Contrary to Dutch study, child helmet therapy does work

plagio story image 200x143Robert Tibesar, MD
, is an otolaryngologist with Children's plagiocephaly clinic.

A recent study by Dutch researchers that challenges the benefits of helmet therapy in infants with plagiocephaly1 – meaning "crooked or oblique head" – claims that only 26 percent of patients reached a full recovery to a normal head shape using the procedure, deeming it ineffective.

We disagree.

Plagiocephaly and brachycephaly – the flattening of the back of the head – result from a prolonged external force applied to an infant's malleable skull. The deformation usually is related to excessive time spent in one position and often is associated with torticollis, a twisted neck.

Since the successful "Back to Sleep" campaign in 1992 to reduce SIDS, plagiocephaly has become quite common, with an incidence of approximately 20 percent. Plagiocephaly is preventable with careful attention to alternating an infant's head position. Once recognized it can be improved with position changes and keeping a baby off the flat spot on the back of the head as much as possible. If an infant has torticollis, physical therapy is helpful. For more-severe cases of plagiocephaly, a molding helmet can be worn to influence the growth of the skull to a more-normal shape.

At Children's Hospitals and Clinics of Minnesota, we have developed an abundance of clinical experience in treating children with plagiocephaly and brachycephaly. Our craniofacial team consists of a craniofacial surgeon, neurosurgeon, pediatric nurse practitioner, physical therapist and certified orthotist. This multidisciplinary team approach for managing infants is in agreement with the American Academy of Pediatrics policy statement on skull deformities.

We see the infant early and offer conservative measures such as "tummy time," position changes and physical therapy to try to improve the head shape. We have conducted our own study showing the long-term results of conservative therapy.2 If these interventions aren't successful and the plagiocephaly or brachycephaly is severe, we offer helmet therapy to correct the head shape.

In our experience, helmet therapy is most successful if started between four and six months of age. We typically achieve a high rate of success in improving an infant's head shape if the helmet is worn as directed. Additionally, we have few complications and a high rate of compliance and parental satisfaction. Because our success rate with helmet therapy is significantly higher than that reported in the Dutch study, we plan to continue to offer helmet therapy to the more severe cases of plagiocephaly and brachycephaly. As always, we'll continue to adapt our therapies, monitor our results and compare them to the world's leading craniofacial centers.


1. Van Wijk RM, van Vlimmeren LA, Groothuis-Oudshoorn CGM, Van der Ploeg CPB, IJzerman MJ, Boere-Boonekamp MM. Helmet therapy in infants with positional skull deformation: randomized controlled trial. BMJ 2014;348:g2741.

2. Roby BB, Finkelstein M, Tibesar RJ, Sidman JD. Prevalence of positional plagiocephaly in teens born after the "Back to Sleep" campaign. Otolaryngol Head Neck Surg. 2012;146:823–828.