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Experts Update Guidelines for Helmet Therapy

One of the most common worries among new parents is that their little one is developing a flat head. In fact, current studies indicate that 1 in 4 U.S. infants has some degree of positional plagiocephaly, or a flat head. So what should a parent do about it, if anything?

There are a few different causes of a flat head. Usually, infants’ heads are flat because they are always lying on them! The current recommendation to put your baby to sleep on his or her back has increased the number of babies with positional plagiocephaly. Sometimes babies are born with misshapen skulls because they were compressed in utero. Other babies have a condition called torticollis, where tightened neck muscles pull the head to one side, causing it to become flat on that side.

At one time, babies with plagiocephaly were routinely sent for helmet therapy. Helmets are fitted specifically for a baby’s skull based on precise measurements and worn up to 23 hours per day for several months. Because the bones in a baby’s skull are not yet fused, the helmets reposition the skull bones into a more anatomically correct position. Usually, a pediatric neurosurgeon or craniofacial plastic surgeon would direct the course of treatment.

For many years, there were no clear guidelines about which babies should wear helmets, when they should be put on, and how long they should be worn. In fact, over time, “helmet therapy centers” began popping up, taking the care away from the physicians and into the hands of less experienced healthcare providers who had no physician oversight.

In October 2016, new guidelines were published in the journal Neurosurgery in an attempt to standardize treatment for babies with flat heads. Surprisingly, when scientists looked at the literature, they found that other, non-invasive treatments were just as, if not more, effective! Specifically, the current treatment recommendations include:

Simply moving the baby’s head to the other side or positioning objects so the baby looks to the unaffected side works well for many babies. This therapy usually works best in infants up to 4 months of age.

Physical therapy. Therapy has been shown to be effective in babies over 2 months old who do not respond to positioning, especially babies with torticollis as a cause of their flat heads.

Helmet therapy. In the most current recommendations, helmets are recommended only for infants with persistent moderate to severe plagiocephaly if other more conservative therapies fail by six months of age. Helmets are also recommended if the baby is brought to medical attention at a later age (over 8 months old).


  • Guidelines for management of patients with positional plagiocephaly
  • Congress of Neurological Surgeons.
    New guidelines review evidence on PT, helmets for positional plagiocephaly
  • AAP News.

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