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Baby Helmet Therapy: Parent FAQs

What is helmet therapy?

  • Helmet therapy, or the use of a cranial orthosis, is a type of treatment prescribed for infants to help correct the baby's skull shape. Helmets work by directing growth from the flat spot, but they must be worn during the time when the skull (and therefore the brain) is actively growing.

What causes a baby to need a helmet?

  • The most common cause for helmets today is a positional head shape deformity, or positional plagiocephaly. There are a number of factors that could contribute to this problem. A thorough exam of each child helps doctors determine the specific cause.
  • In a small percentage of cases, children with an abnormal head shape have craniosynostosis. This condition occurs when there is an abnormal fusion of the skull bones that results in abnormal skull shape and restricted brain growth. This condition is corrected by cranial surgery and may also be followed by post-operative helmet therapy.

Is helmet therapy the only treatment for a child with positional plagiocephaly? 

  • In many cases, a child's doctor may recommend a trial of conservative treatments including physical therapy to see if the head shape problem will correct without the need for a helmet. This is especially the case if the child has torticollis, which is when the neck muscles shorten on one side, causing baby’s neck to turn in a twisted position, tilting his head to one side with his chin often pointing to the other side.  In these cases, physical therapy can help with muscle weakness and head turning preferences so that the plagiocephaly improves. However, children who don't respond to physical therapy and repositioning techniques are often prescribed helmets.

What is the initial process for getting a helmet?  

  • A child's doctor initially recommends a helmet after an evaluation of the child's head shape. The doctor then gives the parents a referral to a certified orthotist near them so that a custom helmet can be made for their child.

Does insurance pay for helmet therapy?

  • Contact your insurance company and employer benefits coordinator to determine the type and level of coverage and what documents are needed from your child's doctor. Insurance varies on types of coverage, but helmet therapy is covered as medically necessary under certain guidelines.

What special training do orthotists have that prepares them for taking care of babies with positional plagiocephaly?

  • Only a few universities in the U.S. have programs for orthotics; these programs must meet stringent criteria set by the American Board for Certification in Orthotics, Prosthetics, and Pedorthotics. Once an orthotist finishes the formal educational portion of training, he or she begins a residency program under the supervision of a certified practitioner to gain practical experience. A year's experience and references are required before the resident can submit an application to take both a written and a practical examination. When a resident passes the exam he can use the credentials of C.O. (certified orthotist), so it is important for parents to check that the orthotist their child is seeing is a C.O.

How does an orthotist fit the baby for a helmet?

  • A laser light scan may be taken of the child's head shape, or the orthotist may instead make a plaster mold. From these measurements, a custom-fitted helmet is designed.
  • Helmets are designed with foam lining inside that may require adjustments after the baby wears it for a little while. The purpose of the helmet is to hold the round areas of the skull steady while allowing the flat spot to gradually grow and round out on its own.

Does a baby need to wear a helmet all day?   

  • Generally, the doctor will ask that the baby wear the helmet 23 hours each day.  It can be taken off for bathing and cleaning.

Are there any side effects to wearing a helmet?

  • If worn properly, problems such as skin irritation, discomfort, and bad odor should not occur. If a child does have any of these problems, the orthotist can adjust the helmet. In most cases, however, children adapt quite easily to helmets. With younger babies, it even becomes something like a security blanket.

What is the best age for a baby to begin wearing a helmet?

  • The earlier a child is diagnosed with positional plagiocephaly and started on helmet therapy, the shorter the period of wear and the higher the chance of achieving full correction of the asymmetry. 
  • Babies referred for helmets at a later age (e.g., 6-8 months), or after having failed to improve with conservative treatments, can still get helmets, but they may have to wear them for a longer period of time than if they had started at a younger age. 
  • Helmets are not effective once brain growth is complete. Three quarters of brain growth occurs by age 2.

On average, how long do babies have to wear a helmet?

  • This is different in every case. A lot depends on the age helmet therapy started. In early infancy, the brain and skull grow very quickly. Therefore, the helmet can direct growth over a shorter time.
  • The orthotist will check your child's progress at each visit to see if the head shape is improving. In some cases, a short 1-2 months may be all that is needed. In other cases, it may be longer (3-4 months, possibly even requiring a second helmet).

What are the consequences if a baby does not wear a helmet?

  • This again depends on age and how severe the abnormality. In these cases, a helmet can help improve the overall shape significantly, whereas minimal change can be expected if nothing is done.
  • Uncorrected plagiocephaly will not influence a child's neurological development, but it can affect a child's social well-being later in life.

Additional Information:

Last Updated
Section on Plastic Surgery (Copyright © 2015 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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