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Plagiocephaly (Baby Flat-Head): Treatment with a Corrective Helmet

What is plagiocephaly?

Plagiocephaly (say: play-gee-o-SEFF-ah-lee) is asymmetry (unevenness) in the shape of a baby's skull. It is also known as "baby flat-head."

Positional Plagiocephaly
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A part of your baby’s skull can become flattened if your baby is always on his back or prefers to look in one direction.

What is a corrective helmet?

A corrective helmet is a type of orthosis (medical device). It is custom-made to treat plagiocephaly in children with moderate to severe skull asymmetry. The helmet is designed to reshape the skull over time.

How long will your child need to wear the helmet?

Your child will likely need to wear the helmet for 4 to 6 months. It is recommended that your child wear the helmet between 18 to 22 hours per day. Your orthotist will give you specific recommendations based on your child’s needs.

Orthotic Helmet
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First visit: measuring and casting

An initial visit with an orthotist is needed to measure your child’s head and make a cast for the helmet. Measurements of your child’s head are taken with the aid of a measuring tape made of cloth and a pair of calipers (a measuring tool). This takes about 20 to 40 minutes.

Measurements

Two measurements of your child’s head are taken:

  • the circumference (the distance around the skull)
  • the distance from the nose to the left and right ears

Casting

The casting of your child’s head is done in 3 stages:

  • Two layers of cotton stockinette tubing (cotton material) will be pulled over your child’s head and a hole will be cut out for the face so that your child can see.
  • Marks will be put on the stockinette with a permanent pencil. These marks will be on the forehead, back of the head, centre of each ear, and around each ear.
  • Finally, strips of plaster bandage are wrapped around your child’s head. This is called “casting.” The bandage becomes hard and is simply lifted off your child’s head without any cutting tools.
Stockinette
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Two layers of cotton stockinette tubing are put on your child, with a hole cut for the face, in the process of creating a cast for your child's helmet.

The casting procedure takes about 20 minutes. The casting process can be a little messy. While we try to protect your child’s clothes as much as possible, we recommend that you dress your child in old clothes for this process.

Second visit: fitting the helmet

A return visit is needed to make sure the helmet fits properly. This visit will be booked 2 to 3 weeks after the initial casting visit. At this visit, you will be taught the proper use and care of the helmet.

The total time required to properly fit your child’s helmet is between 2 and 2 1/2 hours

The helmet will be placed on your child’s head a number of times to allow the correct trim lines to be established. Once this is complete, the helmet will be finished by sanding the edges, adding straps, and splitting the helmet in the appropriate position.

During the final stage of the finishing process, you are free to take a break. When you return, you will be taught how to use and care for the helmet.

  • initial fitting (45 minutes): you and your child need to be there
  • final finishing (1 hour): you and your child can take a break
  • parent instruction (30 minutes): you and your child need to be there

Follow-up visits (30 minutes to 1 hour)

You will have a follow-up visit with your orthotist 3 weeks after the fitting and then every 4 weeks until the end of treatment. Your child’s head will be examined for shape changes. Measurements of your child’s head circumference as well as the distance from the bridge of the nose to left and right ear will be taken. There may be adjustments made to your child’s helmet at these visits.

Becoming comfortable with the helmet

Most small children do not like wearing anything on their heads. It will likely take 3 to 7 days to get your child used to wearing the helmet for 18 to 22 hours a day. For the first few days, have your child wear the helmet as long as possible (half an hour to 1 hour). Anticipate a sweaty head during these first few days.

If your child gets cranky, take off the helmet for 20 minutes, then put it back on. Increase wear time until your child is wearing the helmet only when he is awake. Then, have your child wear the helmet during waking hours and during daytime naps.

Lastly, have your child wear the helmet while sleeping through the night as well as during waking hours and nap hours. Remove the helmet for “tummy time." The helmet may tip forward, making it hard to see when crawling.

Putting the helmet on

  1. Unlock the locking strap over the slotted area of the helmet (where the helmet separates into 2 halves down the middle).
  2. Spread the slot slightly as you put the helmet on your child’s head.
  3. Do up the chin strap. Put your finger between your child’s chin and the strap to prevent pinching when snapping the strap into place. Tighten properly.
  4. The chin strap should not pucker under the chin when the plastic loops that the strap is attached to are pressed towards the cheeks. To check the tightness, hold onto the holes and pull. The helmet should not move more than half an inch. Over time, the strap will stretch and may need to be tightened.
  5. Align the upper edge of the cut-out for the face along the eyebrow line.
  6. Align your child’s ears evenly in the ear cut-outs.
  7. Tighten the slot and lock it in position. Your orthotist will demonstrate this for you.

