Plagiocephaly & Helmet Therapy: Understanding the Basics

Plagiocephaly is a condition where the back of an infant’s head is flat on one or both sides. This condition is generally harmless (it is often referred to as simply “flat head syndrome”) and can be corrected with appropriate treatment. Learning your baby has a condition, however treatable, can be worrisome for parents, but understanding its causes, symptoms, and available therapies can help alleviate the stress of the unknown and support parents as they seek the best care for their child. 

Here, board-certified Richmond pediatric plastic surgeon Dr. Sharline Aboutanos, who specializes in pediatric reconstructive procedures, discusses plagiocephaly and how helmet therapy can effectively address this condition. 

Understanding plagiocephaly

Plagiocephaly occurs when an infant’s head develops a flat spot due to prolonged pressure on one area. Most cases of plagiocephaly are caused by positional molding, when the baby is placed in the same position for longer periods of time, such as being placed on their backs when sleeping—which the American Academy of Pediatrics recommends to help prevent SIDS (Sudden Infant Death Syndrome). In some cases, plagiocephaly can occur if the baby has congenital muscular torticollis—a condition where the neck muscles are tight—which can lead to uneven head growth.

Signs of plagiocephaly

Early signs of plagiocephaly include noticeable:

  • Flattening in one area of the head

  • Asymmetrical facial features 

  • Preferences to one side (the baby may only turn or lay their head in one direction)

Early detection makes plagiocephaly easier to treat, and if caught soon enough, mild cases of plagiocephaly may resolve on their own with parent-supported position changes. Tummy time, while the baby is awake, helps strengthen neck muscles and reduces prolonged pressure on any one part of the skull, and alternating the direction the baby faces during supervised naps can help prevent flattening. Additionally, limit excessive use of carriers that place pressure on the same part of your baby’s head. 

“Dr. Aboutanos is amazing! She is compassionate, understanding, patient, kind. I could go on and on. She treated my daughter with wonderful care. So thankful to have found Dr. Aboutanos, she changed Courtney’s life! Everyone was fantastic!”
—Pediatric patient review

For moderate to severe cases of plagiocephaly, seeing a plagiocephaly specialist like Dr. Aboutanos for timely intervention with helmet therapy is highly effective in correcting the condition. 

When is helmet therapy recommended?

If position changes have not improved the asymmetry in your baby’s head, helmet therapy may be the next step. Dr. Aboutanos considers several factors when determining the need for corrective measures:

  • The degree of skull asymmetry

  • The infant’s age 

  • Possible underlying conditions such as muscular torticollis

The optimal time to begin helmet therapy is after six months of age when the skull is still quite soft and therefore more easily reshaped; however, children up to 14 months old can typically undergo helmet therapy successfully. 

How helmet therapy works 

After meeting with Dr. Aboutanos, should you choose to move forward with treatment, an orthotist company makes a helmet specifically designed to fit your child’s head. Helmet therapy gently reshapes your baby’s skull as it grows. The helmet keeps the prominent areas of the skull in place and allows the flatter areas to fill out. This controlled pressure guides the skull to develop a more symmetrical shape over time. Typically, infants wear the helmet for 23 hours a day, with short breaks for bathing, for three months, depending on the severity of the condition and the child’s growth rate. You’ll have regular follow-up appointments with Dr. Aboutanos and the orthotist to ensure your baby’s head is gently remolding as expected. 

Starting helmet therapy when a baby’s skull is the most malleable, after 6 months, maximizes the effectiveness of the treatment.

Benefits of consulting a specialist 

Dr. Sharline Aboutanos is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital and provides multidisciplinary care with other specialists who may be a part of your baby’s care team. Her expertise in craniofacial conditions, helmet therapy, and understanding of infant skull development help ensure an accurate diagnosis and a tailored treatment plan for your little one. 

Are you concerned about your baby’s head shape?

Dr. Sharline Aboutanos is a board-certified pediatric plastic surgeon and provides expert, compassionate care to families in Richmond, VA, and surrounding areas. Dr. Aboutanos and her team are dedicated to improving the lives of children through specialized interventions for optimal development and aesthetics. To make your appointment with Dr. Aboutanos, please call (804) 355-3410 or contact her online.

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