has been on both sides of this - there is a disconnect between the education being provided at the pediatrician level and the therapist level in order to benefit both the parent and the baby in the area of “flat head”.
Hear me when I say - this disconnect is not the parents fault. More information in areas of conservative head shape correction should be made available to parents at the first mention of “flat head” or flat spots. With proper information and education, the likelihood for the need of a helmet goes down dramatically, and instead of the norm, helmets become a rarity.
In some cases, even after further intervention and repositioning strategies have been completed, a cranial helmet may still be needed. In this event, the parents can be confident that everything was done from a conservative perspective and they can be confident in their decision to move forward.
Last thought to conclude and that’s that the helmet company (one in very particular) is a business.
Just mom to mom, I would be skeptical anytime you visit a clinic that only sells cranial helmets, because their job is to do just that - sell helmets.
I can’t count how many helmet scans I have reviewed with parents that were scared to death after leaving a helmet scan and their infant’s head shape was mild, or even normal…
One helmet company in particular uses fear mongering and scare tactics to convince parents that there is no other option than a helmet.
They use verbiage like “severe deformity”, “bike helmets won’t fit”, “glasses won’t fit”, “your baby may have recurrent ear infections”, and “one ear is forward or one eye is bigger than the other”... I have never been to one of these offices, but I can tell you they are trained to say the exact same thing across the country because every single parent says they were told these things.
And when assessing the scans provided and sent to the parent via email, a lot of times the conclusions they provided to the parents are inaccurate.
After hearing this from so many parents, I started to look into the research they were citing in regards to a few common things parents were told.
Their ratings of severity are completely different from every other head shape severity scale in evidence based practice. And in regards to the ear infections, there is only one research study that states that infants with severe plagiocephaly are more susceptible to ear infections, which based on unbiased evidence based practice, severe deformity is greater than a 12 cranial vault asymmetry index (CVAI) which indicates differences in the sides of the head.
Although I have a lot of problems with this company because they discount the feelings of vulnerable parents, the helmets they are prescribing will not harm the baby. But, instead of using scary sales tactics, I would love to see them give parents an actual repositioning plan to try prior to helmet implementation. But, when their annual revenue is $117 million, they most likely have no desire to change their ways.
To conclude, whatever you decide to do for your baby - helmet or not, is up to you. And as long as you are helping your baby, that is truly all that matters.
My job at Infant Insights is to help not hurt. I have been where you are if your baby is dealing with “flat head” and you are being given the only option of a helmet.
In a perfect world, a few things around “flat head” would change…
- “Flat head” prevention education would happen from day one, at the hospital upon discharge.
- Signs of flattening or any flattening would be noted ASAP.
- Specific strategies for actual head shape correction would be given by the pediatrician or other healthcare provider.
- Helmet therapy would be initiated if the head shape did not improve.
At the end of the day whatever you choose to do, you're a great parent to your baby! And the helmet is usually harder on the parent than it is the baby! I am also NOT against helmets, but I do believe they should be the last line of defense rather than the first.
Sources:
https://pubmed.ncbi.nlm.nih.gov/24784879/
https://pubmed.ncbi.nlm.nih.gov/19816267/
https://link.springer.com/article/10.1007/s00431-016-2800-0
