Plagiocephaly: to Helmet or not to Helmet?

October 1, 2018

Mum and baby with TiMbandTrying to decide whether to give your baby plagiocephaly treatment with or without a helmet is by no means an easy task. Conflicting attitudes and opinions from GPs, HVs, the press, private clinics and other parents can often serve to heighten the anxiety – no matter how honourable the intentions behind their advice might be.

It’s like an emotional seesaw. Do you follow the mainstream view as championed by the NHS, and choose plagiocephaly treatment without a helmet in the knowledge that the deformity may not fully correct? Or do you place your trust in the private clinics that provide helmet treatment for those cases in which the condition doesn’t correct itself?

To investigate how parents are addressing this dilemma, we decided to explore some of the different reasons that are being given for and against choosing plagiocephaly treatment with a helmet. A considerable amount of time spent talking to parents and combing through social media pages, forums and comment threads has revealed to us just how diverse these reasons can be.

Many parents feel that they have damaged their babies in some way. The resulting guilt can colour their actions and make them hesitant to display their ‘failings’ by putting a ‘horrible helmet’ on their babies. To confound matters further, it is not uncommon for friends, family and grandparents to pick up, reflect and reinforce a parent’s own worries without being objective.

This is all understandable, but parents should know that by placing their babies on the back to sleep, they have followed good advice that has saved the lives of thousands of infants. They have not caused any harm and if there is a flattening, this can easily be corrected in much the same way that crooked teeth can be straightened, with early intervention giving a lifelong, permanent correction.

We have shared the various reasons behind parents’ decisions here in the hope that they will help guide you in your own choice. If nothing else, they should serve as a reminder that you’re not alone in all this.

Plagiocephaly treatment with a helmet

Plagiocephaly treatment with a helmetMany parents choose to go down the helmet route following an unsuccessful course of repositioning. In moderate and severe cases of plagiocephaly, there is a limit to how much can be achieved through repositioning alone and many head shapes are so severe that they will never catch up naturally. Such cases often begin with complications before and during birth, and the severity is such that the deformity cannot be fully corrected without further intervention.

There were also certain circumstances that prevented parents from being able to effectively implement repositioning. One little boy had a rare genetic condition that meant he had to spend a lot of time in intensive care, so repositioning was not an option for him. Others had reflux problems or an untreated torticollis (tightening of one neck muscle), making repositioning unworkable. Worryingly, there were also many cases in which parents were not advised to reposition in the first place.

Here are some of the main reasons parents gave for choosing to treat plagiocephaly with a helmet:

  • Many parents were concerned about the questions their children might have in the future if they were to choose not to go ahead with treatment. One source said of her daughter: “I don’t want her to grow up and wonder why we didn’t do anything about it when the option to help her was there.”
  • Several were worried that their children might not be able to wear certain types of headwear later in life. One six year old girl who had previously undergone treatment now has a passion for horses. Her mother remarked that she would not have been able to wear a riding helmet had her head still been misshapen. The same could be said of a number of other activities and occupations, such as climbing, cycling and working in construction.
  • Most parents were concerned about the increased possibility of bullying later in life, and the effect that a head shape deformity might have on their children’s emotional and psychosocial wellbeing. One reported that hearing comments from people in the street triggered her decision to seek plagiocephaly treatment.
  • Some parents chose to treat plagiocephaly with a helmet because they were worried about the potential effects that the condition might have on their children’s neural development. While the exact nature of this relationship may be unknown, there does appear to be a link between plagiocephaly and motor delay, especially where torticollis is involved. (N.B. Treatment will not necessarily improve underlying problems such as these.)
  • Others were concerned about the cosmetic and functional deficits that have been linked with plagiocephaly, such as problems with the eyes, jaws and ears. Research confirms that plagiocephaly can be associated with deficits in middle ear function, jaw proportion, and visual abilities, but again, the causal relationship is not fully understood and there is no strong evidence of improvement in these areas following treatment.

A number of parents had family members with experience of plagiocephaly, which influenced their decisions when it came to their own children. One mum had a cousin with a nine-year-old son, whose deformity remained very noticeable in spite of the doctor’s earlier advice, so she decided to treat her own son. Another parent decided to go ahead with treatment after seeing the difference it had made to the child of another family member.

Plagiocephaly Treatment Without a Helmet

Plagiocephaly treatment without a helmetIn 77% of cases, milder plagiocephaly can be corrected sufficiently without the need for a helmet, through what is known as repositioning. Provided the deformity is mild and repositioning is started early on, the head can usually be returned to within the ‘normal’ range before the bones in the skull begin to harden and the infant starts to move around more independently.

For this reason, many parents choose to try plagiocephaly treatment without a helmet, and instead reposition until the head returns to an acceptable shape. However, there are also cases in which parents do not seek helmet therapy even when the deformity is moderate or severe. This can be for any number of reasons:

  • Some are not aware that this option exists at all, or don’t find out about it until it’s too late. The time lag for referrals to paediatric specialists, neurosurgeons and so on has left many parents unaware of the scale of their children’s deformities and the options that are available until the critical early stage in their development has passed.
  • Many are hesitant about treating a condition that is generally considered to be cosmetic rather than medical. This often follows on from advice given by their health care providers, which leaves many parents with the unsettling feeling that they are being vain and putting their child through an unnecessary treatment.
  • A lot of parents are led to believe that the head shape will correct itself. On the contrary, a study published last year concluded that “only mild cases can be adequately treated by conservative, i.e. non-helmet, management.”
  • The cost of plagiocephaly helmets can be an issue for many parents, as is the lack of funding available. Funding is only provided by the NHS in exceptional cases, and the majority of private healthcare insurers follow their lead. Having said that, treatment costs remain stable and are comparable to many dental and orthodontic treatments, and there are a few charities that regularly provide assistance with fundraising, including Tree of Hope and Headstart4Babies.
  • Some parents get put off by the pushy selling tactics employed by some clinics and the fear of getting ripped off. One mum reported that the practitioner she went to see gave the impression of being a “charlatan salesman,” costing her trust in the profession as a whole.
  • Others worry about the possible discomfort that is sometimes attributed to wearing a plagiocephaly helmet. However, this is rarely a problem and only tends to occur if treatment protocols are not observed correctly.
  • Following the recent controversy surrounding plagiocephaly helmets in the press, several parents simply believe that the correction they give is no better than that which can be achieved through repositioning. The vast majority of the research carried out previously and since has refuted this. Provided treatment is started in the first 14 months and the correct procedures are followed, a visible, permanent correction can invariably be achieved.

We hope this post has clarified some of the points that you may wish to consider when trying to decide whether to opt for plagiocehaly treatment without a helmet or whether to choose helmet therapy for your child. If you’re still uncertain, there’s a substantial amount of literature online that may help guide you in your decision, including research papers, parenting websites, blogs and much more.

If you would prefer to speak to a specialist, Technology in Motion can help. We offer free evaluations to assess the severity of your baby’s head shape deformity, and unlike many other clinics, we won’t recommend treatment unless it’s actually needed. Even if treatment is recommended, we won’t pressure you into anything as we firmly believe that the final decision should be left to your well-founded intuition as a parent.

To arrange an appointment at your nearest clinic, or for more information on plagiocephaly treatment with a helmet, call us today on 0330 100 1800