Conservative Treatment Normalizes Head Shape in Children with Skull Flattening

A recent study by ASPS Member Surgeon Frank A. Vicari, MD, and colleagues of Ann and Robert H. Lurie Children’s Hospital of Chicago reports on the effectiveness of both conservative and helmet therapy, as confirmed by objective measurements.

This study of positional cranial deformity (PCD) reports that more than three-fourths of infants experiencing skull flattening related to sleep position achieve normal head shape with conservative treatment -without the need for helmet therapy. Their report found that the addition of a helmet led to a success rate of over 90%.

Dr. Vicari and colleagues analyzed 4,378 infants with flattening of one side of the head (plagiocephaly) or of the back of the head (brachycephaly). These problems can occur when the baby always sleeps in the same position, causing pressure on the same spot on the skull. This has become a common issue since the recommendation to place babies on their backs to sleep. This campaign, now called the “Safe to Sleep” campaign, has been highly effective in lowering nationwide rates of sudden infant death syndrome (SIDS).


The researchers compared final skull shape for nearly 3,000 infants initially receiving conservative therapy for PCD and nearly 1,000 infants receiving helmet therapy. “Conservative” treatment consists of advice and/or physical therapy, including practices such as encouraging “tummy time” when the baby is awake. “Helmet therapy” consists of a custom-made orthosis to help shape the developing skill.

The researchers measured final skull shape using 3D laser surface scanning.

Conservative treatment normalized skull shape in 77% of infants, with approximately 16% of infants initially assigned to conservative treatment were switched to helmet therapy. The remaining seven percent had “incomplete correction” of skull flattening.

For infants initially treated with helmet therapy, the rate of complete correction was 94%. “In the majority of infants, delaying helmet therapy for a trial of conservative treatment does not preclude the achievement of complete correction,” Dr. Vicari and coauthors write.