A revolutionary study published last month supports the use of helmet therapy in the treatment of flat head syndrome. What does this mean for you and your baby, asks Steve Mottram, Consultant Orthotist and Managing Director of Technology in Motion, and why does the advice provided to parents remain so inadequate?
Ever seen a baby wearing what appears to be a crash helmet and wondered why? Unless you happened upon a particularly accident-prone child, chances are (s)he was undergoing helmet therapy for flat head syndrome.
Also known as plagiocephaly or brachycephaly, the condition affects nearly half of babies to a greater or lesser degree. Because the skull is still relatively soft, extended periods spent sitting or lying with the head resting in the same position can eventually causes a flat spot to emerge.
The deformity can usually be prevented or reversed in the early stages by taking pressure away from the flattened area through what is known as repositioning. In mild and moderate cases, and if started early enough, this will allow for good improvement. However, in severe cases and for infants over six months of age, repositioning becomes less effective – and this is where helmet therapy comes in.
The infants’ flat head treatment involves wearing a custom-made helmet (cranial orthosis) over a period of three to six months. This gradually allows controlled natural growth to correct the position and shape of the skull bones, giving a safe, gentle and permanent correction.
What does the new study add?
The study, published in the Plastic and Reconstructive Surgery (the Journal of the American Society of Plastic Surgeons), provides the strongest evidence yet in support of helmet therapy where conservative (repositioning) therapy has failed.
Steinberg and his team followed the progress of over 4000 patients with plagiocephaly and/or brachycephaly. Some had been assigned repositioning (alone or with physiotherapy) and others helmet therapy. The aim was to achieve a complete correction in each scenario – even if this meant referring patients for another form of treatment partway through the investigation.
The researchers compared patients’ head shape measurements and rates of correction throughout treatment. While repositioning alone achieved acceptable correction in 77.1% of cases, 15.8% of patients required helmet therapy and were moved into this treatment group.
94.4% of the infants who started in the helmet-treated group achieved full correction, as did 96.1% of those who were transferred from the repositioning group into the helmet-treated group.
The researchers also analysed the cases in which conservative and/or helmet therapy had failed. In both scenarios, the two most common reasons were that (a) clinical guidelines had not been followed correctly, and (b) treatment had been delayed until after the recommended age.
In spite of this clear evidence, many of the parents we see tell us that they would not have even heard of helmet therapy had it not been for recommendations from friends and family. Many have been actively discouraged from seeking treatment by their doctor or health visitor, and several feel that their concerns have been ignored or ridiculed. Some have even been accused of being vain.
Why is it that parents are still not being provided with up-to-date advice on the options that are available to them in a neutral and helpful manner? Helmet therapy is a recognised treatment for flat head syndrome throughout much of the developed world, including the USA, Australia and Germany, so why not here?
The NHS website (updated 29/04/2014) advises that:
“The use of helmets and headbands is controversial, and they’re not available on the NHS. This is because there’s not enough evidence to show whether a helmet or headband will make any improvement to the shape of your baby’s head if [repositioning is] taken early on.”
This throws up more questions than answers. Why is treatment seen as controversial? Surely the new study provides some pretty convincing evidence that helmet therapy works, even after a correctly implemented course of repositioning?
The lack of awareness surrounding helmet therapy appears to stem from the outdated advice that is being put forward by the NHS, and by the extension of other healthcare professionals.
So, what can be done for babies with flat head syndrome?
Let’s be realistic here; we’re not suggesting that the NHS reaches into its already shallow pockets to fund the treatment. What we do propose is an urgent rethink regarding the advice that is being provided to parents, so that they can at least make informed decisions rather than finding out what they could have done when it’s too late.
Moreover, the longer health care organisations continue to avoid the issue, the more cases we’ll see of questionable practitioners seeking to take advantage of desperate parents – a phenomenon that already is not unheard of. And without standards to adhere to, there is absolutely nothing to stop these people from cutting corners, potentially harming their patients in the process.
So, what can you do to improve your own understanding and come to a position whereby you can make your own informed decisions? How can you help spread awareness of the issue and encourage others to do the same?
Do your research. Trust your instincts as a parent – they’re there for good reason. Talk to friends and family. Show them this article. Spread the word about your own experiences. The more people are made aware of the issue, the sooner it will be taken seriously – and, all being well, the sooner action will be taken.
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