This is How Long Babies Typically Need a Helmet for Flat Head Syndrome
It’s probably the most common question we get: “How long do you think my baby will need to wear the helmet?” And - like the answer is to most things - it depends. We can usually offer an educated ballpark estimate but it really does depend on a few important factors: age of the baby, the severity of the flatness, the type of head shape, and the goals of the parents.
The average length of helmet treatment is somewhere between three and six months. We understand that that is a wide range and that doesn’t often offer the parents much reassurance, but it really is tough to give a general timeframe. Once we see a baby, go through the intake process, and take our measurements, it’s much easier to offer a prediction.
Here are the factors that influence how long a baby might need a helmet:
Age of the baby when treatment begins.
Firstly, we should note that we use adjusted age for helmet treatment. This is because developmental milestones are very important in the head shape world and we factor in any prematurity that could influence a baby’s ability to achieve them.
It’s well understood and agreed upon that a four-month-old will likely need less time in the helmet than a ten-month-old would, even if the severity level is the same. This is because:
Younger babies grow at much quicker rates than older babies do.
From the ages of 0-3 months, a baby’s head grows about 2cm per month. Between 4-6 months, the growth rate is about 1cm per month. From ages 7-12 months, growth slows to 0.5cm per month. [1]The bones of the skull are more pliable in younger babies than those of older babies.
As a baby' matures, their skull bones develop more and stronger layers of bone cells which makes them less “moldable”. [2] Although a helmet does not compress or push on a baby’s head, we do often see a “shift” happen within the first few weeks of wear in the younger babies that we don’t see in those older than six months.
CDC Head Circumference: Notice the large spike in skull growth from birth to six months and then growth begins to slow after about nine months of age. Since helmet treatment is growth-directed, it is ideal to fit the helmet within the largest growth periods for fastest outcomes.
The one caveat to starting helmet treatment young is that we like to have our babies sitting up independently and sleeping on their sides or bellies prior to ending helmet treatment. This offers reassurance that the baby won’t return to sleeping directly on the back of their head and have a regression in their head shape. So although a baby may achieve our goal measurements quickly, families may choose to continue helmet wear until the baby has achieved those milestones as a protection against regression.
For better understanding of how a head becomes flat, read this article.
Type of head shape to correct
The category of head shape of a baby will also influence how long he or she may need to wear a helmet. If you need a crash course on head shape varieties, check out this post, but here’s a quick recap:
Plagiocephaly refers to one-sided flatness in the back and/or front of the head. A mild-moderate case will involve just the back of the head but a more severe case will display asymmetry in the forehead as well, with a potential shifting of the ear on the flat side. Plagiocephaly is the quickest head shape to correct because it impacts only one or two quadrants of the head.
Brachycephaly is marked by central flattening across the back of the head with widening above the ears and sloping to the crown of the head. The goal of helmet treatment is to gain length in both the front and the back of the head - symmetrically across both sides. This takes longer than plagiocephalic heads because it involves all four quadrants of the head.
Asymmetrical brachycephaly is a head shape that involves a combination of both plagiocephaly and brachycephaly. These baby’s heads are flat across the back with one side being flatter than the other and a possible ear shift. These head shapes take the longest to correct because the helmet first corrects the asymmetry (plagiocephaly) and then aims to create more length to address the brachycephaly.
Scaphocephaly is a less common head shape where the baby’s head is long, narrow, and often high or tall. Helmets can help create a wider look but it is often the most difficult head shape to correct in our experience.
To assess your baby’s head shape from home using your phone, check out this post.
Severity of flatness at the start of treatment.
The reason why it takes months to achieve full correction is because the rounding out of the head is dependent on growth and growth often happens in spurts. So a baby who begins with a mild to moderate head shape requires less growth to round out than a baby who has a severe or very severe flat spot.
Goals of the parents for their baby’s head shape
This is truly the most important factor of all: our primary goal is that the parents are happy with the look of their precious baby’s head. We use measurements as a guideline to determine when we begin the conversation of graduation but ultimately it’s the parents’ call and we support whatever decision they make.
Some families hit our goal measurements and say, “Peace out, helmet!”
Others have become so used to the routine and the baby has no issue with the helmet so they choose to get the full use out of the treatment.
We have some who get “close enough” to the goals and they are so happy with the head shape compared to the “before” that they won’t regret being done even if the goals haven’t necessarily been met.
Our goal isn’t a perfectly round head. Our goal is a more round head shape. We support families in whatever decision they choose.
Whether their baby was in a helmet for six weeks or six months, we have yet to work with a family who regrets pursuing a helmet. If you are concerned about your baby’s head shape, feel free to schedule a free consultation and we promise you give you our most accurate recommendation and advice.
Sources:
Jones SG, Samanta D. Macrocephaly. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809621.
https://www.verywellhealth.com/baby-soft-spot-anatomy-5189224