Thinking of getting a helmet for plagiocephaly

[NewMummy2022]

LO was very large and think he had a side preference although in the newborn haze we didn't notice. Stuck to the lullaby trust rules religiously. He's IVF and my odds were very bad so he's a bit of a miracle. At three months we notice that one side of his head is really very flat. Raise it with the HV. Told it's nothing to worry about (stop googling you silly mummy). Will correct when he starts sitting. Put him in his cot facing the other way. At six months I finally have a Google and am a bit devastated. There's no guarantee it's going to correct and he has bossing to his forehead and one eye is closing ever so slightly before the other. We saw our gp and they've referred us to the 'facial cranial dept?". Chased up today though and nobody can seem to find the referral so GP is looking into it. But we're thinking of maybe going the helmet route. He's seven months now and we had an initial consult with them today. What experiences do people have? All input welcome bad or good.

Both my boys had major flat spots due to always sleeping on a particular side. My understanding is there is very limited evidence that helmets work - it’s quite an American concept that appears to exploit the fears of parents for lots of money! You can’t see my 4 year olds at all now and my 21 month olds isn’t that noticeable. Obviously you do what you feel you need to but I’m so relieved we didn’t go down that route as would have been distressing, pointless and expensive.

Thanks Foreverbaffled. How were their faces? Did they have forehead bossing or eye bulging? Did it improve?

Yes slight forehead bossing and one eye looked a little smaller than the other. Not remotely noticeable now. I worried endlessly but it was pointless. The NHS really doesn’t recommend helmets I don’t think unless guidance has changed in the last 5 years!

There is great evidence that helmets work. Rhey are not a new invention, they have been around for 40 ish years. Unfortunately, more recently, several companies have started up in the US who do not seem to have much skill in making helmets. Recently (ish) there was a study published in the BMJ that concluded that helmets have little effect on cranial asymmetry. Unfortunately, they failed to control for the type of helmet, the skill of the orthotist, or the compliance of the parents with 23 hours a day of wear, so their conclusions are highly flawed. A properly fitted helmet will absolutely correct asymmetry in such a young child.

As for whether you should or not, that is your decision. I helmeted my child because I did not like the shape of her head. Over time, with hair and the change in perspective that comes from no longer looking down on the top of a child's head, the asymmetry will become unnoticeable. Have you ever noticed an adult with an asymmetrical head? I bet not, unless you are a hairdresser! That's because we do not look down on the top of other adults heads. But 12% of adults have significant, uncorrected plagiocephaly, so they are all around you. There are no medical repercussions to not correcting it, it is purely cosmetic.

So your choices are, to do nothing, and wait until the asymmetry is unnoticeable (it will not "go away") or helmet. We used Technology in Motion and we're happy with the results - there are other companies in the UK depending on where you live. Price is about £2800, plus travel to regular fitting appointments.

The helmet will not alter the forehead asymmetry, this will correct with time and growth. The facial asymmetry (one fatter cheek, one eye looks more open, slight deviation to the chin) will correct over time, but you have to be patient - the Cranial base grows very slowly, so it could be well into puberty, depending on the degree of asymmetry.

Helmets are a bit of a faff, but most kids don't mind them. My daughter wore hers for about 3 months. You quickly get used to them, and they become normal and the time passes quite quickly. For some parents, the reassurance that it will eventually be unnoticeable is enough, but for others, that point is years away and if the shaoe distresses you and you have the means, then it's reasonable to helmet.

If you have a Facebook account, you could join the Noggin Doctors Plagiocephaly and Torticollis Discussion Board. You'll get loads of advice there - he is a paediatric Craniofacial plastic surgeon with 20+ years experience. He won't push you either way, but you can chat to other people who helmeted, and people who didn't, and just generally get more information.

The thing is it’s hard to ever know if helmets work as chances are the plagiocephaly would have corrected naturally or certainly dramatically improved.

Well, no. Plagiocephaly is caused by growth of the head against a firm flat surface, because the baby had torticollis and couldn't turn his head the other way. Like growing a pumpkin against a wall, or another pumpkin, it grows flat where it contacts something else, right? Remove that firm flat surface (eg, baby learns to roll and sleeps on their belly) and the head just continues to grow from the shape it is in. Growth on the flat spot hadn't been "paused", it was redirected elsewhere, which is why the other side of the head sort of "bulges".
There are plenty of studies that demonstrate that well fitted helmet will do the job - the issue is, if the helmet does not fit (due to an unskilled orthotist).
As I said, the FACE will correct, the head shape, no. But unless you are looking directly down on top, with wet or very short hair, you probably won't see it. In an adult, that's pretty rare. In a child, more common, but still only cosmetic. Parental choice either way.

A few papers:

Vles JS, Colla C, Weber JW, et al. Helmet versus nonhelmet treatment in nonsynostotic positional posterior plagiocephaly. J Craniofac Surg 2000;11:572Y574

Littlefield TR, Beals SP, Manwaring KH, et al. Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty. J Craniofac Surg 1998;9:11Y17

Graham JM Jr, Gomez M, Halberg A, et al. Management of deformational plagiocephaly: repositioning versus orthotic therapy. J Pediatr 2005;146:258Y262

Teichgraeber JF, Ault JK, Baumgartner J, et al. Deformational posterior plagiocephaly: diagnosis and treatment. Cleft Palate
Craniofac J 2002;39:582Y586

Lee R, Teichgraeber J, Baumgarter J, et al. Long-term treatment effectiveness of molding helmet therapy in the correction of posterior deformational plagiocephaly: a five-year follow-up. Cleft Palate
Craniofac J 2008;45:240Y245

It’s okay, we can disagree about the paths we chose. They both worked out fine for us so that’s great 🙂I’m happy that my decision was correct for my child and I’m glad you feel the same about yours.

Oh, I'm totally in agreement with you on the choice you made. Helmet or not helmet, whichever you choose is right for your child. I would never say anyone was right or wrong for choosing either way.

What I'm disagreeing with is you saying helmets don't correct asymmetry, because the science supports the fact that they do.

@NewMummy2022 Congratulations on your baby - I have a little IVF miracle as well and I know how scary it can be to have that added layer of worry when they aren't well. My DC doesn't have plagiocephaly but has had health issues of their own. I think my main pieces of advice would be to trust your instincts, as you will know your DC better than (for example) your health visitor (who will have lots of children on their caseloads), and to read the latest good quality research/information. PubMed Central is a good source for research papers and is free online.

Goodness, thank you everyone for your experiences xxx

Speedyshoes thank you for the links and group, I'll check those out. You've given me lots to think about. It's really appreciated.

I'll check out PubMed. Many thanks (And congratulations to us!)