Helmeting/Helmet Therapy

Helmet therapy, or helmeting, uses a custom-fitted brace to help gently mold your baby’s skull into a more typical shape. It’s to help your baby’s appearance. It doesn’t affect their development.

The helmet provides a guide for skull-shaping while your baby’s head is actively growing. Infant heads grow most quickly during their first year of life, so your baby’s treatment needs to happen during that time. After that, a baby helmet won’t affect head shape.

Your baby may need to wear a helmet for two main reasons: positional skull deformity and craniosynostosis.

Positional skull deformity

Babies’ heads may become flat or uneven from positioning in the uterus, challenges during labor and delivery, or spending a lot of time in one position. Types of head shapes include:

• Plagiocephaly: A head that’s flatter on one side, also known as “flat head syndrome”
• Brachycephaly: A wider head that’s flat across the back of the skull
• Dolichocephaly: A longer, narrower head shape

Craniosynostosis

Craniosynostosis is when your baby’s skull bones fuse too early. Your baby’s primary care provider will help guide this diagnosis. As your baby’s brain grows, their head takes on an abnormal shape. In some cases, it may affect your child’s brain growth. Your baby will need surgery to correct the issue. They may need helmet therapy after the surgery.

How do I know if my baby needs a helmet?

Your baby’s pediatrician will examine their head shape and growth. If the flattening is mild, they may suggest changing your baby’s position more often.

If your baby has tight neck muscles (torticollis), they’ll recommend starting physical therapy. Your baby may need to work with a physical therapist throughout their first year of life. This is to make sure the muscle tightness doesn’t affect their growth and development.

Your child’s provider may refer you to an orthotics specialist who’ll be able to help you make the decision regarding a helmet if:

• The flattening is moderate to severe
• The flattening doesn’t improve with position changes or physical therapy
• Your baby is older than 8 months

How does helmet therapy work?

Helmeting works by gradually guiding your infant’s skull into a more standard shape while their head is still growing. Your baby’s skull is made of flexible plates connected by joints (sutures). These sutures allow room for your baby’s rapid brain growth.

Because most brain and skull growth occurs during the first year of life, baby helmets are only effective during this period. The best results happen when therapy starts early in infancy, after 4 months old, when head growth is fastest. As your baby gets older, the plates of their skull fuse and their bones harden, so helmeting isn’t effective.

If your baby’s pediatrician thinks your baby would benefit from helmeting, they’ll refer you to an orthotist. Orthotists are healthcare providers specially trained to measure and fit helmets. First, the orthotist will measure the shape of your baby’s head. They may use computer scans to get the specific shape of your baby’s head. Then, they’ll design a custom-fitted helmet made of a hard outer shell with a foam lining.

A custom-fitted helmet creates space where your baby’s skull should expand. It fits snugly over the more rounded areas. As your baby’s head grows, adjustments are made to the helmet.

Does my baby need to wear the helmet all the time?

Your baby will build up to wearing the helmet for about 23 hours a day. During the first week, they’ll start off with an hour or two in the helmet and add more time each day. Most babies get used to wearing them very quickly. You should take your baby’s helmet off during their nightly bath. This is a good time for you to clean it with an alcohol wipe or gentle detergent.

Your baby’s helmet shouldn’t be uncomfortable. If your baby experiences any discomfort or skin irritation, you should have your orthotist adjust it.

How long does helmet therapy take?

The length of helmet therapy depends on:

• Your baby’s age at the start
• Their growth rate
• How severe their skull shape difference is

If your baby begins helmeting at a younger age, they may need a helmet for a shorter time. If therapy starts later (after about 8 months), treatment often takes longer.

In general, most babies wear a helmet for several months. But some may need more time to reach the desired head shape. Your child’s orthotist will check progress at follow-up visits and adjust the plan as needed.

What are the potential benefits and downsides of this treatment?

Helmeting can be very effective, especially when your baby starts the treatment early, and you use it as instructed by their provider. But it requires a significant amount of your time and energy. Helmeting might also not fully correct severe deformities.

Potential benefits include:

• Corrects unevenness: Helmets help redirect growth in flattened areas of your baby’s skull, improving head shape appearance.
• Better outcomes with early use: Starting therapy earlier (around 4 to 6 months) generally leads to faster, more accurate results.
• Supports severe cases: Helmeting is especially helpful when other measures like repositioning or physical therapy aren’t enough.

Potential downsides include:

• Requires reliable care: You baby must wear the helmet up to 23 hours a day. You’ll need to provide consistent care and support for your baby.
• Extended treatment time for late starters: Older infants often need longer therapy, and treatment may not be as successful.
• Time commitment: Managing your baby’s helmet and attending frequent follow-up appointments requires additional time and energy.

Is there anything I can do to make this treatment easier on my baby?

Most babies get used to the helmet right away and don’t experience any discomfort. You can add stickers or decals to your baby’s helmet to personalize it. To ensure the treatment goes smoothly, use the following tips:

• Proper fit: Confirm the helmet fits correctly at your first appointment. Make sure adjustments are made as necessary at follow-up appointments. Don’t try to fit the helmet at home.
• Consistency: The helmet will be most effective if your baby wears it 23 hours a day. You can help your baby gradually get used to it.
• Monitoring: Check your baby’s scalp every day for skin discoloration or sores. Also, keep the helmet clean by wiping it down as instructed.

When should I call my baby’s healthcare provider?

It’s normal for skin changes or mild indentations to appear for a few minutes after you take off the helmet. Call your orthotist immediately if:

• Your baby has any skin irritation, including persistent redness or skin discoloration, sores or swelling
• Your baby shows signs of an infection, including fever, warmth or tenderness under the helmet, pus or a foul odor
• The helmet feels too tight or too loose, it shifts or slides frequently, or it leaves pressure marks on your baby’s scalp
• Your baby is excessively fussy or cries when the helmet is on, refuses to eat or isn’t sleeping
• Your baby shows signs of pain or discomfort that you can’t relieve with the usual soothing methods

How much does helmet therapy cost?

The cost of helmet therapy can range based on several factors, including the cost of the helmet itself and follow-up visits for adjustments.

Insurance coverage varies. Contact your insurance provider to check which orthotic companies are members of their network. When you start the helmet process, be sure to ask the orthotics company if there’s any out-of-pocket cost. Some plans help cover the cost. But others don’t, and you might have to pay out of pocket.