Family Matters

Do Babies with Flat Heads Need Helmets?

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Anyone who’s surmised that putting babies to sleep on their backs has contributed to the increase in babies’ flat-headed noggins can’t be blamed for making the connection: the spike in plagiocephaly has largely coincided with the “Back to Sleep” campaign, launched in 1992 to lower infants’ risk of sudden death.

The most recent statistics find that 13% of healthy babies now have flattened skulls — it’s to the point that doctors are paying attention. But flat heads, while not desirable, are certainly better than the alternative, as neurosurgeon Joseph Piatt, who was chairman of the American Academy of Pediatrics’ (AAP) section on neurological surgery when its policy statement on plagiocephaly was drafted, told Healthland earlier this year: “The AAP perspective on this is that babies with funny-shaped heads are better than dead babies, from a public-health standpoint.”

The AAP’s “Back to Sleep” campaign, which encouraged parents to put babies to bed on their backs instead of their bellies as a way to decrease cases of sudden infant death syndrome (SIDS), has in fact helped drops SIDS cases by 50%. But as babies’ heads have simultaneously become curiously flatter, they’ve sparked an industry of expensive, unwieldy correctional helmets. (Despite the coinciding of Back to Sleep and plagiocephaly, some researchers believe that the rise in flat heads is due simply to increased awareness of the condition.)

Now an updated report released Monday by the AAP advises that in most cases, these scary-sounding “positional skull deformities” can be successfully treated with physical therapy and some other tweaks — no orthotic helmets needed.

Perhaps you’ve seen the occasional infant wearing such headgear; it looks like a football helmet with an opening at the top for tufts of silky baby hair. Lucky tykes have parents who rely on colorful paint, stickers and a healthy dose of Mod Podge sealant to transform the sad-looking medical devices into childhood murals (when my son was a baby, I spent hours creating an underwater scene and a safari theme on his two helmets. If this was something he had to wear 23 hours a day, I wanted it to look cute.)

MORE: Babies With Flat Heads on the Rise: Is ‘Back to Sleep’ to Blame?

A lot has changed since my son was born in 2002. Experts now know that positional plagiocephaly can originate in utero, from growth restriction; at birth, particularly with a forceps or vacuum delivery; or in infancy if a baby spends too much time flat on his back. Most babies turn their heads often enough that no one spot flattens, but my son favored his right side to the extent that by the time he was four months, that segment of his head was nearly linear.

To compensate, we were advised to manually rotate his position in the crib, putting his head at one end for nap and the other for sleep to encourage him to turn his neck to see toward the interior of the room. Anyone who thinks handedness can’t evolve is wrong: my husband and I both re-learned how to change a diaper after we were instructed to put our son on the changing table in the opposite direction so that it forced him to turn his head to the left in order to see us. Parents can also manipulate a baby’s head from side to side, recommends James Laughlin, lead author of the AAP policy and a pediatrician in Bloomington, Ind. Speaking from personal experience, though, baby may not be too happy about that.

MORE: Controversial Posters of Babies with Knives Aim to Reduce Co-Sleeping Deaths

Yet it turns out that these steps, plus at least an hour a day of “tummy time” — supervised time when baby is placed awake on his tummy to strengthen his neck and shoulders — are all most babies need in order to self-correct. “Most of these kids don’t need invasive intervention,” says Laughlin. “Helmets can be uncomfortable and expensive, and studies that have looked at kids after age 3 haven’t shown a persistent molding effect that’s cosmetically noticeable.”

That said, the AAP advises that more severe cases can benefit from an orthotic helmet; if repositioning doesn’t make a difference by six months, the group recommends seeking a specialist’s opinion. My son got his first helmet at 6 months old. Our pediatrician was skeptical; so were we, yet we also reasoned that the helmet couldn’t hurt — and it just might help reshape a skull so flattened on the right side that I worried how my son’s brain could grow normally.

The helmet did appear to help — even the doctor acknowledged that — although it’s impossible to know how much my son’s skull bones would have rearranged themselves on their own. At 9 years old, his head remains flat, although thanks to a generous dusting of sandy-brown hair, it’s likely unnoticeable to anyone other than his parents.

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME‘s Facebook page and on Twitter at @TIME.


Just came across this article as we are going through a similar situation rt now. Bonnie, are you saying the helmet didn't help your son at all? Pls reply... thx


This is all BULL CRAP. Great, the USA Doctors have found yet another way of making money. It is selfish, misleading and cruel to scare new Moms into having these helmets (which are painful to the baby!) on their babys' head!! Hello? What did we do 50 years ago? Or 100 years ago? NOTHING and we all made it through life just FINE!!! This stupid "invention" reminds me of the glasses holder Steve Martins character invented in the movie "The Jerk". At first everyone wanted one, then it turned out, it made everyone cross-eyed. I HOPE Moms ignore their greedy Doctors advice. Their heads will be JUST FINE, as nature intended!!!


@DrDot Your comment is shameful.  You have no idea what you're talking about.  There is absolutely no research anywhere that suggests that a cranial helmet is painful for a baby to wear.  My daughter wore one and never once fussed or cried due to the helmet.  There are thousands of parents in support groups that have had excellent experiences with helmeting their child.  Plagiocephaly is not a cosmetic issue, it's a medical issue.  Many children that have misshapen heads and facial asymmetry have ear infections more than children that don't have Plagiocephaly.  They also have misaligned jaws that cause TMJ, which is painful.  What about the mental aspect of it?  Those are just a few things.  My daughter has severe Plagiocephaly and Brachycephaly along with a diagnosis of Congenital Muscular Torticollis (which she has PT for every week).  I can assure you I didn't leave my baby laying around and neglect her.  "Their head will be just fine..."  You tell that to the 2 and 3 year olds that I have seen at the Neurosurgeon/Craniofacial Plastic Surgeon's office that have severe Plagiocephaly that never corrected.  I guarantee you, if your baby had Plagiocephaly you would sing a different tune.  Lastly, don't talk about stuff you know nothing about because it only makes you sound ignorant. 


@jb2006 @DrDot 

Well said. These helmets absolutely have there place. What loving parent wouldn't spend the money? Adding a helmet to a child is medically proven to be one of the best ways to show everyone you're happy to throw away money on your special snowflake.

This placebo is worth every dollar.