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updated: 12/23/2013 8:20 AM

When do babies need molding helmets?

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I've always found it especially nice working in a group practice where it's easy to get a quick second opinion from a pediatric colleague.

On a steady office morning, one of my partners stepped out of an exam room and waved me over, requesting, "Take a look at this baby's head shape and tell me what you think."

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The 4-month-old was sitting happily on his mother's lap, and was very cooperative as I looked at his head from various angles. On "aerial view," the back right of the skull showed mild to moderate flattening, but the boy's ears and both sides of his forehead were fairly symmetrical.

Mom reported that while she felt the back of the head was not perfectly shaped, it had in fact improved since his last well exam. I found my partner and told her I didn't think a molding helmet was warranted in this case and, commenting that she was of the same opinion, my colleague returned to the room to wrap-up the visit.

As Dr. James Laughlin and associates from the American Academy of Pediatrics explain in their clinical report in the journal Pediatrics, flattened and uneven skull shapes can occur in utero or can develop during the first few months of life.

The AAP authors acknowledge that the back sleeping position is likely to account for the increase in "cranial asymmetry" seen since the early 1990s, but urge parents to continue to follow this "Back to Sleep" recommendation since it "has been associated with a drastic decrease in the incidence of sudden infant death syndrome."

Most cases of benign positional skull asymmetry will not require the use of corrective devices, since they often improve if the affected infant is frequently repositioned, engaged in gentle neck-stretching exercises, and put down for supervised periods of "tummy time" while awake.

If such diligent measures fail to result in head shape improvement by six months of age, or if skull asymmetry is severe, the AAP committee notes that cranial orthoses, commonly referred to as skull-molding helmets, can be considered. Helmet use appears to be most effective if used between 4 and 12 months of age when the skull bone is most "malleable."

In their online article on positional skull deformities in PediatricsConsultantLive, plastic surgeons Peter J. Taub and Paul Pierce caution that successful use of molding helmets requires a real commitment from caregivers.

The surgeons find that many babies take some time to warm up to the idea of helmet-wearing, with corrective treatment plans typically requiring 23 hours of helmet use daily for up to a four- to six-month period. Cost can also be an issue if helmet use is not well-covered by a particular insurance. Caregivers must also repeatedly follow up with specialists as the inner lining of the helmet will need to be adjusted and modified as the child's head reshapes and grows.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.

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