Health Care for Children

Question
 
The pediatric neurologist who saw our 3-month-old son recommended he get a helmet for his flat head. A friend neurosurgeon in Ohio told us that his hospital doesn’t recommend the helmets as the condition will automatically correct itself. My mother’s osteopath said that the helmets can cause more harm than good and we should bring our son to him. So we are very confused.

Answer
 
The first thing that is important to find out is whether the condition is plagiocephaly (an abnormal head shape that will likely correct over time) or craniosynostosis, an abnormal head shape caused by the fusing of some of the bones in the skull. Craniosynostosis is likely to worsen over time without treatment, and earlier treatment works much better. The difference is usually confirmed with a head CT.

There are two main treatments for plagiocephaly: helmets and “active-counter positioning” — keeping the baby out of the position that produces the abnormal shape. In general, this condition gets better nicely. One large study in the Journal of Craniofacial Surgery compared the two options recently and found the results of the two similar overall. The helmet, however, was three times faster.

Craniosynostosis is the one with fusion. In this situation, early treatment is usually best. The best results I am aware of come from minimally invasive surgery. I’ve heard of the helmet being used after surgery for this. If you suspect craniosynostosis, then your doctor will most likely order an x-ray. Most agree that this condition cannot be determined by a physical exam only.