For the first 3 weeks, do not expect the helmet to stay in position. It will tend to rotate and may tip to one side because the inside of the helmet is symmetrical (even) but your child’s head is not. As your child’s head begins to change shape, the helmet will start to rotate back in the other direction until it will stay in the proper spot.

Taking the helmet off

  1. Unlock the closure strap over the slot (where the helmet separates into 2 halves down the middle).
  2. Undo the chinstrap.
  3. Spread the slot open slightly and remove the helmet.

Things to watch for

The helmet will tend to create red spots on your child’s head. These areas will be red whenever the helmet is worn. These spots may go deep red but they should not blister, swell excessively, or become an open wound. If this happens, discontinue the use of the helmet and call your orthotist as soon as possible.

Use and care instructions

Precautions

  • The tension on the slot in the helmet (where the helmet separates into 2 halves down the middle) must be adjusted 3 to 4 times a day. During the day, the head will get bigger due to increased water volume in the tissues. If the tension of the helmet is not adjusted to make room for the larger head size, the helmet may become too tight, causing too much pressure on the skull. This may cause a headache or in extreme cases, vomiting. Your orthotist will teach you how to adjust the tension on the helmet. Do not re-centre the helmet more than 4 times a day.
  • Since the head regulates body temperature, you must check that your child is not overheating with the helmet on. You may need to use thinner clothes and blankets. Watch for heat rashes.
  • If your child has a fever, do not put the helmet on your child until the fever is gone.
  • Be careful not to be knocked in the face when you are close to your child while he is wearing the helmet. The helmet is very hard and can hurt you if you are hit by it.
  • There will be redness on your child’s head. Lotion can be applied to the red spots.

Keep the helmet clean

Keeping the helmet clean is very important to decrease the risk of bacteria caused from sweating. The following steps will keep your child’s helmet as clean as possible:

  • Wash your child’s hair once a day.
  • Wipe the inside of the helmet twice a day with an antimicrobial sanitizer on a damp cloth. Wipe vigorously and allow to air dry.
  • After cleaning, dust the front of the helmet (forehead area) with corn starch to allow the skin on the forehead to glide more easily along the helmet.
  • Wash the chin strap once a week in the washing machine. Do not place it in the dryer, as the elastic will deteriorate. Make sure the dome is facing away from the skin when putting the strap back on the helmet.

Decorating the helmet

Feel free to decorate the helmet with car model paint or stickers to make it more pleasing for your child. Car model paints are available at craft supply stores. Remember to plug the ventilation holes if you are spray painting the helmet.

Other reminders

  • The helmet can be removed for up to 6 hours.
  • Your child can sleep in any position with the helmet on.
  • Check your child’s head position with the helmet on in the car seat. If the neck is tilted too far forward, you may need to remove the helmet when riding in the car seat.
  • The helmet will spin off centre at first. This is normal. Over the period of 3 to 4 weeks, the helmet will spin less as your child’s head changes shape.

If you have any questions or concerns, call your orthotist.

Key points

  • A corrective helmet can help treat your baby's plagiocephaly or "baby flat-head."
  • The helmet is designed to correct the shape of your child's skull over time.
  • Your child will likely need to wear the helmet for 4 to 6 months.
  • You and your child will need to visit the orthotist several times to measure, cast, and fit your child's helmet.

The Certified Orthotists at the Centre for Orthotics and Medical Devices

12/29/2009

At SickKids:

How much the helmet costs

In Ontario, OHIP does not cover any of the cost of the corrective helmet; however, most extended health insurance plans may cover all or a portion depending on your coverage. Ask your orthotist for an insurance letter to submit to your insurance company for coverage. If you need help to pay for the helmet, visit our reception desk for a listing of charitable organizations that may assist you.

A minimum of 50% of the payment for this device is expected at the time of the casting. The remaining 50% of the cost is expected when you receive the helmet. We are unable to bill your insurance company directly.

Please visit or contact The Centre for Orthotics for further information on pricing.

All proceeds from orthotic treatment at The Centre for Orthotics go to support patient care and research at SickKids. For more information, please see www.centrefororthotics.ca.

 





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