Heads, Helmets, and Outcomes:
Do Helments help Make Infants' Flat Heads Round?
On May 1, 2014, the British Medical Journal published a study of the use of helmets in 6 month old infants whose heads had flattened in back, to see if use of the helmets led to rounder heads by age 2 years.
The issue is that as we are dropping the rate of SIDS by having our infants sleep on their back, we are all also seeing many more infants develop some flattening on the back of their heads. This flattening usually peaks at 6 months of age, since later on infants sit up and spend much less time flat on their back.
For many families, the flattening raises concerns and the use of a computer designed helmet fitted to take the pressure off the back of the head and promote rounder symmetrical head growth has been received as a welcome option for treatment, particularly when the flattening gets severe enough to bend the face.
This is purportedly the first study to look at how helmets did compared to no helmets. The study was done at an excellent center in Seattle. A total of 84 infants at age 6 months joined the study. All had similar degrees of head flattening. An equal number, 42, had helmet therapy for two years, at 23 hours a day, and has no therapy. At the end of the study period, examiners who did not know who got a helmet for 2 years and who did not took a look and tried to pick out who had been treated.
The dramatic result was that the 42 children who had helmet therapy had no rounder heads than the 42 who had no treatment.
In this study, the use of helmets offered no benefit over the natural rounding of the head from simply growing.
A nice review is contained in a NY Times article on the publication. http://well.blogs.nytimes.com/2014/05/01/helmets-do-little-to-help-moderate-infant-skull-flattening-study-finds/?ref=health
You will note that doctors are taking these findings seriously, many are surprised, but they do not dismiss the study. Curiously, the manufacturers of the helmets dismiss the findings.
My own take on the study is that it presents powerful evidence that the use of computer-modeled helmets to reverse head flattening in infancy does not work for mild to moderate flattening. The study has little to say about very severe deformities. Very severe deformities are defined as severe flattening to a point the head shape is altered severely in the face.
A study with a good control group finds that use of helmets to reverse mild to moderate flattening of the head has no impact on ultimate outcome. This finding argues against the use of such helmets when the flattening is mild or moderate. It does not have much to say about severe deformations.
It looks like sleeping on your back will flatten the back of your head, but after 6 months of age it naturally gets rounder. Not bad news as we drop the risk of SIDS.
Dr. Arthur Lavin
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