Cranial Orthosis Treats Abnormal Head Shape in Infants By Amit Bhanti, CPO

Many babies are born with an abnormal head shape as a result of the pressure exerted on them during their passage through the birth canal. Though the shape may correct itself within about six weeks of birth, in many cases, the head can remain asymmetrical. Plagiocephaly and BrachiocephalyBabies born with an uneven flattening of one side of the back of the head suffer from a condition known as plagiocephaly. Brachiocephaly is a similar condition that results in an even flattening of the head. Both of these are caused by repeated external pressure to one side of the head, causing a flat spot. They are often combined with an uneven bulging of the forehead on the opposite side of the flattening. Other than being present at birth, this condition is most often the result of babies spending a lot of time in a position where the back of the head is resting against a flat surface (such as a crib, stroller, swings and playpen). Because their heads soft to allow for brain growth during the first year of life, babies under the age of one are susceptible to their heads being “molded” into a flat shape. Treatment for some cases of plagiocephaly and brachiocephaly may entail simply repositioning your baby during sleep to encourage them to alternate their head position while on their backs. In addition, making sure your baby has plenty of supervised time on their stomachs not only helps the condition, but strengthens their neck muscles as well. However, for more serious cases or for those that progress beyond six weeks, your pediatrician may refer you to an orthotist for a custom-molded cranial helmet for your child. The cranial remolding helmetThe cranial molding helmet is used to remold the head into a symmetrical shape as the baby grows. It allows the flattened areas to round out and prevents the bulging areas from progressing. The helmet does not put pressure on the baby’s head, but guides the growth to specific areas to improve the head shape. Custom-fit and easy to put on, the helmet is usually worn 23 hours a day. This allows the device to capture as much growth as possible, while also making it possible for the baby to be bathed and clothed. It is important to slowly introduce the helmet to the baby by following an initial wearing schedule of an hour at a time with a ∏ hour break. During the break, baby’s skin should be checked for redness or irritation. If there are no problems, the wearing time can be increased by one hour to a total of two hours. This pattern should be followed until he or she can wear it for 23 hours per day. The baby should not sleep in the device

until he or she can comfortably wear it six to eight hours while awake. Babies usually don’t like the helmet at first, and parents have to be diligent in helping him or her get used to it. Unless the skin is irritated or there is persistent redness, the helmet is not hurting the child, and usually it becomes a part of their routine in a few days. In most cases, adjustments will need to be made to the helmet as the baby grows and the head shape changes.

The decision to discontinue wearing the helmet will be made by the physician in conjunction with the orthotist. Generally, success is measured when the head rounds into the symmetrical shape of the helmet or when the head has reached an acceptable degree of symmetry. It is not common for the head to revert back to its original uneven shape.

A very close follow-up schedule is maintained so the progress is monitored closely, and the treatment goes on until the sutures in the cranium fuse (cranial sutures are are the fibrous bands of tissue that connect the bones of the skull). Usually there is no shaping after that, so there is not much chance that the head will go back to flattened position. Typically once fusion happens, weaning from wearing the helmet starts. If parents see anything abnormal once the child has been out of the brace, they should contact their physician or orthotist.

It is very important to start treatment for these conditions early since the growth of the head slows down after the age of one. If your baby's head seems asymmetrical, and remains asymmetrical beyond 6 weeks old or if you start to notice a flat area after 6 weeks of age, see your pediatrician for referral to a orthotist. Comprehensive Prosthetics & Orthotics has offices in Peoria, Bloomington and Peru. For more information, contact CPO at 309.676.2276 or e-mail info@cpousa.com.