Morrison Goodwin was born in March 2018 with a head that looked a bit like a “Lego block,” says his mom Georgina, a sales executive in Los Angeles. Morrison was twin baby A, packed below his sister Rae at the bottom of Goodwin’s uterus. Goodwin mentioned her observation about her son’s head to her pediatrician, who recommended various exercises and repositioning with the help of their physical therapist.
When Morrison’s head shape didn’t budge, their pediatrician suggested visiting a cranial remolding orthosis clinic. The doctors there diagnosed him with moderate plagiocephaly, suggesting it might eventually impact his sleep and bite, and recommended a baby helmet to round out his head. “We were very skeptical. It wasn’t a slam dunk,” Goodwin says. “This is a business. I’m guessing that they’re more likely to want to give you a helmet, if that’s how they make their money.”
Even so, Goodwin warily gave the green light. “Our insurance paid for it. And it’s very noninvasive. You’re a new parent. You’re like, well, I’m supposed to set this kid up for success, and I’m told to do this,” she tells POPSUGAR.
Plagiocephaly and brachycephaly – two types of flat head syndromes – have recently been on the rise in the United States. In 1994, the National Institutes of Health launched its Back to Sleep campaign, after a slew of studies showed that tummy sleep is linked to an increased risk of sudden infant death syndrome (SIDS). “It worked wonderfully,” says John Girotto, MD, FAAP, FACS, the section chief of pediatric plastic surgery at Helen DeVos Children’s Hospital in Grand Rapids, MI, who specializes in craniofacial surgery. Rates of SIDS dropped from 130 to 78 deaths per 100,000 live births between 1990 and 1996. “But what happened is kids developed misshapen skulls,” he adds.
Because babies now spend more time lying on their backs, their soft heads develop flat spots. At first, many pediatricians and surgeons were concerned about the long-term effects, Dr. Girotto says. But by the late 1990s, researchers confirmed that babies simply had “positional” molding and most didn’t require surgery.
Today, however, an entire industry promises to fix babies’ flat spots via “helmet therapy,” also called helmet orthosis. Clinics with mottos like “reshaping children’s lives” devise their own guidelines for helmet therapy and sell baby helmets, which can be personalized with Star Wars and Minnie Mouse motifs. Some have Instagram accounts with tens of thousands of followers. Got an especially photogenic baby? You can even submit a pic of your helmeted baby to your orthotic company’s “calendar contest.”
To be clear, these clinics probably aren’t harming their patients. But the question of how often baby helmets are really necessary remains. Amy Mischnick, PT, a pediatric physical therapist at Cincinnati Children’s Hospital who treats flat head syndrome, says that part of her job is to provide evidence-based recommendations to parents. This includes, she says, correcting “misinformation, especially when it is used as a scare tactic to place emotional pressure on parents to pursue helmeting not based on facts but on unfounded fear and guilt.”
Why Do Babies Get Flat Heads, Anyway?
Some babies, like Morrison, are born with a flat spot (aka positional skull deformity), often due to their position in the womb. But most flat spots tend to develop gradually after birth, due to pressure from staying in the same position while sleeping and playing. The most common positional skull deformity is plagiocephaly, a flat spot on one side of the head that makes the opposite forehead prominent, which may affect nearly half of all 4-month-old babies. Brachycephaly is less common and occurs when the back of a baby’s skull is very flat and wide.
Parents usually notice a flat spot within three months of birth, when a baby’s skull is soft and moldable. “At that point in time, behavior modifications usually do a great job of helping the skull round out,” Dr. Girotto says. For example, your doctor may recommend using a baby carrier or an “exersaucer” chair instead of a car seat or bouncer; increasing tummy time; and switching the direction baby sleeps. You should follow other safe sleep practices, though; never place head-shaping pillows or any other objects in your baby’s crib.
These tactics are only effective until a baby learns to roll over, at about 6 months of age, because you have less control over their sleeping position. “By the same token, they will no longer be stuck in their flat spot while they’re sleeping. They will roll over, so they’re going to do their repositioning for themselves,” Dr. Girotto says.
The vast majority of babies with plagiocephaly also have torticollis – a tight muscle on one side of the neck causing their head to tilt. A few physical therapy (PT) sessions with a trained practitioner can loosen the muscle and address a flat spot within a few weeks. Even if your baby doesn’t have torticollis, however, one to two PT sessions may also be helpful. A therapist can assess the cause for your baby’s flat spot and offer suggestions to address it – often without a helmet. “The younger an infant is when they start PT for torticollis or plagiocephaly, the faster you will see results and the more likely you are to get full resolution,” Mischnick says.
Do Babies Ever Really Need a Helmet?
