In a new study, researchers advise against using corrective helmets for babies with positional skull flattening, after finding there wasn’t any noticeable difference in outcomes of babies who had helmet therapy and those who didn’t have therapy.

Parents who have children with positional skull flattening may opt to have their children wear corrective helmets. According to a new study, published in the journal BMJ, babies with this condition do not benefit from wearing these helmets. In fact, the study found that at two years of age, children who have no treatment have similar outcomes.

Skull deformations, known as positional skull deformation or plagiocephaly, occur in about one baby in five under the age of six months, as a result of lying in the same position for long periods. The condition has become more common as a result of campaigns, such as Back to Sleep, which advise parents to lay their babies on their backs to sleep to reduce the risk of sudden infant death syndrome (SIDS).

Positional skull deformities can develop in the early months of life because a baby’s skull is growing fast and the skull bones are still soft enough to change shape as a result of pressure.

The researchers, based in the Netherlands, studied 84 healthy full-term babies who had a moderate or severe positional skull deformation – either plagiocephaly, where one side of the head becomes flattened and the ears can become misaligned, or brachycephaly, where the back of the head is flattened and the front of the skull may bulge.

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Beginning at age six months, half the babies wore rigid, custom-made, closely fitting helmets for 23 hours a day for a six-month period. The other half did not receive treatment.

At two years of age, detailed measurements of their head shape showed no significant difference in the degree of improvement in skull shape between the two groups.

The researchers reported no significant difference in the two groups’ recovery from treatment. About 25.6 percent of babies who had helmet therapy had a full recovery at two years of age, compared with 22.5 percent of those who didn’t have any treatment. Both groups showed similar improvements, although only a quarter made a full recovery to a normal head shape.

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According to the study, all of the parents whose babies wore a helmet reported side effects. Skin irritation was reported by 96 percent of parents. Seventy-seven percent of parents said they felt hindered from cuddling their baby. An unpleasant smell was mentioned by 76 percent of parents, while sweating was reported by 71% percent of parents. Finally, almost one third said pain was a side effect.

When it came to being satisfied with their child’s head shape at two years of age, parents of both groups were generally satisfied. The average satisfaction score was 4.6 out of 5 among those whose babies had worn helmets compared with 4.4 among those whose babies had no treatment.

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Commenting on the greatest impact of the study’s findings, lead study author Renske van Wijk, MSc., Department of Health Technology and Services Research at the University of Twente, told Healthline,“Based on the equal effectiveness of helmet therapy and skull deformation following its natural course, and high prevalence of side effects, such as skin irritation, problems with babies accepting the helmet, and parents feeling hindered from cuddling their baby because of the helmet, as well as the high costs associated with helmet therapy, we discourage the use of a helmet as a standard treatment for healthy infants with moderate or severe skull deformation.”

When queried whether the researchers were surprised by any of the findings, van Wijk said, “We were surprised that we didn’t find any relevant differences between groups. Furthermore, at the age of two, only 25 percent of infants who were included in the study showed full recovery. Despite this, parents of infants in both groups showed high satisfaction scores, on average 4.5 out of 5, with their infants’ head shapes.”

“For parents of five- to six month-old infants with moderate or severe skull deformation, we would discourage helmet therapy in healthy infants. But parents with concerns should always speak to a doctor,” said van Wijk.

Emphasizing that it remains vital for parents to continue laying babies on their backs to sleep to reduce the risk of SIDS, van Wijk said, “Additionally, it should be advised to put a baby on its tummy while awake from an early age on to prevent positional skull deformities. Furthermore, changing sides when bottle feeding and altering the position of the head each sleep (left to right) are important prevention measures for positional skull deformation, but can also be used when a deformation has been detected. When you have concerns about a positional preference or flattening of the skull, don’t wait, but ask for advice on (re)positioning your infant.”

In an editorial, accompanying the article on the study, professor Brent Collett, Ph.D., from the University of Washington School of Medicine, said parents would want to know whether treatment would result in improvements above and beyond what would be expected by not doing anything at all.

Collett went on to say future research is warranted to learn whether children with the most severe PPB (positional plagiocephaly and brachycephaly), who were excluded from this trial, show meaningful improvement. Additional work “incorporating behavioral and public health strategies to promote ‘tummy time’ and similar positioning strategies should be explored,” concluded Collett.

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