My Baby’s Head Is Flat! Study: Expensive Helmet Likely Won’t Help

Miles, a patient at Boston Children's Hospital, wearing his corrective helmet (Photo: Katherine C. Cohen/BCH)

Miles, a patient at Boston Children’s Hospital, wearing his corrective helmet (Photo: Katherine C. Cohen/BCH)

When my son was an infant, we followed modern medical wisdom and always put him to sleep facing upward. Within a few weeks, he developed a noticeably flat plane on one side of the back of his soft, bald little head.

“Deformational plagiocephaly” is the technical term, and it’s a widespread condition that has risen sharply since public health campaigns to put babies to sleep on their backs began in the 1990s. It affects at least one-fifth of American babies and possibly closer to half. My own overwrought, sleep-deprived diagnosis sounded more like, “Oh, no, my baby’s head is going flat!”

We brought him to specialists who raised the prospect that he might need to wear a helmet virtually non-stop for a few months, to protect his flat spot from pressure and help it round back out.

A helmet? All day and night? But there was no actual danger from his moderate head-flattening, no known risk except perhaps of future ridicule. In the end, we tried a custom-carved foam “head cup” and special “positioner” pillows to help vary which side he slept on. And we consoled ourselves that he just wouldn’t be able to become a skinhead when he grew up, which was surely just as well.

It’s the kind of parental decision you can second-guess yourself about forever. (There’s no sign of any flatness nine years later beneath his full head of hair, but what happens if he goes bald?) So I found welcome reassurance in a study just out in the journal BMJ on “Helmet therapy in infants with positional skull deformation.”

The paper is small but it’s the first randomized, controlled study — the gold standard in medical research — of helmets for plagiocephaly in babies. And it found that, at least in 84 babies without other risk factors, the helmets don’t help. The babies tended to improve with or without helmets. From the press release:

There was no meaningful difference in skull shape at the age of two years between children treated with therapy helmet and those who received no active treatment. Both groups showed similar improvements although only a quarter made a full recovery to a normal head shape, according to the team of researchers based in The Netherlands.

The results are especially underwhelming when you consider that the helmets, made of firm foam in a hard plastic shell, can cost as much as several thousand dollars, even in Great Britain, where the national health system doesn’t tend to pay for them.

The findings can also seem a bit daunting when you consider that once the flat-headedness developed in babies, only about a quarter of them fully “normalized,” helmet or not.

Dr. Carolyn Rogers-Vizena, a craniofacial surgeon in the department of plastic and oral surgery at Boston Children’s Hospital, emphasizes this point: By no means should concerns about head flatness dissuade parents from putting babies to sleep on their backs, which is known to protect against Sudden Infant Death Syndrome. Back-sleeping alone should not be blamed, she added; babies who develop flat heads usually have other risk factors that lessen mobility, including neck tightness, prematurity or developmental delays.

Also, the study offers useful new knowledge but it’s only one small study, she said, “it’s certainly not the be-all and end-all.”

Because the study is the first of its kind and has not yet been reproduced by other researchers, “it won’t yet dramatically change my practice,” Dr. Rogers-Vizena said. “But it gives me something new to tell parents when we’re counseling them, and hopefully bigger, higher-powered studies will come out so we can get a sense of who’s an appropriate candidate for a helmet and who’s not.”

The study excluded many babies who would be typical patients for Dr. Rogers-Vizena, those with more severe cases or the neck tightness known as torticollis.

Still, it could offer some solace to parents agonizing over the helmet decision, as I did.

“There’s a huge amount of parental anxiety around deformational plagiocephaly,” Dr. Rogers-Vizena said, “and I think there’s often a lot of guilt, because parents feel, ‘I did this — I didn’t pick him up enough or he was in the wrong position in utero.’ And hopefully this will alleviate some of that anxiety and say, ‘You don’t have to be super-aggressive’” about getting plagiocephaly treated, and “parents shouldn’t feel like they’re being negligent by not helmeting.”

(Note: Helmet makers are questioning the study’s findings, The New York Times reports, saying that a helmet’s benefits all depend on the right fit.)

Ideally, of course, you head off head problems before they happen. In an editorial that accompanies the paper, Brent R. Collett of the Seattle Children’s Research Institute writes in part that the findings highlight the importance of preventing plagiocephaly — whether through public messages about “tummy time” or other means.

A striking 2011 French paper found that prevention is highly possible if new parents are actively educated to help their babies move more freely. Only 13 percent of babies in the study whose parents got preventive education developed plagiocephaly, compared to 31 percent in a control group. (Also striking, from the abstract:  “For each supplementary hour of immobility during the third and fourth months of life, the risk of Deformational Plagiocephaly at four months doubled.”)

The French study used a brochure headlined “For baby’s sake, let’s do things differently from day one” and “Give baby room to move!” It included statements like “I only use my baby’s car seat when traveling” and “If baby always turns his/her head to the same side, I attract baby’s attention on the other side” whether “by talking to or looking at baby at every contact” or “with a toy or brightly colored material close by.”

