For What Reason Do Infants Need Helmets? - Anna at Home

Although cranial helmet therapy is widely used in the United States, many foreigners are surprised to learn of its prevalence among American infants.

It may come as a surprise to some that cranial helmet therapy is widely used in the United States, but it is. Having had experience with neonatal and pediatric care in different parts of the world (my first son was born in Europe, second son was born in Mexico, but we also moved back to the US during their babyhoods) I was fascinated by baby helmets and debating what’s best for my own child based on quite a number of different medical opinions

The function of infant helmets

Baby helmets, or Cranial Remolding Orthosis (CRO), are used to help correct a child's skull shape by guiding the child's head growth in the right direction. As part of a treatment plan to shape the baby's skull, these devices may be recommended.

Each infant's helmet is measured and sized by a cranial specialist to accommodate future head development.

Baby helmets are designed to prevent craniosynostosis and plagiocephaly, also known as "flat head syndrome." The latter is the result of abnormal fusion of the skull's bony plates and is treated by surgical decompression followed by a course of helmet therapy.

About half of infants younger than a year old have plagiocephaly, but most cases improve with age.

As to why baby helmets are becoming more common, The rate of SIDS has dropped from 1 in 1,000 in 1992, when the American Academy of Pediatrics Task Force on Infant Positioning and Sudden Infant Death Syndrome recommended that healthy infants be positioned supine for sleeping, to 0 in 2017. A drop from 1992's 2 per 1000 live births to today's 0 56 births per 1000 in 2001

Positional skull deformity has increased dramatically along with the decline in sudden infant death syndrome; it now affects an estimated 13% of otherwise healthy singleton infants, making it a common problem for pediatricians to treat. Due to the prevalence of back-supportive baby products like cribs, swings, and car seats, more and more infants are developing flat spots on the backs of their heads.

For how long should infants be required to wear helmets?

Children between the ages of 1 and 4 months old should not wear helmets. Conservative treatments for flat head syndrome in infants 4 to 6 months of age may be exhausted before helmet therapy is considered.  

The majority of brain development occurs by age 2, so helmets won't help once that stage is over. They should be used on infants before the age of 6 months, preferably before the age of 2 months, when the skull is still malleable.

On average, infants wear their helmets for 23 hours per day, coming off only to take a bath, which is also an opportunity to clean the helmet.

There is no hard and fast rule about how long a baby should wear a helmet, as every child develops at a different rate. When using a helmet, the typical duration of treatment is three months.

Price of infant safety helmets

Very high price. Depending on your policy, a baby helmet can cost anywhere from $1500 to $4000. The topic is rarely discussed at all.

Clearly, not everyone can afford physical therapy or other medical appointments due to their high cost. The high price tag has led me to the conclusion that a baby helmet is a "luxury item."

The Benefits and Drawbacks of Using a Baby Helmet

In the United States, baby helmets are widely used, but in other countries, you'd be hard-pressed to find a child sporting one. A helmet is necessary for craniosynostosis, but why is treatment for plagiocephaly recommended as standard intervention for babies with plagiocephaly in the United States while babies elsewhere are expected to self-correct? In my opinion as a nurse, the answer lies in how the question is framed within the medical community.

Preventive medicine is emphasized in the United States, while in Europe and Latin America the emphasis is on curative medicine after the fact. In the United States, pediatricians frequently recommend baby helmets even if their patients are healthy, all in the name of "playing it safe"

Even if one or both of a set of twins doesn't have plagiocephaly, a helmet may be recommended as a safety measure.

Since studies on the benefits of helmets for skull deformities have yielded conflicting results, even within the United States, many doctors will have divergent views on the topic. Research shows that the rate of improvement in skull shape between the helmet therapy group and the control group is very close; however, all parents in the helmet group reported at least one side effect, such as parental anxiety, ear deviation, or skin irritation.

To avoid the need for a helmet, milder cases of plagiocephaly can be corrected by repositioning in 77% of cases.

Conservative measures, such as supervised tummy time while the child is awake and changing sides when the child sleeps, should be tried before resorting to a helmet unless the baby's case is severe. Taking the price into account, in particular

Should a child with a positional skull deformity only undergo helmet therapy?

It depends Altering your baby's normal position or beginning physical therapy may be helpful if the condition is mild.

The development of a child's brain or any other medical issue is unaffected by a positional skull deformity. It takes an X-ray scan to determine if there is damage to the brain. My son and I did this, and the doctor said he doesn't need a helmet while we work to fix the issue.

Babies diagnosed with plagiocephaly are often referred to physiotherapy. Babies with torticollis, which affects roughly 20% of babies with positional flattening, benefit greatly from physical therapy, specifically in the form of stretching and strengthening exercises.

When a baby has torticollis, the muscles in his or her neck are tighter and more contracted on one side, and the child turns his or her head to that side only.

After consulting with five doctors in the United States, Italy, Mexico, and Poland about my son's torticollis and plagiocephaly, all but one (you can probably guess which one) agreed we can avoid the helmet if we keep working on him based on a scan. After persistent turning, tummy time, and physical therapy, I'm happy to report that my son no longer has any noticeable skull deformities.

Is treatment with a helmet mandatory

In cases of plagiocephaly, the use of a helmet is always considered a voluntary treatment option. In some cases, it may prove useful, but this is not always the case. Without a helmet, the child's head shape may improve anyway, so parents shouldn't feel guilty if they can't afford one.

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