When my baby needed a helmet…
This is Warner, my oldest son who wore a helmet.
Our helmet journey.
Warner was born in 2015, about 3 years after I started my career in orthotics and prosthetics. I completed a portion of my residency at a Hanger Clinic located inside of Childrens Hospital of Wisconsin in Milwaukee. Due to the location, there was a large volume of these patients coming in for treatment of cranial deformities. This early exposure and experience with cranial remolding orthoses piqued an interest and passion that has stuck with me throughout my career.
Warner was born by emergency c-section due to fetal distress after being in labor for about 8 hours. I immediately noticed his head shape was asymmetric. I knew that babies’ heads are often misshapen right after birth due to the skull mechanics that allow the plates to shift and move as a baby’s head travels through the birth canal. Even though Warner did not travel through the birth canal, he had been stuck in one position throughout labor. This irregular shape typically corrects within the first few weeks of life, so I wans’t terribly worried at first. However, his shape persisted and it started to really bother me.
Eventually, I brought up my concerns with his head shape to my husband. He suggested I was over-reacting because I was dealing with babies who had cranial asymmetries on a daily basis, so I was extra sensitive to it. Nevertheless, I brought him into the clinic I was working at for a 3D scan of his head when he was 3 months old. This showed a mild-moderate asymmetry (5-7mm diagonal asymmetry). I could tell that he preferred to look to his right side and tried to reposition him every chance I got but torticollis was never mentioned by any of the medical professionals we had seen. He did have a very severe tongue and lip tie that had to be released twice. There have been recent suggestions that there may be correlations between tongue-tie and torticollis. I suspect Warner has a mild case of torticollis that went undetected.
Because I noticed he preferred looking to one side I tried repositioning him every chance I got. Repositioning is something that is very easy “in theory”, however, it is much more difficult in practice. For example, Warner was not a good sleeper and it was very difficult to get him to fall asleep. So, there were times when it had taken me over an hour to get him to fall asleep and there was NO WAY I was about to “gently reposition his head” to look the other direction- something I often suggested to parents that I worked within clinic. Repositioning is really only effective until babies gain the head and neck control to move themselves back into their preferred position. Warner also went to a daycare center, so even though I had talked to them about repositioning, increased tummy time, and trying to keep him out of bouncers and swings, I knew that he would inevitably be spending time on the flat spot of his head.
As the flatness persisted I talked to my pediatrician about his head shape and he insisted it was mild and that I didn’t need to be too worried. He suggested that I “wait and see” and the head shape would probably get better on its own. Again, this is something that I KNOW isn’t really true. Head shapes will look better with time due to proportional growth, but they will not spontaneously round out on their own.
Warner’s head shape continued to bother me until Warner was 10 months old and I finally just made the decision to get him a helmet. To put this into perspective I recommend starting treatment for a cranial remolding helmet around 4 months for best results. I was knowledgeable on this topic, heck, I was a PROFESSIONAL specializing in this topic, and I still found myself questioning my intuition. I had been wanting to trial a new style of the helmet - a clear version - and this was my chance. Quite honestly, if this opportunity hadn’t presented itself I don’t know that I would have done the helmet at all. When I think about what was holding me back from doing a helmet right away, I think I was so worried about offending my pediatrician and feeling like people would think I was “crazy” and overreacting that I just kept postponing the inevitable. Head shapes are like optical illusions, “once you see it, you can’t unsee it”. And for some parents, myself included, this caused a lot of anxiety. All I could focus on was Warner’s head shape, other baby’s head shapes, my own head shape, etc. We all want to do what is best for our child and when you don’t know what that is, it can be very stressful.
Warner wore his helmet for 8 weeks and I saw really good improvement, even at 10 months: his numbers went from 7mm diagonal asymmetry to 2mm asymmetry. Below is his current head shape. I can still see the small amount of asymmetry present in his head, and it still bothers me (just a little). I am SO happy that I did a helmet. For me it wasn’t that I was worried about cosmetic issues, I wasn’t even worried about medical or functional issues, it was that I noticed something that was wrong and I knew how to correct it… and I would be reminded of that every day if I did nothing about it.
If I have one regret it is not wearing the helmet longer. I call it the “8-week fatigue” and I see it with almost every family I work with. After 8 weeks of helmet wear, we almost always see results. There is usually enough improvement that parents start to feel like “it’s so much better, let’s be done”, even if they are still in a severe category. Babies tolerate helmets very well, but for parents they are annoying… it’s stinky, is sweaty, and cleaning it is just another “thing” you have to do. After 8 weeks, you start to get “over it”.
Had I done the helmet at 4 months old when I first noticed the head shape I am confident I would have gotten full correction in these 8 weeks. But as a baby gets older, their head grows at a much slower rate. Helmets rely on cranial growth to get head shape correction. So the same amount of growth required for full correction when starting at 4 months, will take much longer when starting at 8 months. This is why I am so passionate about early intervention. I never want to have to convince a family to proceed with helmet treatment, but I also want to make sure that they understand that this is something that we can only correct for a very short amount of time and the results will be with your child for their lifetime.
MY advice to moms… if you are on the fence… do it. I often compare the cost of a cranial remolding helmet to braces on your teeth. Braces can cost upwards of $6,000 and treatment can be done at any time in your life. A CRO costs 1/3 of that and can only be used up until 18 months. And do as I say.. not as I do… do the helmet right away, at 4 months, when you will be able to wear it for 8 weeks get awesome results and one round head.
Top Down View- Warner’s Current Head Shape (age 6)