Helmets are for sports, not for skull deformations

Forget the helmet when it comes to positional skull deformation, say the results of the first randomized, controlled trial to investigate the issue.

In a study called HEADS (HElmet therapy Assessment in Deformed Skulls), researchers from the Netherlands included 84 infants aged between 5 and 6 months with moderate to severe skull deformation. Half the participants wore a custom-made helmet designed to redirect skull growth for 23 hours a day for 6 months; the other half received no intervention.

No significant difference occurred in the change score for either plagiocephaly (unilateral flattening of the skull) or brachycephaly (symmetrical occipital flattening) for either group (mean difference, -0.2; 95% confidence interval [CI], -1.6 to 1.2; P=0.80; and mean difference, 0.2; -1.7 to 2.2; P=0.81; respectively). Only about one-quarter of both groups (26% of the helmet group and 23% of the natural course group) achieved a full recovery by 2 years of age.

Parents of children in the helmet therapy group had slightly higher head shape satisfaction scores and slightly lower anxiety scores at 2 years than parents in the natural course group, but the differences were not significant. Although more of the helmet group had sleep problems and spent more hours crying, again, the differences were not significant. All the parents of the children assigned to helmet therapy complained of at least 1 adverse effect. Adverse effects included skin irritation (96%), a hindrance to cuddling (77%), unpleasant helmet odor (76%), augmented sweating (71%), pain (33%), and helmet acceptance problems (24%).

The researchers concluded by recommending against helmet therapy. Instead, they said, children may benefit from physiotherapy or simple repositioning while sleeping.

An accompanying editorial points out that positional plagiocephaly and brachycephaly now affect about 1 in 5 infants. One of the main reasons for the increase in incidence is that parents now overwhelmingly sleep infants on their backs to help prevent sudden infant death syndrome. 

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