Molding Helmet Therapy

Molding helmets are used to treat a condition called Occipital Plagiocephaly (OP), in which an infant's head develops flattening on one side of the back (occiput) of the head, best seen by looking down on the top of the infant's head. OP is caused by the baby lying on his or her back with the head turned to the side of the flattening. The recommendation that all infants sleep on their back has led to a dramatic decrease in Sudden Infant Death Syndrome (SIDS), but has also led to an increase in cases of OP. We strongly recommend that parents place their infants to sleep on their back, but it is best to vary the position that they sleep in to prevent flattening.

It is important to remember that OP is a cosmetic problem, and the brain continues to grow normally. Your child will not have any disabilities from this condition and if treatment is begun early, usually before six months of age, the results will be very good with satisfactory head shape by four to five years of age.

The infant should be examined to exclude craniosynostosis, a rare, but more serious condition in which the skull bones are fused improperly and that usually requires surgery to correct. OP produces a parallelogram shape to the head with occipital flattening on one side (right side in 80%), displacement of the ear on the same side, and prominence of the forehead on the same side. In contrast, craniosynostosis usually produces a trapezoidal head shape with flattening of the forehead AND occiput on the same side. If the diagnosis is uncertain, skull X-rays or a CT scan can further evaluate if necessary although most do not need any further studies.

Treatment options for infants with OP include both repositioning and, in severe cases, a molding helmet. Infants are usually first treated by repositioning them early (by three to four months) - changing their position so that they aren't constantly lying on the flattened side of the head. Providing 'tummy time' during the day when supervised is also recommended. Mild or moderate deformities will usually correct on their own with these measures. If there is no improvement within several weeks, a molding helmet or head band may help to further reshape the head. Molding helmets are worn for twenty-three hours each day, usually for three to six months, to gently mold the skull's shape back to normal.

About 10-15% of children with OP also have congenital torticollis in which the infant has difficulty turning away from the flattened side due to tightening or scarring of the neck muscles. These infants may also benefit from physical therapy exercises to stretch the neck muscles.

 

To make an appointment, please call 717-531-3828.

30 Hope Drive, Suite 2200, Entrance B
Hershey, PA 17033
Phone: 717-531-3828
Fax: 717-531-7120 
2494 Bernville Road, Suite 106
Reading, PA 19605
Phone: 610-898-1800

Evaluation

Most often, doctors can make the diagnosis of positional plagiocephaly simply by examining the child's head, without lab tests or X-rays. Doctors will also note whether regular repositioning of the child's head during sleep -  the most common treatment for positional plagiocephaly - successfully reshapes the child's growing skull over time (true craniosynostosis typically worsens over time).

If there is still some doubt, X-rays or CT scan of the head will show the doctor if the skull sutures are open or fused. If they are open, the doctor will probably confirm the positional plagiocephaly diagnosis and rule out craniosynostosis.

Treatment Options

Treatment for the flattened head, if caused by sleeping position, is usually simple and painless for your child. Your child's doctor will probably recommend alternating both your child's direction in the crib (one night with his head toward the top of the crib, one night toward the bottom) and his head position during sleep (one night with the left side of his head touching the mattress, one night with the right).

Even though your child will probably move his head around throughout the night, alternating sides is still beneficial. There are wedge pillows made to keep babies lying on one side or the other, but be sure to check with your doctor before using one to ensure that it is appropriate and safe for your baby. The American Academy of Pediatrics (AAP) does not recommend using any devices that may restrict the movement of an infant's head.

In addition to alternating sides, you may want to consider moving your baby's crib to a different area of the room. If there is something in the room (a window or toy, for example) that is catching his attention and causing him to hold his head in a similar position day after day, moving his crib will force him to look at it from another position.

Always be sure your baby gets plenty of time on his stomach during the day, especially while he is awake and you are nearby. Not only does "tummy time" give the back of your baby's head a rest, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, being on his stomach will help him learn to push up on his arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen his neck muscles.

If torticollis is the cause of your baby's flattened head, a course of physical therapy and a home exercise program will usually do the trick. A physical therapist can teach you exercises to do with your child at home. Most moves will consist of stretching your child's neck to the side opposite of the tilt. Eventually, the neck muscles will be elongated and the neck will straighten itself out. Rarely, surgery is needed to correct the problem.

For kids with severe positional plagiocephaly, doctors may prescribe a custom molding helmet or head band. These work best if started between the ages of four and six months, when your child grows the fastest, and are usually less helpful after ten months of age. They work by applying gentle but constant pressure on a baby's growing skull in an effort to redirect the growth. You should never purchase or use any devices like helmets or bands without having your child first evaluated by a doctor.

Although helmets may not improve the outcome in all children, some children with severe torticollis would be more likely to benefit from their use.