In recent years, the number of babies with an abnormal skull shape has increased considerably. Every year, approximately 10% of babies born in the Netherlands develop an abnormal skull shape. This recovers naturally in about 75% of babies. The remaining babies, approximately 5,000 per year, need help restoring the skull shape. Some of this can be helped with the so-called redressal helmet. One of the reasons for the increasing number of babies with an abnormal skull shape may be the advice to place babies on their backs while sleeping. This advice is given to prevent the prone position. The prone position is seen as one of the possible causes of cot death. Although a baby who lies on his back is more likely to develop a preferred position, it is also possible to adopt this preferred position in the womb. This preferred position (and the associated unevenly distributed pressure on the skull), in combination with the baby’s skull that is still very easily moldable, creates an increased risk of crooked growth. In addition, premature closure of the skull sutures can also cause crooked growth of the skull. This form of deformity may require surgical intervention. In addition to crooked growth of the skull (side and back), there is also a possibility that the face shows asymmetry.
There are different forms of skew, including:
- Scapocephaly (boat skull)
- Plagiocephaly (crooked occiput/skull)
- Branchycephaly (wide skull)
- Trigonocephaly (wedge skull)
Remedial helmet therapy
Reduction helmet therapy can take place if there is abnormal skull growth and the skull sutures have not yet closed. Because skull growth (size) gradually decreases after the fifth month, spontaneous recovery of the flattening is in many cases no longer possible. This recovery can occur until the fifth month due to the rapid growth of the baby’s skull. In approximately 75% of cases of deformity, the skull recovers naturally. Remedial helmet therapy will therefore only take place after the fifth month. Often other therapy has already been undertaken in the period before the therapy. This includes physiotherapy, osteopathy or sometimes even chiropractic. The baby’s preferred position can also be caused by a blockage in the neck and/or shoulders.
The restraining helmet offers the head growth space on the sides where necessary. This ensures that the growth of the skull is possible at the location of the flattening, even though the baby is in his or her preferred position. The head is not pressed to change its shape. This is a common misunderstanding. The helmet also doesn’t hurt once it’s completely custom-made. What you should take into account is that there is a greater chance that your baby will start crawling later than normal or not crawling at all. This is partly due to the fact that the helmet makes your baby top-heavy, which means that your child’s head is too heavy for the neck muscles when crawling.
Especially in the beginning, some overpressure points may arise because the foam in the helmet (on the inside) has not yet been cut out correctly. It is therefore of obvious importance to listen carefully to your baby’s signals and regularly check for any overpressure points. In addition to the excess pressure when wearing the helmet, putting on and taking off the helmet is often a less pleasant experience, especially in case of branchycephaly, because the baby’s head is wider than the point where the helmet is pulled over the head. Good instruction by the therapist on how to put on and take off the helmet plays a very important role. Finally, the design is also very important. Today there are several designs, including the helmet without a chin strap and the two-shell helmet. The absence of the chin strap prevents irritation under the chin due to chafing or sweating, for example. The advantage of the two-shell helmet is the flexibility, which is particularly useful when putting on or taking off the helmet. Finally, you can also opt for a version that is cut out at the ears or a helmet that extends over the ears. With this latest version, an additional disadvantage is that the sound for the baby is distorted and muffled.
Remedial helmet therapy possible?
Whether remedial helmet therapy is possible is assessed by a doctor. He or she will also take the parents’ motivation into account in the decision. 100% motivation from the parents is essential. Especially the period where the helmet has to be left on 23 hours a day demands a lot from the parents. However, they should always remember that, no matter how difficult it may be, keeping the helmet on for 23 hours a day is only to the baby’s advantage.
If it is decided to start the therapy, a mold will be made with plaster to allow the helmet to be adjusted to size. The helmet will be ready within a few weeks. You can also choose from various motifs. Fitting and delivering the helmet usually takes several hours due to the instructions given to the parents and the complete customization of the helmet. The remedial helmet therapy usually lasts between three and six months. Intensive aftercare will take place both during the therapy and afterwards. This includes trimming the inside of the helmet and keeping track of the shape correction.
Reduction helmet therapy is a method that helps correct crooked growth of a baby’s skull where natural correction is no longer possible. Unfortunately, the long-term disadvantages of the remedial helmet are not yet known. The question is of course whether the uncertainty of these possible negative consequences outweighs the benefit of correcting your child’s skull. If you have any doubts about whether or not to start therapy, always talk to a plastic surgeon in the hospital. He or she will be able to provide you with independent advice, which will make the decision at least a little easier for you (and your child) as much as possible.