Why Are More Babies Wearing Helmets?

The Rise of Flat Head Syndrome

One main reason positional plagiocephaly or skull deformity (flat head syndrome) is increasing is because of the success of the American Academy of Pediatrics (AAP) "Back to Sleep" campaign. Started in 1992, AAP recommended that parents put babies to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). This advice has lowered the number of SIDS cases.

However, it has also caused more babies to develop flat spots on their heads when they're a few months old because they spend more time lying on their backs.

What Causes Flat Head Syndrome?

According to the APP, several factors contribute to the development of flat head syndrome, including:

• Sleeping on the back: To reduce the risk of SIDS, babies sleep on the back or side of their head for many hours, which can lead to flat spots.
• Multiple births: Twins or triplets have less space in the womb, which can cause their heads to get flat spots before they are born.
• Prematurity: Premature babies have softer skulls and are more likely to develop flat spots while lying on their backs during their NICU stay.
• Tight neck muscles: Muscular torticollis (wryneck) can cause a baby's head to turn and rotate to one side.

The Role of Tummy Time for Infants

Creating a safe environment for babies to grow and develop is one of most important things you can do as a parent or caregiver. Tummy Time is when babies who are awake and being watched closely by a responsible adult, lay on their stomachs for short periods of time throughout the day in order to develop the muscles they'll need to roll over, sit up, crawl, and walk.

"Tummy time is very important to prevent flat head syndrome. When your baby spends time on their stomach while awake and supervised, it helps strengthen their neck, shoulder and arm muscles," says Margaret Grell, MD, team leader at the Cleft and Craniofacial Program at Joe DiMaggio Children's Hospital. "This helps their motor skills develop and reduces pressure on the back of their heads. Pediatricians recommend newborns to 3 month olds have 3- to 5-minute sessions a few times throughout the day, and increase that time to 15-30 minutes each day as they get stronger and older."

Helmet Therapy for Babies

Sometimes, repositioning and tummy time are not enough to fix flat head syndrome. In these cases, your infant might need helmet therapy. Helmets are custom-made devices that gently mold the shape of a baby’s skull as it grows. They are usually worn for 23 hours a day.

Babies under 3-4 months are generally too young for helmet therapy. However, if your doctor finds that the flattening is severe enough, babies can wear them as early as 4 months old up to 12 months.

If your baby has surgery for craniosynostosis, your doctor may recommend helmet therapy afterward to help further correct the head shape.

Why the Increase in Helmet Use?

More babies are using helmets because there is more awareness and diagnosis of flat head syndrome. Advances in medical technology have made helmet therapy more accessible and effective. Parents are also more aware of the long-term cosmetic effects of untreated flat head syndrome, so they seek early treatment.

Signs Your Baby Might Need Helmet Therapy

Not all babies with flat spots need helmet therapy. Mild cases often get better on their own with repositioning and as the baby grows. A pediatrician or specialist can help decide if your baby needs helmet therapy. Here are some signs your baby might need helmet therapy:

1. A flat spot that doesn’t improve with repositioning by 4-6 months of age.
2. An uneven head shape, with one side flatter than the other.
3. Misaligned ears, with one ear pushed forward.
4. A bulging forehead on one side.
5. A noticeable bald spot on the flat area of the head.
6. Difficulty turning the head to one side, which might mean stiff neck muscles (torticollis).
7. Moderate to severe flattening that doesn’t improve with repositioning and tummy time.
8. The flat spot is still there after 4 months of age

While the increase in flat head syndrome might seem worrying, it is a result of successful SIDS prevention strategies. You can help prevent flat head syndrome by including tummy time in daily routines – and be careful about how long your baby spends in carriers.

For those who need it, helmet therapy is a safe and effective way to ensure babies grow up with nicely shaped heads. Visit our Cleft and Craniofacial Program for more information to determine if your baby needs to be referred to a craniofacial plastic surgeon or the craniofacial team.