Here’s more on prevention from the orthotics company Boston Brace’s page on plagiocephaly:

Repositioning: An infant’s skull is incredibly flexible in its growing stages prior to cranial maturity. This makes it vulnerable to risks of flattening while placed against any surface for long periods of time.

To avoid this, some medical experts recommend a technique called “repositioning,” which simply means alternating the infant’s position to evenly distribute the gravitational pressures on a growing skull.

Suggested means of repositioning include encouraging infants to respond to toys and stimuli equally on both right and left sides. If flattening becomes apparent on a certain area of the infant’s head, parents should encourage a position in which the flattened portion of their child’s head is not in contact with any surface. Also recommended is to have an infant spend time on their stomach, which must be supervised for safety reasons.

Dr. Rogers-Vizena says there are also many products on the market to help prevent or alleviate plagiocephaly, from donut-shaped pillows to other head supporters and even hats, but there hasn’t been enough research for her to be able to recommend any of them.

Readers, any anecdotal evidence to share?

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  • Kendra Clay

    I HAVE A 7 MO OLD PREEMIE THAT HAS THE FLAT HEAD DUE TO TORTACOLLIS AND JUST FOUND OUT YESTERDAY THAT MEDICAID WILL NOT PAY FOR THE HELMET IN TEXAS… DOES ANYONE KNOW OF ANY TYPE OF ASSISTANCE WITH GETTING ONE BECAUSE THIS THING IS $2100 ($1800 IF I PAY IT OFF IN 4PMTS VS 5) AND BEING A MOM OF 5 AND CURRENTLY IN COLLEGE I HAVE NO CLUE HOW I WILL GET THIS SO DESPERATELY NEEDED HELMET FOR MY DAUGHTER… PLEASE HELP! THANK YOU

  • Kimy

    Really interesting study. Thanks. I personally use the Cocoonababy which prevents the risk of severe plagiocephaly and is used in maternities all over the world. http://www.cocoonababy.com
    Cheers

  • Judy W

    i am a pediatric physical therapist. it is interesting how one study on how
    helmets aren’t beneficial for “mild plagiocephaly” can go viral.
    while i agree that parents shouldn’t feel negligent when choosing to not helmet
    their babies, parents should also read the fine prints in studies such as these
    before assuming it automatically applies to their situation. every baby’s
    different. seek out second opinions. try different things. you’ll be glad you
    did.

    for more regarding helmet recommendations from a PT perspective, read
    here:

    http://nspt4kids.com/parenting/babies-misshapen-heads-plagiocephaly-helmets-physical-therapist-perspective/

  • lcsar

    My son had forceps following a very long, difficult labour, a cephalohematoma and torticollis – all risk factors for a misshapen head. We recognized it early and did everything “right” – exercise and distractions to make his dang head turn to the LEFT for once, he was only in his car seat for in the car, I babywore constantly, I even put him on his tummy to sleep for naps with an Angel Care monitor (and his door open so I could see him… he was my first, I was a little neurotic!) ;) Eventually I moved to overnights on his tummy too, with the monitor, trying to “fix” his little head. By 4 months it was quite severe, so we were referred to neurosurgery. Between 4-6 months it started reshaping fairly nicely and we did not get a helmet. However, it is still quite obviously deformed (to me, if you look down from the top) and his eyes and ears are a little asymmetric. Probably not noticeable if you’re not looking for it. He is 2.5 years old now, so it’s not likely to change. Sometimes I worry about his head properly fitting bicycle and other sporting helmets when he’s older.

    My newest son is 5.5 months old. Fast, easy delivery. No forceps, no cephalohematoma, no torticollis. He sleeps on his back for all naps and overnight, and always has. His head is perfectly round.

    So for all of you misinformed ignoramuses stating that plagiocephaly is caused by parents not holding their children enough, you can kindly keep your judgemental assumptions to yourselves. Parents have enough guilt to bear as they try to do their best to love and raise their children as it is.

  • JCA

    Our son was premature and had low muscle tone. He started seeing a cranial sacral massage therapist at 4 months. It improved his head shape and his feeding incredibly. We went twice a week for months so in the long run it probably cost as much as the helmet, but he loved it and we saw results.

  • Bob

    How is it possible they can market these medical devices as treating this condition without presenting proof they work first? Can manufacturers and doctors now be sued for making false claims about the effectiveness of this treatment? What other medical devices are in use without proven effectiveness? I know FDA requires clinical trials of drugs must show effectiveness prior to approval, it’s strange that manufacturers of medical devices don’t have to show the same.

    • Geof Tibbs

      They do work. This is the first (only) study that has said they don’t.

  • Trung

    Our son had to wear a helmet for 6 months, but our insurance covered it (maybe because his condition was so severe?). Also, he started walking as soon as he got the helmet (at 8 months). The cranial therapist said it was not uncommon for kids to advance quickly like that because if they fall there is no pain from bumping their heads. Thus they lose their fear of falling. I don’t know if that’s true or not but was in our case.

