Questions To Lucy


My baby has flat head. What shall i do?
Question to Lucy Best, Orthotist, BSc (hons) SR Orth, MBAPO


Q: My GP said that the flat spot will go away by itself and some recent research showed that helmet treatment is no better than repositioning only. Is this right?

A: Your GP is right for most babies: about 20% of infants aged 4 months now have some degree of flattening at the back of the head. In most cases, without a helmet, this will resolve itself by the age of 2 years. However, about 3% of children will continue to have flattening. That is about one child per school class. Previous research has constantly shown that helmets are more effective than repositioning alone. However recent research from the Netherlands, (published in the BMJ 1 May 14), showed helmet v. no helmet results to be the same at aged 2 years. While we welcome this new research we note that it was on a small number of babies (42 in helmet, 42 no helmet) with moderate to severe plagiocephaly/brachycephaly. It did not include babies with very severe flattening, premature babies or babies with torticollis (neck stiffness) or dysmorphic features. Many of the babies treated in the UK with helmets would therefore not be included in this study. Also in this study, at the end of the helmet treatment, none of the babies measured in the normal range. With the LOCband, the cranial remoulding helmet which I use, however, all babies who complete treatment have measurable improvements to their head shape and many reach the normal range.

Q: I never see bald men with flat heads, so surely it is not such an issue?

A: “Flat head syndrome” is relatively recent and thought to be a direct consequence from the “back to sleep” recommendation where parents are advised to lay their babies on a flat firm mattress, lying on their back. This advice first came out in 1991 in the UK and was widely taken up a few years later, so hence not many people with flat head syndrome have yet reached adulthood.

Q: “Is flat head syndrome” just a cosmetic problem or does it cause brain damage?

A: Some studies show that children who displayed deformational plagiocephaly as infants have a slightly higher risk of requiring special education assistance at school. However it is not yet known whether plagiocephaly/brachycephaly cause the delays or whether the delays encourage the development of the cranial asymmetries.

Q: Are there any concerns if the head is left untreated?

A: Apart from cosmesis, an unusual head shape may make fitting safety helmets (e.g. bicycle, motorbike, work hats, police/army helmets) more difficult.

Q: Does the helmet hurt the baby?

A: Babies often adapt to the band very quickly and it should not be painful. Any red marks are monitored by the parents and the helmet is adjusted as required.

Q: How is the helmet made to fit the baby?

A; Scanning technology is used to obtain a 3D image of the baby’s head. This is a quick and safe procedure. From this image a model is made which is used to manufacture the customised cranial band. Images are also used for recording the before and after shape.

Q: How do I know if my baby needs a helmet?

A: Making a decision to embark on Cranial Remoulding Therapy can be difficult and naturally causes anxiety for parents. Hampshire Orthotics Ltd offers a free no obligation initial assessment for babies aged 3 - 18 months. During this time measures are taken to establish the severity and whether a cranial remoulding orthosis is recommended.

Q: What is the best age to treat?

A: The youngest is when baby has good neck strength and can sit (supported) with head remaining upright. This is usually around 3+ months old. In young babies, aged up to 7 months, the head is very flexible still and growing fast, so this is the ideal age for treatment and the time in a LOCband is only 3-6 months. For older babies, aged 8-18 months, treatment time takes longer 9 - 12 months and the correction may not be as good as with the younger babies. My advice is to try repositioning seriously for a month and if there is not reasonable signs of correction, then if you want the best chance of a normal head shape for your baby, don't delay and start helmet treatment if considered appropriate.

Q: What about physio, chiropractic and osteopathic treatment?

A: Many of the babies I treat see one of these health professionals in addition to the LOCband treatment and I believe a multiple team approach can only be beneficial (although there is no evidence to prove this yet). Find one that specialises in cranial work and babies.

​​Q: Can the helmet be painted?

A: Yes! I work with a very talented artist, Abi Jones. If you would like a custom painted helmet, it will be
made in a plain colour and then once it is fitted you take it to her for the decorating. This makes the helmet experience so much more enjoyable for the parents and your baby will have a great keepsake afterwards! The alternative is a printed on pattern which is included in the price (which also looks cute).

Q: Will my baby need more than one helmet?

This is extremely rare, even with the most severe head shapes. This is because the helmet is made with a foam inner layer which is gradually ground out as the head grows. Thicker foam is included for the very severe cases so that there is enough growth allowance within the one helmet. A second helmet is sometimes needed if there was a period of time not wearing the helmet, for example for a long period of illness, and the head changed significantly in that time. This is however very rare as your orthotist will do their very best attempt to get the original helmet to fit again.

Q: How many appointments will I need?

Around about 10 appointments are needed in total for the scanning, fitting and review/adjustment appointments and final scan. 

Q: Will my baby's head get flat again after the treatment is finished?

Once the treatment is finished your baby will be older and much more mobile and sleeping less. The neck will be free to move and the head shape nice and round, so there won't be a constant pressure on the original flat spot. The bones of the skull will be less mobile. Because of this, there will be a very low risk of the head shape flattening again. In babies that we have recalled after 6 months out of treatment, there was about 1mm of movement (better or worse). If a baby is still very young when the treatment is finished and the anterior fontanelle (soft spot on the top of the head) is still open and is still preferring to lie on the original flat area, we advise the helmet is worn during the nights and nap times until the baby is older. In this case, the helmet will need reviewing every month or so.

​Q: What do I do now?

If you are worried about your baby's head shape, despite trying re-positioning, make an appointment to see Lucy for a free, no obligation measure of the head and chat.  023 8000 5505.