Treatment of Plagiocephaly with Helmets

There are multiple helmets that have been evaluated and approved by the FDA for treatment of positional plagiocephaly. Best response to helmet therapy occurs between four and eight months of age. It is during this time that the skull is thinnest and the brain is growing the fastest. Corrections can occur in a short period of time, i.e., 2-3 months. Little response is noted if the child is older than 12 months of age and a protracted period of helmet wearing is necessary. As children become older they learn how to remove the helmet and this creates further difficulty.

The Helmet may be either Active or Passive:

The Cranial Adjustment C.A.P. has recently been approved by the FDA for the treatment of positional plagiocephaly. This is a prefabricated helmet that is available in several sizes and offers the distinct advantage of being adjustable. The prosthesis can adjust to the appropriate size to fit the child’s head for treatment. In addition, it has the advantage that it can be enlarged as the child grows thus allowing the child to be treated in one helmet.

Adjustment to Wearing a Helmet

It takes time for the child and the parents to become comfortable with wearing a helmet. For the first several days, the helmet should be worn for 2 to 3 hour intervals. When it is removed, the child’s head should be examined for areas of irritation. Usually these are temporary, but occasionally a revision of the helmet is necessary if the areas of irritation persist. Most children will adapt to a helmet within 2 to 3 days. If the parents are consistent, the helmet is accepted very quickly. If parents are agitated and inconsistent, it takes a child much longer to adapt to the helmet.

Initially, the helmet should be worn as close to 24 hours a day as possible. It should be removed for bathing and then replaced. Movement of the skull is basically an orthodontic procedure. The application of small amounts of force over a protracted period of time is more effective than intermittent applications of force by the helmet. Helmets should be worn when the child is sleeping as this is the time when most pressure is placed upon the head. In reality, children spend a great deal of time with pressure applied to the back of their skull during waking hours. Car seats, swings, bouncy seats, and positioning children on adult furniture are almost always accompanied by the child resting on its head. Particular attention should be paid to insuring that caregivers in day care centers are consistent in using the helmet. Many children in day care centers are left in car seats, swings, etc. In such positions, they are content and require little care, but are in the long run delaying correction of their cranial deformity.

Many children perspire in the helmet, particularly during warm months. Stocking champs, which are available in most department stores are worn under the helmet and are helpful in making wearing more comfortable. Deodorant, soaps, and other chemical irritants are best not used on the helmet, as these contribute to the development of rashes. When washing of the helmet is necessary, plain water or mild soaps are recommended.

How Long Should the Child Wear the Helmet?

Most experts agree that the end point in helmet wearing should be when the ears are straight and the children have a cosmetically acceptable skull. Most of the long term sequelae of positional plagiocephaly can be avoided if the anatomic deformity of the ear malposition can be corrected. Once the ears are straight, the parents and physicians should determine when the posterior skull is cosmetically acceptable. Treatment is then terminated.

Preventing a recurrence of the deformity is important, particularly in young children. As long as the fontanel is open and the skull thin, the deformity can recur if the child remains in a fixed position, placing pressure on the back of the skull. Often times the helmet is worn just at night if the child is inactive while sleeping.