  • Erin Smith

    While the Back-to-Sleep campaign obviously had a large impact on this issue, I don’t think we can ignore the role played by the increase in the use of “Travel Systems.” Little baby pods with handles that click in and out of car seat bases and strollers. You never even have to touch your baby! Drives me crazy to see these in such wide use. Worst is seeing someone walking down the street with their little one bawling away in the car seat/stroller contraption. Pick that poor little thing up! He just wants some physical contact! Cosleeping and babywearing go a long way in preventing the flathead issue and, IMHO, result in happier parents and babies. Medical issues like torticollis aside, I really think this is a preventable problem if we just use some common sense. If you’re not a cosleeper, tilt your baby one way one night and the other the next. Or, gasp!, get a breathing monitor and let him sleep on his tummy sometimes (cheaper than a helmet!).

  • guavass

    US babies, not Americans. America is a continent, and this article is only talking about US babies, not all American babies.

    • Johnny Heedless

      You’re both an idiot and a douche. If moronic douches like you ran the world, we’d be forced to call Mexican babies “United Mexican States” babies or Salvadorian babies, “Republic of El Salvador” babies. Do you see how that works? The term “American” is the common demonym for U.S. citizens in the English language because the USA ends in “America”.

  • Lisa

    We noticed a plagiocephaly and torticollis in one of my twins when she was about 3-4 months old. Her head wasn’t flat in the back, but kind of skewed to one side in the back, which was probably attributed to her more limited mobility in utero as the baby who was mostly underneath her sister for the last trimester. We used a ‘helmet’ (DOC band, as I believe it was called) that was custom fitted just for her and adjusted every two weeks. There was no indication that it caused her any discomfort (and believe me, she would have not hesitated to let us know), and she was in it for about 3 months. She also had physical therapy for the torticollis. Both were immensely helpful, and the DOC band definitely produced positive results in reducing the plagiocephaly significantly. Our insurance covered the cost at 65%. I am only commenting here because the article above requests readers’ anecdotal evidence, and while the choice to go with a helmet is one for an individual family, I’d hate for anyone to be dissuaded from pursuing the option based on this article alone. Randomized studies with control groups may be the ‘gold standard’ in medical research, but there are still many details about the research left out of the report above. When we made the decision to go with the helmet, I felt pretty sure I was doing the right thing as a mother for my child, and the outcome has confirmed that feeling. Thank heavens I had no idea at the time, as I was out and about with my little sweeties, that apparently so many people who knew nothing about our situation might have had so many opinions and judgments upon seeing us, if many of the comments below are any kind of reasonable representation of so many people’s utter confidence in their own conjecture.

  • Tim

    Our daughter’s head had a flat spot. The helmet fixed it. End of study.

    I would do it again and would not think twice.

    This “study” sounds a like a misinformation campaign. Why.

  • Guest

    WBUR, I don’t think I’ve ever said this about you before, but this article is incredibly irresponsible. It’s poorly researched, badly reported, and based on a flawed study of flawed helmets in another country. Shame on you.

  • Geof Tibbs

    As a cranial remolding specialist, i have to chime in. This study has several major flaws, all of which are unknown to parents. First off, the study was done in the Netherlands where FDA regulation is not standard such as is the case here in the states- so any medical professional can fit helmets there without a standard of practice. Secondly the helmets, by a huge majority of roughly 75%, are described by parents in the study to have an inappropriate fit that causes issues for the baby. That’s staggering. If the helmet doesn’t fit it won’t work, period. The study defines head shapes that we treated as averaging moderate-severe without torticollis, delays, or prematurity of birth (which are major factors in helmet patients and cannot be ignored), but some of them are undoubtedly mild-moderate and shouldn’t have had helmets in the first place. Finally- all you need to know about the study: the kids wore the helmets up to 6 months with little change. If the helmets are designed and fit appropriately then you shouldn’t need more than 3 months to get major, lasting results. and the helmets are being covered more and more by insurances now. Some as little as $500 coinsurance.

    • emilyzola

      Thank you!

    • Johnny Heedless

      Here’s the good news… Now that this study is released, the few insurance companies that were covering these helmet scam will surely drop their coverage. Then, thankfully, “cranial remolding specialists” will be forced to go back to doing something worthwhile instead of scamming all these unfortunate, easily-duped, guilt-ridden parents out of their coinsurances and copays.

      I wonder how many of these easily-duped parents getting scammed by “cranial molding specialists” also trust Jenny McCarthy for immunization advice.

      • Geof Tibbs

        “Orthotist specializing in infantile cranial remolding while working in step with a team of surgeons” is too long. But you get the idea.

        I could be straightening scoliosis or helping CP kids walk, but I chose this. We all find meaningful work to do. This is mine.

  • Mansgame

    Ok, how about we invent a device that lets babies sleep upside down like a fruit bat? Orrrrrrr how about a rotisserie type device that turns the baby a few revolution per hour? Orrrrrrrrrr how about we stop being so paranoid about everything? Your kid is not that special.

