Flat head brachycephaly plagiocephaly

[PrettyMaMa]

Anyone used a helmet for their child and are the results good ??
Going into this journey and would love some advice from any parents

Any before an afters???
Who did you work with ??

plagiocephaly
brachycephaly

I realise that you’re looking for experiences of those using helmets but we went down the non-intervention route.

My DC had positional plagiocephaly (due to lying with head turned to one side - resulted in a big flat spot). Referred to NHS specialist paediatric physio, who wasn’t a great believer in helmets and instead recommended using a beanbag to support baby’s head when lying down, encouraging sitting, crawling etc.

15 years on, DC’s head has attained a pretty good shape and you’d never know. I’m glad that we didn’t put them through wearing a helmet for months on end.

Our baby had plagiocephaly, he was our first and it was very noticable (to us) we went down the helmet route because we felt we should do everything we could to allow our son to have a more typical rounded head shape, as a boy we assumed he would probably want a short hair cut when older and his ears were noticably (to us) wonky, and one side of his forehead protruded more than the other.

The actual process of him wearing the helmet was fine, he got used to it very quickly. But we are not convinced that the helmet did anything to help him that his normal head growth wouldn't have done on its own. He is now four and his head looks like any other four year old's head, you would never tell we'd worried so much about it when he was a baby. Wish I had put the money for the helmet into savings for him to be honest!

I looked into the research and there's not much evidence that the helmets do much so decided not to go down that route. It's taken years but ds is rising 5 now and it seems better, so I've got more confidence recently that it will resolve itself. I really didn't think this last year! It is not noticeable under his hair, which I leave slightly longer but still short.

We didn’t go for/weren’t offered a helmet. In fact due to COVID, the specialists only ever saw pics we sent. At 2.5 it looks much better, perhaps due to having hair now. I can still see the flat bit but don’t think it’s overly obvious to others.

We've had a very tough time with helmeting, I'm not sure I would do it again given a second chance.

It's a nonsense. We were days away from having our son fitted for one. The negative information about them is overwhelming. We decided not to go ahead.

We used specific baby pillows and ensured he wasn't laying down for long (not that he'd let me have him out of my arms for more than 3 minutes at a time! 😴) and at 2.5 his head is very proportionate.

We used a Mimos pillow instead and did lots of physio (he had torticollis) and the two combined with lots of tummy and sling time (which I did anyway) helped and I'd say got 99% of it. I swear I still notice it in the bath but no one else can see it.

God please don’t do this to your child. Those helmets are bullshit and I thought there are only in America? Our first son had a flat head syndrome
And was classified as “significant”. It was very noticeable to us and others. At 3 month old we insisted on tummy time which he hated so we signed him up for swimming (even better than tummy time). It was extremely noticeable at 1-3 months. By 5 months it was only noticeable to us and by 7 months it was all gone, and his head was round and beautiful:) still is today at the age of 3.

Also just as PP said I also used the special pillows and some physios too.

We used one the change was significant, ds was unfazed by the whole experience. I don’t regret it

I have a big flat bit on the back of my head. I’m 51 and was born with hip dysplasia so lay in one position. And d’you know what? I’m fine. Absolutely fine. Been proposed to multiple times (so not a freak, looks-wise) and had a very ordinary life. Don’t put your poor child in a helmet.

sharing my experience and photos of before and after:

noticed my son had a flat head at about 2 months old. Some days I would look and think it wasn’t an issue and others was convinced I had to do something about it. After a few months of debating and falling out with my partner who thought it wasn’t an issue we let it drift as we were told by Chiropractors, Osteopaths and my NHS pediatrician that it was a mild case and would round out on its own. When my son was 6 months we went to see Technology in Motion as I didn’t see much improvement. They put his details on a chart and said he was in the severe category due to having a combination of brachycephaly and plagiocephaly, but estimated that after helmet therapy he would still be in the moderate category. Of course I panicked because time is of the essence for achieving the best results with a helmet.

