Q: My GP said that the flat spot will go away by itself and some recent research showed that helmet treatment is no better than repositioning only. Is this right?
A: Your GP is right for most babies: about 20% of infants aged 4 months now have some degree of flattening at the back of the head. In most cases, without a helmet, this will resolve itself by the age of 2 years. However, about 3% of children will continue to have flattening. That is about one child per school class. Previous research has constantly shown that helmets are more effective than repositioning alone. However recent research from the Netherlands, (published in the BMJ 1 May 14), showed helmet v. no helmet results to be the same at aged 2 years. While we welcome this new research we note that it was on a small number of babies (42 in helmet, 42 no helmet) with moderate to severe plagiocephaly/brachycephaly. It did not include babies with very severe flattening, premature babies or babies with torticollis (neck stiffness) or dysmorphic features. Many of the babies treated in the UK with helmets would therefore not be included in this study. Also in this study, at the end of the helmet treatment, none of the babies measured in the normal range. With the LOCband, the cranial remoulding helmet which I use, however, all babies who complete treatment have measurable improvements to their head shape and many reach the normal range.
Q: I never see bald men with flat heads, so surely it is not such an issue?
A: “Flat head syndrome” is relatively recent and thought to be a direct consequence from the “back to sleep” recommendation where parents are advised to lay their babies on a flat firm mattress, lying on their back. This advice first came out in 1991 in the UK and was widely taken up a few years later, so hence not many people with flat head syndrome have yet reached adulthood.
Q: “Is flat head syndrome” just a cosmetic problem or does it cause brain damage?
A: Some studies show that children who displayed deformational plagiocephaly as infants have a slightly higher risk of requiring special education assistance at school. However it is not yet known whether plagiocephaly/brachycephaly cause the delays or whether the delays encourage the development of the cranial asymmetries.
Q: Are there any concerns if the head is left untreated?
A: Apart from cosmesis, an unusual head shape may make fitting safety helmets (e.g. bicycle, motorbike, work hats, police/army helmets) more difficult.
Q: Does the helmet hurt the baby?
A: Babies often adapt to the band very quickly and it should not be painful. Any red marks are monitored by the parents and the helmet is adjusted as required.
Q: How is the helmet made to fit the baby?
A; Scanning technology is used to obtain a 3D image of the baby’s head. This is a quick and safe procedure. From this image a model is made which is used to manufacture the customised cranial band. Images are also used for recording the before and after shape.
Q: How do I know if my baby needs a helmet?
A: Making a decision to embark on Cranial Remoulding Therapy can be difficult and naturally causes anxiety for parents. Hampshire Orthotics Ltd offers a free no obligation initial assessment for babies aged 3 - 18 months. During this time measures are taken to establish the severity and whether a cranial remoulding orthosis is recommended.
Q: What is the best age to treat?
A: The youngest is when baby has good neck strength and can sit (supported) with head remaining upright. This is usually around 3+ months old. In young babies, aged up to 7 months, the head is very flexible still and growing fast, so this is the ideal age for treatment and the time in a LOCband is only 3-6 months. For older babies, aged 8-18 months, treatment time takes longer 9 - 12 months and the correction may not be as good as with the younger babies. My advice is to try repositioning seriously for a month and if there is not reasonable signs of correction, then if you want the best chance of a normal head shape for your baby, don't delay and start helmet treatment if considered appropriate.
Q: What about physio, chiropractic and osteopathic treatment?
A: Many of the babies I treat see one of these health professionals in addition to the LOCband treatment and I believe a multiple team approach can only be beneficial (although there is no evidence to prove this yet). Find one that specialises in cranial work and babies.