  • Jackie Ferrara

    If kids heads are being deformed, maybe question the premise of being on their backs all the time. Just a thought. Or we should just accept the flat skulls.

    • Kara Thrace

      A live child with a flat head is preferable to a dead one with a round head 100% of the time. See the decades of longitudinal SIDS data, and you’ll never question putting your baby to sleep on his/her back again.

      • emilyzola

        Seriously. And thankfully, we don’t have to choose between flat head babies and dead ones, either. As the author of this incredibly irresponsible piece sort of noted, a slight flat spot will self-correct without a helmet in most cases, with some mild interventions on the part of parents. The helmets are for severe deformities.

      • Jellin027

        Oh God, what drama – such overreach.

      • Jackie Ferrara

        Obviously. I’m going to go out on a limb and suggest that maybe heads getting deformed is being on ones back too much. Not just sleep, in other words.

  • Rick

    omigod how has this species lasted this long?!?!

  • Esther

    My daughter had mild/moderate plagiocephaly and was recommended one of these helmets. However, our insurance wouldn’t cover in in cases of moderate severity. We took her to a chiropractor to correct the torticollis, and her head shape corrected itself. Over the course of a few months, she went from 8mm asymmetry to the statistically insignificant 3mm asymmetry. I hope parents won’t read this article and decide to do nothing. Torticollis is a serious hindrance to mobility and proper development. After her first treatment, my daughter no longer screamed when placed in tummy time and was soon able to lift and turn her head.

  • Jessica

    Having babies sleep on their back shouldn’t cause a flat spot. It is caused when parents leave babies in car seats and strollers for long periods of time. If babies spend most of the day being held, in tummy time or being worn, their heads won’t have time to flatten. We bed share, baby wear and breastfeed, and have never had any problems.

    • emilyzola

      The kind of deformities that result in helmets are not the small flat spots that come from car seats, strollers, etc. The helmets address severe deformities that usually have an underlying cause, like torticollis. A regular flat spot will grow out in time on its own.

    • Kym Wallace

      My three are ages 14-22 and we also bedshared, wore babies and breastfed. No problems. All three are healthy and in the top 6% of their high school classes and going on to do great things. Strange that in the US ignoring thousands of years of success (no cow milk or sleeping in cribs alone) is considered “weird.”

  • Breanna

    the western worlds obsession with making infants independent of their mothers/parents and putting them in ‘containers’ really exacerbates this problem, its not JUST laying them on their backs. Its bouncers, swings, etc. Women who wear their infants in wraps and carriers that keep their infants heads upright are then ridiculed and told their babies will never be independant.

    • emilyzola

      Feeling oppressed?

      • Pamela Smith

        Feeling defensive?

        • emilyzola

          As a matter of fact, yes. There’s nothing quite as hurtful as being told that you’ve caused a physical deformity in your baby through neglect. Also, nobody has ever ridiculed me for baby or toddler-wearing. Most people just make smoochy faces and say nice stuff.

          • a mom

            i’ve been mocked a bit for baby wearing. nothing to get my panties in a bunch over, but it isn’t fun having others question parenting choices. in general, i try to remember that we each get our own kids and each of us does our best to care for them as well as we can. abuse– well, that’s different. but aside from abuse, i try to mind my own business :-).

          • emilyzola

            I live in Boston and everyone wears babies — men, women, grannies, babysitters, random people who just like the look. You can’t get a stroller onto the damn train, so it’s pretty much required.

          • Heather Owens

            Yeah, baby’s are the new black. ;)

  • I’m Only Here to Read Comments

    Of all of my babies, friend’s babies, and family member’s babies, I know of only one who had this problem and that kid was seldom picked up. She’s 14 now and her head is still deformed. It can be avoided by putting them to sleep on their side, which is safer than on their back, especially if they are prone to spitting up. Just reverse the side they sleep on each time you put them down to sleep. Put them in a side-sleeper wedge and there is nothing to worry about. Use a little common sense. In a lot of cases (not all), it isn’t the position they sleep in, but the lazy parents who leave them in the crib all the time.

    • FreeFerris

      No, current medical wisdom is no slide sleeping. There’s a higher risk of SIDS from side sleeping vs. back sleeping.

    • emilyzola

      A Sanctimommy in her native habitat!

      • Lindarose Curtis

        yes you are!

        • emilyzola

          Lady, what is the problem?

          • Jellin027

            You are!

    • Lily Green

      I wore my baby, did tummy time, did repositioning, held him for most of the time, and he still ended up in a helmet. You have no idea what you are talking about, no one just leaves their baby in a crib, or carseat all the time.

      • Alex NH

        No one? Ever? Everyone is a great parent that doesn’t neglect their child?

  • MetalManny

    It “affects at least one-fifth of American babies and possibly closer to half” of babies? This is absolutely NOT true. Get your facts together before you start posting garbage. Moron!

  • Brett Husebye

    Okay here is an example. Wrap a thread around your finger 10 times. What happened after pulling it tight after just a few seconds? And you just told me there is no pain or suffering from a properly fitted helmet? Keep that thread on your finger for 3 minutes what happens? That helmet constrains the natural growth of their head. Your head is developed already use the brain in it to protect your children. .

