Cranial orthosis, commonly known as helmet therapy, has been used for decades to treat abnormal head shapes in infants. While its use declined in the early 2000s due to questions about its effectiveness, recent research has renewed interest in this non-invasive approach for correcting skull deformities that can arise due to restricted movement, sleeping position, and other factors.

The cranial helmets apply gentle, consistent pressure to protruding areas of an infant’s head, allowing skull growth in flattened regions. This helps guide the baby’s soft, malleable skull into a more normal shape as it grows. Timing is critical for successful treatment, as skull bones are thicker, and growth slows by nine months of age.  After this point, helmet therapy becomes less effective.

According to Stuart Weiner, CPO, LPO, an orthotist at Cranial Centers in New Jersey, “The take-home message for pediatricians and parents is that earlier helmet therapy intervention leads to better outcomes.” Research has shown that beginning helmet therapy at 4-5 months can correct skull deformities in 3-4 months. However, initiating treatment after 12 months of age often requires helmet wear for 5 months to see improvements.

The American Academy of Pediatrics recommends that infants take a cranial measurement during their 2-month well-child visit to check for any asymmetry. For babies with mild to moderate flattening in the back or side of the skull, repositioning strategies may be recommended first, such as placing the baby to sleep with the rounded side of the head touching the mattress, varying positions throughout the day, and providing tummy time when awake and supervised.

If asymmetry persists or worsens at the 4-month visit, a referral to a pediatric neurosurgeon or craniofacial specialist should be made for further evaluation and potential helmet therapy. Left untreated, skull deformities can worsen progressively as the bones fuse, so early assessment and intervention are ideal.

Helmet therapy has proven to be a safe, non-invasive approach to correcting skull shape abnormalities, with no restrictions on the baby’s activities. According to Weiner, “Helmet therapy is painless and well-tolerated when properly fitted and monitored, with infants adjusting to the helmets rapidly.”

While helmets may not be deemed medically necessary by some insurance plans, resulting in out-of-pocket costs for families, experts argue that the benefits of timely treatment far outweigh the financial burden. Untreated skull deformities can lead to teasing and bullying for children later in life. There are also concerns about potential impacts on motor skills, visual field, and cognitive function if cranial asymmetry is allowed to progress.

Early detection through regular well-child checks and swift referral to a specialist for helmet therapy evaluation allows for optimal correction of skull shape abnormalities. Weiner stresses the importance of early intervention, stating, “Acting quickly leads to faster improvements and shorter treatment duration, thus providing the greatest benefit for the infant and family.”

Revisiting the evidence on cranial orthosis confirms that this basic approach remains an effective first-line option for abnormal head shapes. Pediatricians are vital in monitoring head symmetry from birth and referring infants for early assessment and intervention when indicated. With close follow-up, helmet therapy initiated in the first few months of life can gently reshape a baby’s skull for lasting improvements.

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