The Helmet Clinic, now a part of Children’s Hospital & Medical Center of Omaha’s Plastic & Reconstructive Surgery Department, specializes in evaluating, diagnosing, and treating infants with an abnormal head shape. The only clinic of its kind in the region, we have diagnosed and cared for thousands of infants, correcting abnormal head shapes for over 25 years.
With our experience, we can recommend the right personalized plan for your child and family.
Conditions We Treat
At Children’s, our team is prepared to diagnose, treat, and provide follow-up care for the following conditions:
PlagiocephalyPlagiocephaly (PLAY-gee-oh-SEF-uh-lee) – sometimes called deformational plagiocephaly or positional plagiocephaly – is a common and treatable disorder. Plagiocephaly develops when an infant’s soft skull becomes flattened in one area left or right side due to repeated pressure on one part of the head before or after birth. Positional plagiocephaly can look different depending on which part of the skull has a flat spot and severity (mild, moderate, or severe). Sometimes the forehead of the face, cheek, or ears are also uneven (asymmetry).
BrachycephalyBrachycephaly (BRAY-kee-seh-fuh-lee) is flattening of the back of the head (occiput), and head shape is symmetric (even), short, and wide.
Muscular TorticollisMuscular Torticollis is a shortening of the muscle in one side of the neck, causing the head tilt in one direction. You may notice that your baby prefers turning their head to one side and has difficulty turning to the other side. Your baby might also tilt head with one ear toward shoulder when in an upright position.
Other ConditionsFor other types of skull malformations, such as Craniosynostosis (premature cranial suture fusion), Children’s Hospital & Medical Center of Omaha’s experts in our Departments of Neurosurgery and Plastic Surgery work together to diagnose and treat.
What Causes Head Flattening?
Plagiocephaly and brachycephaly are common in infants. Most babies develop head flattening by sleeping regularly in one position, and since the American Academy of Pediatrics began advising Back to Sleep (placing your baby on their back to sleep), studies have shown 20 to 25% of infants develop some degree of plagiocephaly.
Other causes of plagiocephaly and brachycephaly include:
- Crowding or position in the womb: Multiple babies (twins, triplets), an abnormal shape womb, or uterine fibroid can lead to head flattening. Other potential causes in utero are breech position, a mother with a small pelvis, a pregnancy with decreased amniotic fluid, or a baby with a large head.
- Premature infants: Babies who are born prematurely have skull bones that are softer than full-term and turn their heads less often.
- Medical problems: Infants requiring critical care with extended periods of time in a fixed position or developmental delay that makes it hard for infants to change position can cause head flattening.
- An infant that looks only right or left: Sometimes this is the baby’s preference, or it can be baby’s neck muscle is too tight on one side (called torticollis).
At the time of your child’s Helmet Clinic Visit, our team offers the following services:
Physical TherapyIf your child is not already established with a Physical Therapist, or they are established and you have questions or concerns, our Children’s Helmet Clinic Physical Therapist will complete a thorough exam to evaluate for Torticollis or any gross motor developmental delay (using the Alberta Infant Motor Scale). If findings are abnormal, the Helmet Clinic provider will place a referral for necessary treatment and provide education for treatments that can be done at home.
Helmet ProviderBy conducting a thorough review of your child’s birth and medical history, physical exam, and cranial measurements, a Children’s Nurse Practitioner can typically make a diagnosis. Your child’s diagnosis and treatment will be explained in detail, and we will make sure all your questions are answered. If a helmet is recommended, a Children’s provider will place an order for helmet therapy. If there is any concern for skull abnormality other than positional flattening, the provider might further evaluate by ordering imaging, such as skull X-ray, CT scan of the head, or ultrasound of the head to further evaluate. If needed, your child may be scheduled for a follow-up in the Children’s Plastic Surgery Clinic or referred to another pediatric specialist.
Helmet LabHelmet therapy is a research-supported and effective non-surgical treatment option for treating positional head flattening. If head flattening doesn’t improve with repositioning, or flattening is moderate or severe, your child may be recommended a helmet for treatment. If a helmet is ordered, your child will be seen the same day by a certified orthotist in the Children’s Helmet Lab. A STAR SCAN (a scan that uses light instead of radiation and only takes minutes) will be done to obtain more detailed Cranial Measurements, and the orthotist will review the results and discuss the process for ordering a Helmet.