    • Holly T.

      Except that the helmet is not a thread, and isn’t put on tight, if you read the description below, it discusses the way the helmet is made to allow the head to grow.

    • Rebecca Elder

      You have no idea how this medical device works. Kindly shut up, would you?

    • emilyzola

      What? Okay, so that’s NOT how the helmet works. It doesn’t squish the head into a round shape. Instead, it’s constructed from a solid piece of molded foam. A space is carved out of the foam over the flat spot. Picture the inside of a cantaloupe after you’ve removed the seeds. Then take a spoon and scoop a little of the melon out in one place. That’s what it looks like on the inside. The baby wears the helmet 23 hours a day, and as the head grows, it grows into the empty space, causing the flat spot to round out. The faster the head grows, the sooner the helmet comes off, which is why it’s most effective on young babies. Every two weeks you take the baby in for adjustments. They take a bunch of measurements of the baby’s head and then carve out more spots on the helmet. Over time — a pretty short time — the baby’s head rounds out. It’s not painful or even uncomfortable, any more than wearing hat is painful. Also, the top is open so it doesn’t get too hot. And it velcroes on the side, so it never has to be too tight.

      • emilyzola

        Also, it’s not particularly cumbersome. It’s not like anyone would PREFER the helmet to the head (although helmet babies look surprisingly adorable), but we were still able to breastfeed (in a variety of positions, including side-lying, cross cradle, and while walking in a carrier), cosleep, and do all the snuggly stuff. And he learned to crawl during his helmet time, so although it adds some weight, it’s not enough to cause any problems. If anything, it strengthened his neck, which is clearly a big deal with the grandma set. They worry a lot about weak necks.

        • emilyzola

          But that one hour a day of no helmet — man we were ALL OVER that head. You’ve never seen a family go crazy on a head like we did from 6-7. We’d take turns — my husband, me, and our 5-year-old– rubbing it, smelling it, mooshing our faces on it. We’re still probably way more into his head than we would have been if it hadn’t been forbidden fruit for so long.

    • emilyzola

      People, do NOT wrap your baby’s head in thread. Also avoid rubber bands, duct tape, rip ties, bungee cords, and saran wrap. This is not a DIY project!

  • Gale Pryor

    Sleep sharing and baby carrying are, along with breastfeeding, the three ways in which mothers have cared for their babies for millennia. All three in their own ways reduce or prevent the risk of both plagiocephaly and SIDS. It makes sense that babies’ physical development would expect an environment shaped by these ancient behaviors, rather than an environment shaped by cribs and car seats.

    • emilyzola

      It’s true, I birthed my baby directly into a car seat and left him there until he was six months old. Was that wrong?

    • KellyK

      But today’s fluffy pillowtop mattresses are quite different from the beds used for millenia. Unless you’re cosleeping on a firm mattress with no down comforter or blankets, stick with a crib.

      • Aibrean

        My daughter co-slept on a tempurpedic mattress for the first two months of her life with pillows, sheets and a comforter because it was winter and she was just fine. The paranoia over co-sleeping is ridiculous.

        • ms_kat

          Well if it worked for you, it MUST work that way for everyone. Data be damned.

        • KellyK

          Because your fortunate sample size of one deserves to diminish statistics & science? I lived in Chicago & knew people who worked for the company that the city had outsourced picking up dead bodies to. They picked up dead babies ALL THE TIME due to this. But hey your baby turnes out fine so they must be hallucinating or something. “babies who share a bed with a parent are up to five times more likely to die of SIDS”; “Nine out of 10 SIDS deaths that involved sleeping with a parent or caregiver would not have occurred in the absence of bed-sharing” http://blogs.babycenter.com/mom_stories/05222013-new-co-sleeping-study-reveals-shocking-sids-risk/

          • http://elizabethgrattan.com elizabethgrattan

            No. Suffocation is NOT SIDS.

            From the study you cite:

            “Although bed sharing occurs in about 90% of the world population, western industrialised societies consider solitary infant sleep a normal and desirable arrangement.3 In fact, infants are expected to exhibit adult sleep profiles by 3-4 months of age.19 There are, however, potential benefits to bed sharing. Parents sleeping with their infants inadvertently provide stimulation through vocalisations, body movements, radiant heat, respiratory sounds, odours, and possibly expired gases.3 Infants who share the parents’ bed arise more frequently and simultaneously with the mother and spend less time in stage three to four of quiet sleep.3

            Although the cause of the sudden infant death syndrome is multifactorial, contemporary hypotheses include defects in arousal or cardiorespiratory control.20 If bed sharing were protective for the sudden infant death syndrome it might override potentially fatal breathing errors or decreasing arousal deficits.21 In contrast, bed sharing may increase the risk of the syndrome through accidental suffocation by overlaying or hyperthermia.6 In this study, there was little evidence of an effect of bed sharing on the syndrome. Additional prospective studies are required to determine whether other unknown physiological or behavioural risk factors associated with sharing a bed may increase the risk of the sudden infant death syndrome.”

