Much Ado About Helmets

I don’t usually blog on the recent headlines and research as it’s easier to tweet or post with regards to articles.  However this one feels in need of more exposure, mostly because the results are so surprising.  Last week a blog in the New York Times reported on a study regarding the use of helmets for children who were experiencing positional plagiocephaly.  This is an ongoing problem for young babies since the Back To Sleep campaign was instituted secondary to SIDS research.  And as Physical Therapists we have been diligent in our efforts to support both the Back to Sleep portion of the campaign and bring more awareness to the Tummy To Play part of the initiative that has gotten lost in the original messaging.  And for infants that have significant asymmetry, we have coordinated with paediatricians and orthotists in the fabrication and use of custom helmets for the treatment of skull deformation.   However, this new study  indicated that 6 months of helmet therapy appeared to make no difference in the actual outcome for a group of 42 children displaying severe skull deformation.   That is a surprising result indeed.

But before we think about tossing these helmets from the treatment repertoire, I think we need to exercise some caution.  First of all, as always, we need to note that this is a relatively small sample of children.  42 children does not make a robust sample size.  Second, there were some concerns regarding fit/movement of the some of the helmets (of course, we know these are part of real life treatment as well).  And third, these were children who were not exhibiting any other difficulties in connection with the plagiocephaly – no torticollis, no craniosynostosis and no dysmorphic features.  This is not indicative of most of the children I see with positional plagiocephaly, whose presentation is more complex.

So let’s take this study and put it in to our problem-solving mix.  Let’s keep in mind that there are now questions with regards to the usefulness of helmet therapy in some children with positional plagiocephaly and have thoughtful discussions with parents about how to proceed with treatment for their children.  Let’s hope that someone repeats the study with a larger group of children so we can get a clearer picture of the best course of action for these little ones.  And most of all, let’s continue with our public awareness of the Tummy To Play campaign so that we are proactively focusing on the prevention of positional plagiocephaly.


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