Treatment Options for Plagiocephaly/Brachycephaly
In most cases, treatment is non-surgical, and multiple methods can be used. Treatment recommendations include:
SleepAlways place your baby to sleep on their back.
Position ChangesEarly repositioning can sometimes correct an abnormal head shape. Your infant’s pediatrician might recommend gradually increasing supervised tummy time during awake playtime, changing your baby’s head position when sleeping on their back (left to right/right to left), and alternating positions in the crib and on the changing table.
Frequent HoldingPicking up and holding your infant will take pressure off their head. Be sure to alternate which arm you hold them in, and position your child off the flat side of their head. When necessary, use – but limit – time in infant seats, car seats, and swings.
ExercisesA physical therapist might recommend exercises, especially if your child has Torticollis (an imbalance of neck muscles). Interact with your infant from different sides during feeding, changing, and playing.
Corrective HelmetIf needed, a Children’s provider will prescribe and carefully monitor a helmet to treat head flattening safely and successfully. Helmets are most effective in infants from 5 to 6 months old who have moderate to severe flattening. However, there are times when helmets are recommended for children younger or older, up to 15 months old.
Always follow your infant’s pediatrician’s directions when positioning your baby for sleep and play. As with any health condition, keep other caregivers, such as family, friends, and daycare personnel, updated when it comes to your child’s treatment regimen.
How Helmet Therapy Works
Helmet therapy is a time-sensitive elective treatment for abnormal head shape, flattening, or asymmetry. As infants reach 12 months of age, their bones in the skull become more firm and are generally less flexible to the molding effects of helmets. As a result, helmet therapy is not a treatment option for children and adults.
The helmet is a lightweight plastic shell with a foam liner. It acts as a brace to gently redirect the growth of a baby’s skull to correct the shape by allowing growth in the flattened areas.
Keep in mind – few people have perfectly round heads. Helmet therapy is used to improve the severity of flattening or asymmetry to prevent future psychosocial or other potential complications. Even when treated with a helmet, your child’s head might not be perfectly round. The goal is to have improved head shape closer to a mild range and prevent issues later in life.
At Children’s Helmet Clinic, our team will work together closely with your family to manage your infant’s care and make sure everyone’s needs are met.
If you decide to proceed with helmet therapy for your child, it will take about two weeks for a custom-fit helmet to be made based on your child’s STAR SCAN measurements. Once their helmet arrives at Children’s, your infant will be scheduled with a certified orthotist at Children’s Helmet Lab for initial helmet fitting. At this visit, we will review treatment and care instructions.
To get the most benefit from the helmet, your child should wear their helmet 23 hours a day. The 1 hour off allows time for bathing and skin checks. At their fitting, you will be given instructions on how to work up to this total time over a period of 5 days.
Your child’s length of treatment time varies based on their age and severity of abnormality. However, it’s usually between 4 to 6 months. It’s critical to follow the recommended wear schedule for the best outcome.
For periodic adjustments as your baby grows, follow-up helmet Lab appointments will usually be scheduled every 4 to 6 weeks.
At Children’s Hospital & Medical Center of Omaha, the Helmet Clinic Team includes experienced, qualified plastic surgery professionals and other pediatric experts who care for infants with a variety of head shapes. Our team understands that congenital or acquired head shape deformities might be concerning. It is important to remember that positional head flattening does not affect brain growth or cause developmental delays. Our specialists are here to help.
Plastic & Reconstructive Surgery
Most children are referred to the Helmet Clinic by their pediatrician or another specialist. However, you can schedule your child without a referral if your child’s insurance company approves. For financial questions specific to helmet cost or insurance coverage, call the Hanger Clinic at 402-384-8727.
No matter your child’s age, we recommend calling for an appointment or with any questions. Though a flat spot on an infant’s head is generally not a concern, it is still important for your child to be evaluated for other types of head abnormalities to prevent potential complications. Helmet therapy is mostly effective in the first year of life (during rapid head growth). If your infant is considered out of age range for helmet therapy, they can be scheduled in our Plastic Surgery Clinic.
To schedule an appointment for your infant at our Helmet Clinic Department, call 402-955-7450.You can also call our clinic if you have any questions for our team or if you would like educational material on repositioning sent to you while you are waiting for your infant’s scheduled appointment.
Prior to your child’s visit, we recommend having a referral, your child’s birth record, and a recent physical exam.