        • anon

          The safety of co-sleeping depends entirely upon the level of movement of the parents during sleep. If you do not shift around in your sleep, great! Go for it! As someone who moves A LOT in her sleep, I would never feel it is safe to co-sleep with my child.

  • emilyzola

    Our son had torticollis from birth, and also slept about 18-20 hours a day. We did physical therapy and repositioning — we reoriented our entire lives to make him look the other way, bathing, changing, and feeding him from the other side — but the head kept getting more misshapen. By the time he was four months old, his head was shaped like a crooked tri-corner hat with a point on top — sort of like a long turnip, or like Sloth from Goonies (he was still very cute). We had him fitted for a helmet at six months, and were told that outcomes varied from baby to baby, but we may be looking at anywhere from four to eight months. We were diligent about the helmet, keeping him in it 23 hours a day and getting it refitted every two weeks. Within two months his head was a normal shape, and he no longer had to wear it. He’s now a year old, and has a lovely, round head. There is no doubt in my mind that the helmet solved the problem, because I was able to witness the transformation firsthand. What most people don’t realize is how the helmet works. It doesn’t squish the head into a round shape. Instead, it is made from a solid piece of molded foam, and an area over the flat spot is hollowed out. As the baby’s head grows — and the heads grow quickly! — the only place for it to expand into is that hollow spot. So at our first follow-up fitting, we could see that our baby now had a flat spot with a small lump on it. The helmet was adjusted, and the lump grew into a hill, then a mound, then smoothed in with the rest of the head. Each night at bath time we would remove the helmet and go all over our baby’s head, marveling over the progress. His face also changed — his extreme skull deformation had made his eyes and ears crooked, and the front of his face was shifted to match the back (think of looking from above at the sides of a box — if you push the back of it askew, the front is also skewed). As the helmet reshaped his head, his face became more symmetrical and his face eyes shifted into a normal position (his ears are still slightly askew and will remain that way, but who cares).
    I’ve read some uninformed — and downright nasty — comments on this topic, and I won’t dignify them by responding individually, but I will say that while the helmet bothered US a lot, it didn’t bother the baby at all, that the progress his head made was quick and obvious (particularly in contrast to the worsening state of his head before the helmet), and that nobody has ever loved anyone as much as we love our kids, and we didn’t do anything wrong. (Not on this front, anyway!)

    • Mummy

      We faced a very similar problem with our beautiful baby girl and used a helmet diligently for 6 months. It was a hard period for us as parents but 100% worth it. Our daughters head and features are now symmetrical. With the torticosis we used a cranial osteopath but this alone would not solve the flat spot problem. We feel the helmet made a huge difference and would do the same again given the choice.

      There are a lot of misinformed hurtful comments out there which do not fully appreciate the reality.

      Both my children have slept on the tummy from 5 months, had strong necks from both and able to raise the head. It was just very unfortunate with the torticosis the damage was essentially done within 2 months.

      Personally we would always recommend a helmet based on our personal experience and circumstances.

      • chocoshatner

        Add our family to the list of people who absolutely benefitted from the cranial helmet. Our son was in his helmet for six months and the difference was staggering.

    • Mary Trudeau

      My daughter was a transverse lie in utero, and like your son, was born with a torticollis. By age 3 months, her facial asymmetry was increasingly disturbing, and she, too, had a three cornered head. We chose a helmet and physical therapy, and by the age of a year her deformity had resolved. The plagiocephalic deformation had nothing to do with sleeping, car seats or benign neglect…the torticollis restricted her head movement and limited her ability to straighten her neck. Physical therapy lengthened the muscles in her neck, and allowed her to have normal posture and body positioning. The helmet was nothing short of miraculous and my daughter has a beautiful face.
      The number of people who commented on our baby in her plastic helmet was incredible. Everyone had an opinion. For most children, this is a medical issue, not a cosmetic enhancement.

  • SRC

    I’m concerned that this article will prompt parents to NOT seek treatment or examination at the least for plagiocephaly. If due to torticollis and left untreated, it can lead to facial asymmetry as well as cranial deformity. There is also somewhat of a correlation between torticollis and infantile scoliosis which can be either self-resolving or progressive. All of these conditions should be monitored and/or treated by experienced medical professionals, especially progressive infantile scoliosis which can life threatening.

    • emilyzola

      I would hope that any parent would be smart enough to listen to a medical professional instead of a poorly researched and badly articulated article about a faulty study. I HOPE.

      • Matthew Beck

        I don’t remember reading anywhere saying “all helmets are bad”. Instead I does state that babies WITHOUT OTHER RISK FACTORS normally do not need a helmet. Also where is there a prior study saying helmets are needed… there is not one because this was the first controlled study. Even if the group was small, this was a beginning. Are you a medical professional? I hope not because your beside manner in each if your replies is appalling. The problem wiyh this article is that most of the readers have not read it accurately.

