Helmet Therapy - You've Got Questions, We Have Answers
helmet therapy
As a pediatric physical therapist with over 13 years experience, I know that the thought of a helmet for a baby can be daunting for parents. In my personal experience, the more knowledge you have as a parent, the more empowered you are to make an informed decision about your child. Let’s take away the stigma behind helmet therapy by sharing what we know.
First, let’s define some terms so you know what I’m talking about. Plagiocephaly is a flat spot on one side of the head. Brachycephaly is the flattening of the skull along the back of the head. Positional plagiocephaly/brachycephaly is caused by pressure to the skull in utero or after birth. (1)
My child has a flat spot, why would I consider helmet therapy?
(Note that there are other medical or protective reasons a child might require helmet therapy. For the purpose of this article, I am focusing on helmet therapy for non-surgical positional plagiocephaly/brachycephaly)
Helmet therapy may be a beneficial treatment choice for infants with positional plagiocephaly and brachycephaly in a moderate to severe cases of deformity. The severity of skull deformity is usually measured with 3D imaging or a hand caliper (ruler) by a specialist or PCP. (2, 3)
Research shows that helmet therapy in moderate to severe cases improves facial asymmetry, jaw alignment, as well as the flat part of the skull when applied correctly. This type of intervention can improve the child’s future for fitting bicycle helmets, wearing glasses, or even chewing food. (3)
When will my infant start helmet therapy?
We know that the skull is most malleable between 4-5.5 months old. Most studies point to ideal times of helmet wearing from 4-12 months due to brain and bone development. Another criteria considered for helmet therapy is the infant’s head control. Typically, these orthotic devices weigh about 8 oz which can be significant for a baby. Babies can safely hold their head up with the weight of the helmet around 4-6 months. (1, 3)
Are there negatives I should know about when considering helmet therapy?
Skin integrity: Rashes are always a reality when introducing something new to infant skin. In places like where I live in Austin, TX, it’s hot. The helmet orthotic is padded with a thick foam inside a molded plastic shell which increases sweat, skin break down, and rashes.
Cost - Unfortunately, in most cases, helmets are an out of pocket expense, and they are not cheap.
Stigma - I hear from parents in my practice that they worry what other people think of them when their child is wearing a helmet in public and often express feelings of guilt.
Is a helmet the only treatment my child will need?
No. Typically, positional plagiocephaly/brachycephaly goes hand in hand with Congenital Muscular Torticollis. CMT is a condition where the front muscle in the neck shortens and impacts the tilt and rotation of the head. Studies show that early conservative management of CMT like with physical therapy is optimal for developmental success. (4)
As a parent, it goes without saying that you want what is best for you child. Knowledge is power and “wait and see” is not the solution.
CMT and helmet therapy
Questions or concerns about your child’s head shape, posture, or development? Contact Boost Babies today for your pediatric physical therapy needs!
References
(1) Fenton, R. A pediatric epidemic: Deformational Plagiocephaly/Brachycephaly and congenital muscular torticollis. Contemporary Pediatrics, Feb2019; 36(2): 10-18. 8p.
(2) Bok Ki Jung; In Sik Yun. Diagnosis and Treatment of positional plagiocephaly Archives of Craniofacial Surgery , Apr2020, Vol. 21 Issue 2, p80-86, 7p
(3) Graham, Tiffany; Millay, Kelly; Wang, Jijia; Adams-Huet, Beverley; O'Briant, Elizabeth; Oldham, Madison; Smith, Shacoya. Significant factors in cranial remolding orthotic treatment of asymmetrical Brachycephaly. Journal of Clinical Medicine , Apr2020, Vol. 9 Issue 4, p1027, 1p.
(4) Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA academy of pediatric physical therapy. Pediatr Phys Ther. 2018;30:240-290.