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Posted by Dr. Monica Wonnacott | August 6, 2020

To Helmet Or Not To Helmet? That Is The Question.

When the American Academy of Pediatrics recommended that babies sleep on their back to prevent SIDS (Sudden Infant Death Syndrome), there was a sharp rise in the problem of flat heads in babies. More babies were sleeping on their backs and their heads were getting flat as a result. Since sleeping babies on their backs dramatically decreased the number of cases of SIDS, having babies just sleep on their bellies again was not a viable option. So what came of all those flat heads? The baby helmet industry was born.

Everybody has seen a baby wearing one of those baby helmets or DocuBands (a type of partial helmet). The idea is to put pressure on the parts of the head that are sticking out and leave room for the flat parts to fill in a more rounded shape. The goal is that you gradually reshape the head over time. So why not just use a helmet?

Problems with helmets:

  1. The helmet interferes with natural cuddling and interactions with your baby.
  2. The baby has to wear the helmet 23 hours a day, 7 days a week, for multiple months.
  3. The helmet is heavy and uncomfortable.
  4. The helmet (by nature of applying pressure to the parts of the head that stick out) can rub or irritate the skin and/or leave sores.
  5. The helmet causes the infant’s head to be hot and sweaty.
  6. The helmet starts to have a bad odor.
  7. The helmet attracts unwanted attention (it simply feels bad having people stare or make ignorant comments about your baby’s appearance).
  8. The helmet is time consuming, requiring multiple appointments for frequent adjustments.
  9. The helmet is expensive, averaging $2300.00 and is often not covered by insurance.

How likely is an adverse effect from a helmet?

Your infant is essentially guaranteed to experience at least one adverse effect from using a helmet. A 2015 study published in the NIH, confirms this. It showed that ALL parents reported at least one adverse effect (not including lost time or economics in that list) from the children that received the helmet intervention group (compared to no a no helmet group).

Should my baby use a helmet?

Whether or not you should invest the time, money, and effort to pursue a helmet can be tricky. Pediatricians seem to have different thresholds for when they refer patients for helmets. Most agree that very severe cases should be referred for a helmet.

How do I know If my baby’s flat head is severe?

Baby’s with severe cases have very misshaped heads. The average person doesn’t have to look from any certain angle to determine that the baby’s head is flat. It is particularly concerning when the opposing forces from the flat spot cause the face to become uneven (e.g., the eyes or ears are uneven, the forehead sticks out on one side). When a child’s face is markedly uneven, it becomes visually distracting and is generally a good indicator that it may be time for a helmet or band.

Do I have to use a helmet if my baby’s head is just mild or moderately flat?

No. While you may still choose to use a helmet/band, the scientific evidence on it’s effectiveness for mild to moderate cases is mixed. According to the AAP,

“There is currently no evidence that molding helmets work any better than positioning for infants with mild or moderate skull deformity.”

What can I do instead of a helmet?

The most important thing to do is to relieve the pressure on the flat spot of the head. This is done primarily by repositioning the head during sleep (turn the head away from the flat spot). The hard part is getting the baby to keep the head in the new position; many babies will automatically reposition the head to the flat side as it is the comfortable position. The AAP discourages the use of sleep positioners and pillows as they are a suffocation risk. So what is a parent to do? The MoWo solves this dilemma. Since the positioner is attached to the infant’s back, it is impossible to suffocate on it. It keeps the infant positioned to allow the head to naturally and comfortably rotate to the correct side.

Additional measures beyond repositioning include: neck stretches (the muscles of the neck can get tight causing the head to stay positioned to the flat side), encouraging lots of tummy time and sitting up, and avoiding excess time in car seats (or other items that cause the head to rest against something hard).