Where are you in your helmet journey? Plagiocephaly affects an estimated 20% of babies. Whether to keep repositioning or to start helmet therapy is directly related to your child's age, severity, and growth. Other factors your family may want to consider include how positioning is going, upcoming family vacations, developmental milestones, and insurance/financial requirements. In general, getting measurements and information sooner is always better than later. But if you are considering a helmet and not sure if it's time to come in for an evaluation, see some general guidelines below.
Your baby at 0-2 months:
Whether your baby is fresh home from the hospital or you have been snuggling them at home for the last couple of weeks, this is the time where you are really getting to know the new addition to your family. At this time they are also growing rapidly. Your baby changes daily and unbelievably, so does their head shape! At this time you want to be an observer of your baby's cranial development. Take special note if your baby seems to prefer a position, side of the head to lay on, or a specific direction to look in. Your baby is going to have some asymmetries at this time because they were just snuggled up in the belly, it can take time for this initial shape to change. If you aren't sure about your baby's head shape, be sure to mention concerns to your pediatrician early. It is also a good idea to document changes with photos.
At this time, intentionally positioning your baby off the flat areas and starting tummy time are going to be the best ways to avoid needing a helmet. Continue to follow APA guidelines and place your baby on their back for sleeping, but take note if their head continues to fall to the same side.
An evaluation at our clinic at this time would allow you to get initial measurements taken and specific advice on repositioning. During our evaluations we provide a free three-dimensional scan of your baby's head. This scan is used to identify asymmetries, central flattened, or areas of restricted growth. The benefit of an early scan is that we can compare it to a repeat scan taken weeks later to see how your little one's head is responding to repositioning attempts. Early scans are very helpful for families and practitioners as they allow us to make informed decisions regarding early intervention.
Your baby at 2-4 months:
Main Idea! Observe and Reposition
You're getting into the swing of things. Maybe you have a bedtime routine that includes stories, a bath, and relaxing music. Your baby is also starting to spend more time awake. As they become more active you will be able to better notice their neck strength and head shape. While it is true that all baby's are different and complete milestones at different times, cranial bones continue to form and close during this time whether your baby is rolling or not.
At this time, many pediatricians will recommend tummy time and repositioning if your baby has a noted flat spot. If you are concerned that your baby is not meeting milestones or has an underlying condition that causes them to spend more time on their back, it is advisable to get your baby's head measured and possibly to speak with a physical therapist.
Your baby at 4-6 months:
Main Idea! Get a Baseline to Compare How the Head is Changing & Start Treatment
Positioning your baby is effective up to 4-6 months of age. At this time your baby is still not completely mobile and somewhat dependent on you for positioning. While you can reposition your baby onto the more prominent side of their head, there is no guarantee they are going to stay there. As your baby starts movin' and groovin', they will be more difficult to consistently position off the flatter side of their head.
How do you know if positioning is working? It is a good idea to look back at pictures but you may want to get measurements taken. At Orthopedic Motion we like to look at how your baby's head is changing over time when possible.
Your baby at 6-8 months:
Main Idea! Time to Make a Decision
Helmeting by 6 months of age allows for the most effective treatment. Research also shows that the head changes less on its own after 6 months of age. If you are thinking your baby may need a helmet, share your concerns with your pediatrician or schedule and appointment for a cranial consult.
If you feel your baby's head shape has made progress on it's own, we can help guide your decision with measurements taken here in the office. This helps determine how much change your baby's head would need to complete before no longer being medically concerning.
Your baby at 8-12 months:
Main Idea! Get Your Concerns Addressed
Have you and your pediatrician or physical therapist been monitoring your baby's head shape prior to coming in for a helmet evaluation? If you continue to have doubts or just noticed that your baby has some flattening, now is the time to come in before your baby's cranial bones suture.
Over 12 months:
Main Idea! Your Baby May Still Have Time for Treatment
While early intervention is ideal, there is still hope for babies over 12 months of age with continued flattening. How much correction we can get is based on if the soft spots (yes there are two!) have closed and if your baby still has some growing to do. Please contact our office so we can have a cranial expert assess if correction is needed and still possible.
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