  • Suzanne Wilson

    Mother of four, grandmother of five, all with round heads. My babies and grandbabies could lift their heads from birth, and turned over voluntarily and independently from two months or earlier. At that point they all slept on their tummies by preference. Babies who are on their backs all the time not only have deformed heads, but have weak necks, arms and torsos and become unable to turn over. If you are going to plunk your baby on his back to sleep, at least put him on his stomach the rest of the time. He will then be able to raise his own head, push up on his arms, and get in his preferred, comfortable position. Can you imagine having to sleep in the same position all the time, and being too weak to turn yourself?

    • ellenry

      As a Grandmother too I completely agree..I am a mothers helper/nanny to a 2 1/2 month old who doesn’t hold her head up well, much less turn over. (She also has problems sleeping). My kids could roll over by 3 months. These things become fads. My babies slept on their side with a rolled blanket behind them, because WE were told that they could choke to death by regurgitating while laying on their backs. Olivia’s mother insists that she only lays on her back..It is a bad idea..if you ask me.

      • emilyzola

        There’s been at least a 50% decrease in SIDS cases since the start of the back-to-sleep campaign. I’m glad things worked out for your own children, but many, many babies were not so lucky. Knowing what we do now, would you really want to risk it? Olivia’s mom is absolutely correct. And a rolled blanket is a SIDS danger as well — the baby’s face can get wedged against it. This is not some fad or old-wive’s tale like the ridiculous thing you mention about babies regurgitating into their own mouths (they turn their heads to the side, which is why they have the crooked skulls mentioned in this article) — this is proven science with many, many years of data to back it up. Many years of data on babies who did not die. Also, the babies who get helmets are not the ones who develop a small flat spot from back-sleeping — they are babies with severe skull deformities. So please stop with the “in my day” and the hand-wringing about weak necks. I don’t see a ton of five-year-olds walking around with their chins lolling on their chests because they were cruelly forced to sleep in their backs for a few months.

        • a mom

          i wonder how much of the need for babies to sleep on their backs comes from the risk of breathing in fumes from toxic chemicals in mattresses? have you seen any studies about this?

          • emilyzola

            I’m not getting into that! I’m just here to defend helmet babies. But we bought Ikea crib mattresses because they use at least slightly less toxic flame retardants.

        • Lindarose Curtis

          You certainly are nasty in your replies. Things were different in “my day” have a little compassion.

          • emilyzola

            For what?

          • Jellin027

            She is NASTY because she is a ZEALOT

          • emilyzola

            Yes. I do feel zealous about living babies receiving appropriate medical interventions. I’m just crazy like that!

          • Jellin027

            Crazy would be the operative term

        • Brandie

          I actually gotta agree with the grandmothers to a point. things were different in their day and guess what? I’m willing to be a bunch of our “facts” become dangerous to do in the future and we will all be looked down upon because we didn’t know better. with how fast baby safety changes it’s am miracle any baby survives! I know someone who lost a baby while sleeping on the couch, something I did many times with my own
          baby who is now 7, sad things happen sometimes and as a parent we do what we feel is best for our child, you are allowed to feel strongly about co sleeping but so yourself a favor try to be a little nicer about, nothing about your post will make anyone want to side with you right or wrong when you present it in such a nasty fashion. I also do agree with you about co-sleeping and I wouldn’t recommend it without a separate co-sleeping bed for baby. also the above commenter never said it was cruel to sleep baby on the back only made a point to give the child enough tummy time to strengthen their necks and arms which is what you are suppose to do. I don’t think you read her comment fully.

          • emilyzola

            Nobody is anti tummy time. And again, the kinds of deformities addressed by these helmets are way beyond what you see from the a stage back-sleeping baby. I don’t think I said anything particularly nasty in response to the grannies, unless disagreeing totally is somehow nasty.

          • Matthew Beck

            Ummm. You are wrong these were about normal slept on back deformities. .. I guess you didn’t read the article before forming your opinion on its outcome.

        • TLM

          But what you are forgetting is that the data “In my day” was the current NEW data.. it was not a fad… I have 3 children and everytime I had a new baby the way they SHOULD sleep was changed.. This to will pass with new info in a few years like everything else and your grandchildren will be sleeping different…

    • Linda McInnis

      A good majority of people slept on their stomachs as infants, and they are alive with regular shaped heads. Many infants prefer to sleep on their stomach and find it more comforting, because they feel the mattress against their body, which is similar to being held against the parent’s body. Also, many infants may “spit up” while they sleep, and there is no discussion on the likelihood of choking on their own “spit up” when they sleep on their back. In addition, infants develop the ability and strength to lift and move their head and shoulders more earlier when they sleep on their stomach. As an infant, my brother slept on his back, and his head became permanently flat (think old Frankenstein movie). Although I was put on my back, I could not sleep well that way and fussed and cried, so I slept on my stomach, and I had no flat head – I was much more active than my brother, so that may be why I had a preference for sleeping on my stomach. In about 5-7 years, they will tell parents to select the best method for the baby to sleep.