In the end we let it go. Now he is 1 year old I have definitely seen some improvement, particularly today as I cut his hair. However, compared to his baby pals who have normal egg-shaped heads, my son’s is quite round and his ears stick out at the top as a result of his head being more prominent at the front. I still wonder now if we had got a helmet if his ears would be less pointy. I will never know but I don’t beat myself up about it anymore as it seems to keep improving, only since he started sleeping on his side, sitting up and crawling.

I would say go for the helmet if you’re brave enough and have the monies as I honestly believe the little ones won’t remember, but if you are unsure it actually works and isn’t a waste of money, like I was, I hope I’ve given you some hope that it will improve on its own, as the head still has lots of growing to do.

There is actually very good evidence that helmets work to correct head shape. The critical thing is the skill of the orthotist in fitting a helmet. There are some great orthotists and some poor ones. In the UK, at least one of the big helmet companies have them 3D printed which removes some of that variation.

Cranial asymmetry doesn't just go away. As a child grows, there absolutely can be some improvement in shape, but the majority of the improvement comes from a change in perspective, as the child is no longer below the line of vision of the parent. 12 % of adults have asymmetry (and an additional 12% brachycephaly) but you probably never noticed one (unless you are a hairdresser in which case you know full well that flat heads do not just "pop out" or self correct!)

Unfortunately a lot of people really minimise the distress it causes some parents when their child's head is asymmetrical.

I helmeted my daughter and I don't regret it for a second. What I wish is that I had known about The Perfect Noggin in time, as I could have used that instead, and saved myself a lot of money and stress. www.theperfectnoggin.co.uk

No @Speedyshoes there really isn’t lots of robust evidence that helmets do anything except lighten parents’ wallets. If there is, then do feel free to share it here.

Yes, Welshweasel, there is plenty. Helmets are not a novel invention, they have been around for several decades and there are numerous peer reviewed studies that show that a properly fitted helmet (and this is absolutely key) will correct cranial asymmetry.
Once you understand how/why the head flattens in the first place, the fact that a helmet will correct this is logical and obvious. A child's head grows very fast in the first 4 months of life, to accomodate their fast growing brain. Babies with torticollis are unable to turn their heads towards the tight muscle, so face the other way they whole time. When laid on a firm, flat mattress (per current guidance), the side in contact with the mattress does not grow. The growth is redirected to the side which is not in contact with the mattress. Hence, the baby's head grows asymmetrically, with one flat side.

Put that baby's head in a properly fitted helmet, and there is just enough contact pressure on the "overgrown" side, and none on the flat side (where the void is inside the helmet) to direct future growth towards the flat spot. No helmets push in overgrown head, that is a nonsense idea. The head GREW flat, and it is GROWTH which corrects the asymmetry.

There’s also plenty of evidence that for the vast majority of cases, helmets don’t make any difference. They weren’t recommended by my DC’s paediatric physio in 2005 and they still aren’t recommended by the NHS.

Like I said, the helmet has to fit properly. Fitting a helmet is a skill. Some orthotists can't do it. A poorly fitted helmet is a waste of money. A well fitted helmet will do the job of correcting asymmetry.
Plagiocephaly is purely a cosmetic issue. And helmets cost a LOT. About £3000 in the UK, plus petrol and time costs. The child is not medically disadvantaged if you don't choose to correct it. Some helmet companies claim kids will have issues with bike helmets or sunglasses etc but this is patently untrue they just say it to sacre parents into spending the money. So the NHS is not going to recommend an intervention which is medically unnecessary. Its the parents choice.

The reason I recommend the Perfect Noggin to my mum friends of babies with torticollis is that is it a fraction of the price of a helmet and you can avoid all the inconvenience. No one WANTS to helmet their child. But some parents do want to change the shape.

A well fitted helmet will do the job of correcting asymmetry.

As will doing nothing.

And why do NHS Trusts state the following?

There is clear evidence and expert consensus that a helmet does not affect the natural course of skull growth and should not be used.

gmeurnhs.co.uk/Docs/GM%20EBI%20Policies/GM%20EBI%20Helmet%20Therapy%20Policy.pdf

@Noodles85 his head looks great, I can't see any issue with the one year picture.

We were told our baby boy has a mild flat head by a private osteopath, it's flat at the back. He's 6.5 months atm, and i think it looks a bit better than it did at four months. Aware we've a limited window and leaning towards leaving it also and hoping it just rounds out

Flat at the back is brachycephaly. Over time you can expect natural improvement of up to 4% on the Cranial Index. That might get you into normal range if the flattening is mild. If significantly flat, it will still be flat into adulthood. You can see adult brachycephaly everywhere. It goes unremarkable upon, but it is demonstrably flat.

@Dreikanter 12% of adults have cranial asymmetry. So doing nothing doesn't correct the asymmetry. As I said, it becomes unnoticeable because we don't view adults from the top down, plus hair covers it. But will an asymmetry of 16mm correct itself? No. There are plenty of studies to show this.

Unfortunately, the NHS is behind the curve with this. It doesn't help that there are flawed studies which conclude helmets don't help. But there are flawed studies which claim all sorts of things - I have a PhD and I know first hand that just because it is published doesn't automatically make it true.

12% of adults have cranial asymmetry. So doing nothing doesn't correct the asymmetry.

But mild cranial asymmetry is purely cosmetic, yes? Why go through uncomfortable and costly treatment for something that doesn’t affect normal development and is unnoticeable once an adult?

Unfortunately, the NHS is behind the curve with this.

Where is the definitive evidence proving that it’s a worthwhile and effective treatment?

Countries like the US, where the medical insurance industry will fuel uptake of treatments, aren’t comparable to the UK, where clinical evidence of benefits have to be demonstrated to justify the cost.

Everyone’s bodies are asymmetrical. We don’t bind kids feet so they don’t end up a half size different to each other. We don’t have scores of women having boob jobs because one boob is slightly larger than the other.

In terms of studies, the ones I’ve read were not terrible, and given the potential money involved it’s interesting that the companies that recommend these helmets haven’t made sure a robust study is performed to show the benefit.

Both my kids had pretty severe plagiocephaly. They are now 3 and 6. Are their heads totally symmetrical? Absolutely not, but the improvement since they were babies is very marked. Is it really noticeable to the naked eye, with a full head of hair? Nope!

I’d be interested to know if you have any conflicts of interest @Speedyshoes

The 2019 NICE guideline NG127 includes this section on plagiocephaly:

Recommendation 117 – Positional plagiocephaly
Making a positive diagnosis of positional plagiocephaly allows the parents to be advised on how to change the child’s position to prevent further moulding. By identifying positional plagiocephaly early and allowing parents to reposition their child frequently, the degree of moulding will be limited. This removes the need for parents to seek expensive orthotic assessment (including radiation) and treatment for what is a benign and preventable condition.

And:

The committee does not recommend referral for investigations or management for a condition that has an excellent prognosis over time.

The committee made these recommendations by consensus following an evidence review that did not yield any relevant clinical or economic evidence.

@Dreikanter
Even significant (i don't personally like the term severe, because there are no medical consequences, so to me it seems emotionally loaded) plagiocephaly has no medical consequences.
Why do something about it? Because of how some parents feel. I hated the way my daughters head looked. It changed how I felt about her. It kept me awake at night. I thought everyone was judging me. Initially, I thought it was my fault and that I had "broken" her. Even once I had learned that it was purely cosmetic (ie no medical consequences) that didn't change how I felt about the LOOK of it. I know, from talking to other parents, that I am not the only one. Does that make me shallow, or superficial? Quite possibly. But I couldn't change it. What I could change, with my disposal income, and available time, was the shape.

What the NHS consistently fails to take into account is that emotional toll. There probably is a way to measure it, but I don't know how, I am not a social scientist.

The NHS has been recommending repositioning for 30 years. With a child with torticollis, it is futile. My daughter could not physically look the other way. I had her in Physiotherapy from 6 weeks old, but she still flattened. The constant insistence by the NHs that you can reposition, drives parents (who believe the failure is down to them) to desperate measures, buying unsafe pillows or wedging the cot mattress. The incidence of flattening has remained unchanged since the advice to reposition was first introduced - as a strategy it has demonstrably been found wanting.