    • Lindarose Curtis

      some babies are born with misshapen heads or with skulls joints that have grown together on one part of the skull, there are other reasons for this also. I knew a baby who’s skull plates were too far apart so wore a helmet. There is also the fact that flat spots are more common now because of babies sleeping on their backs, being placed in car seats, etc, but this is usually minor.

  • J Shah

    our 4 month old daughter had brachy and planoephaly. after 5 months of helmet, we have attained a 95% correction.
    The goal is to pursue correction ASAP. As per our neurosurgeon, correction rate is much lower after 9 months

  • Jessica Douglas

    My son had brachycephaly and we used a helmet from 6-10 months with incredible results. Our son had no issues whatsoever with adjusting to wearing the helmet, and I couldn’t be happier with the outcome. It’s a small sample size to base a paper on, and our real-life results are proof enough for me.

    • MBerka

      I am happy for you, but for others making this decision now, a small study on 84 real-life babies is probably the best data available at the moment. Perhaps a larger one will establish who is likely to benefit from helmets and who is not.

      • Brittany Huffman Lichter

        A larger study in which the same criteria are used for sample selection (excluding babies with underlying factors like prematurity and torticollis), as well as the use of one-size-fits-all helmets, will very likely result in the same outcome. Conducting another study using the same methods would be a waste of money, at best, and misleading for parents seeking useful advice. Instead, a more useful study would include both types of babies (“normal” babies whose flat heads are due to poor positioning vs. those with other underlying problems) and make the distinction between them. Using only customized helmets which are regularly carved out by someone especially qualified to do so would be essencial, as well. Also, researchers must include the exact age of the subjects while undergoing helmet therapy, as infants experience fluxuations in growth. If baby’s head isn’t still growing significantly, helmeting won’t work. Finally, the study must note how much, if any, physical therapy the participants receive. While a helmet can help a baby’s skull to round out, it will likely not stay that way if there are additional problems, such as low muscle tone or tight neck muscles, that will simply undo any improvements caused by helmeting.

        Our son was born 8 weeks premature, had low muscle tone, and had torticollis (tightness in his neck which caused him to want to tilt his head to one side). We agonized for weeks about whether or not to helmet. Seeing a helmet specialist (he also fitted people for prothetics), who took detailed measurements to determine that our son’s head would more-than-likely continue getting worse if we did nothing, was invaluable. Because our son was still well under a year old and had regular physical therapy to stretch tight muscles and strengthen weak ones, he made considerable progress in just 3 or 4 months. It’s one of the best decisions we’ve ever made. I hope this one study doesn’t dissuade others in similar circumstances from seeking medical advice, because time – and accurate information – is of the essence.

    • Kenneth Orke

      Correlation does not equal causation. Just because your experience doesn’t match up with the majority of the study doesn’t mean it isn’t correct. The point is spending thousands on a helmet to fix a problem that can easily be avoided is silly.

      • emilyzola

        The author asked for anecdotal evidence.

      • Geof Tibbs

        Edited.

      • Dulcey Lima

        The study results out of the Netherlands are perplexing, given the high number of skin problems and poor outcomes. The authors of the study did not specify the type of helmet that was used, but given the poor results, it seems likely that the helmets used were not custom molded orthoses which are the standard of care in the United States. The Netherlands frequently uses helmets that are fabricated using just a few measurements of the baby’s head (rather than based on a custom mold or scan of the babys head.) Before physicians across the world change their recommendations to parents, the Netherlands study should clarify their methods and the type of helmet used. Their evaluation criteria also utilized two simple two dimensional measurements to evaluate the 3 dimensional shape of the head. This methodology has been criticized in every study that has ever been done on the subject of plagiocephaly in the last 10 years..

        Not every head shape problem can be prevented with tummy time and positioning changes. Babies with torticollis or neck asymmetry often require therapy and a cranial remolding orthosis (helmet) to improve neck range of motion and symmetry. Even parents who have done everything perfectly–repositioning, tummy time, picking up their children, etc. can have babies with head shape deformities–often because of intrauterine constraint or constraint during the birth process. Several studies have indicated that up to 80% of babies with plagiocephaly also have some type of neck muscle asymmetry, and these children, and those with severe deformities were excluded from this very small Netherlands study.

        • Matthew Beck

          Could you site some specifics, as far as sources about their health system and how they work, when you bash the Netherlands. This article admitted that the Netherlands study was small, but also that the US replies were from the manufacturers, which is always suspect. This is just saying that the overwhelming growth in helmet wearing might be an expensive over reaction. Don’t jump to the incorrect conclusion that all helmets are wrong… I don’t remember reading that anywhere.

    • Lily Green

      Our son has been in his helmet for 4 months and his brachycephaly ratio has improved by almost 4%. Add us to your sample.

  • Brett Husebye

    Ive got a big head and always had one and I had seizures and headaches during the fusing of the protective bony plate. Don’t subject your child to added pain and potential suffering that could result in brain damage just because of the shape of their head. Use your brain parents to protect your child’s!

    • emilyzola

      A properly fitted helmet does not cause pain or suffering.