Dr. Girotto only recommends helmets to babies with health conditions that may reduce the effectiveness of PT and positioning changes, such as neurologic issues. Mischnick usually reserves helmets for babies with torticollis who struggle to turn their head because of severe plagiocephaly.
The key to correcting a flat spot without a helmet is to start early: talk to your doctor about techniques to address your baby’s flat spot as soon as you notice it’s an issue. If repositioning is started before a baby with a mild flat spot is 6 months old, or before 5 months in babies with a moderate deformity, “helmeting is not typically needed,” Mischnick says. That said, moderate to severe flat spots may require a helmet, especially if parents haven’t started repositioning before a baby is 4 months old, she says.
There are other cases when a helmet might make sense. If you have multiples, you might not have the bandwidth to reposition them. Some babies are more resistant to tummy time, while others snooze long stretches at night and always end up on their flat spot. If your baby is in day care, you may have little control over how often they end up in a swing or bouncy seat. Or you might simply want faster results. “In America, we don’t like to wait,” Dr. Girotto jokes.
Even if you do nothing, flat spots tend to go away on their own – especially if they aren’t severe. “If you look at children at 4 to 5 years, barring the medically complex ones, generally their overall head shape will be the same with or without a helmet,” Dr. Girotto says.
A 2017 study of 248 children with positional skull deformities found that while PT sped up the time it took for kids’ heads to round out, all children with brachycephaly had a normal head shape by 5 years of age. Among kids with plagiocephaly, 80 percent had a normal head shape by 5 years old, 19 percent had mild plagiocephaly, and only one percent of kids still had a moderate to severe plagiocephaly. (None of the children in the study were given helmet therapy.)
A 2022 study on skull shape did take into account helmet therapy, but came to similar conclusions. While helmet therapy reduced the overall rates of plagiocephaly in 5-year-olds, it didn’t perform much differently than other interventions, like repositioning therapy or physical therapy. A 2023 review of research concluded that helmet therapy may be beneficial for babies who are diagnosed with moderate to severe plagiocephaly after the first several months of life, or when repositioning exercises aren’t helpful. However, the authors note there’s a “scarcity of scientific literature,” making it “difficult to determine the gold standard therapy.”
Overall, experts generally say that helmet therapy isn’t necessarily a slam-dunk solution.
“There’s no real downside to using them, but there might not be any real upside,” Dr. Girotto says.
What to Know About Baby Helmet Companies
Kendra Callari Casserly noticed a flat spot on her son Beckett’s head in June 2022, about a month after his birth. Beckett’s pediatrician recommended repositioning and other exercises, which Callari Casserly carefully practiced for three months. When his flat spot remained at his four-month appointment, their pediatrician suggested they consult a baby helmet company. In a free initial assessment, the clinic’s staff measured Beckett’s head and diagnosed him with moderate plagiocephaly and brachycephaly.
The orthotist at the clinic explained that Beckett’s left eye was fiver millimeters closer to his ear than his right side and said that a flat spot “kind of interferes with everything, because if your ear canal is a couple millimeters off, you might lose hearing in that ear. Same with vision,” Callari Casserly says. This made getting a helmet “a very easy decision,” she says, adding that paperwork submitted to her insurance mentioned that a helmet “will reduce the risk of hearing damage, balance issues, and vision disturbances, which if left untreated may require further medical attention.”
After Callari Casserly decided to move forward, the clinic shared images of what Beckett’s head could potentially look like without a helmet. “Once we saw the visuals, we were like, oh my goodness,” says Callari Casserly, a digital content marketer in Las Vegas. “I went into this thinking that Beckett’s flat spot was my fault. I had so much guilt. So being told that you were doing everything right and that this just happens really brought me comfort I didn’t know I needed.”
Callari Casserly is happy she and her husband ultimately opted for a helmet: it was relatively easy to use and completely corrected Beckett’s flat spot. “If there’s something I could have done and to prevent it to begin with, I would have. Knowing that this wasn’t at all going to hurt him, I was all in,” she says. “He was also young enough, he grew pretty attached to it. He never gave us a hard time putting it on. He loved it.”
Plagiocephaly may make the ears and eyes slightly misaligned, which could theoretically cause a problem. But “most of those things autocorrect over the course of five years,” Dr. Girotto says. Both Mischnick and Dr. Girotto aren’t aware of any research proving that misalignment can lead to permanent hearing or vision issues. Mishnick adds that it’s not something the ophthalmologists, audiologists, nurse practitioners, or PTs tell families at her hospital. “It sounds like a scare tactic that is not evidence-based,” she says.
Babies with plagiocephaly are also more likely to have jaw misalignment, as Goodwin’s doctors suggested – although research shows helmets aren’t necessary to fix this issue either, “despite what some companies may say,” Mischnick says.
What to Know When Considering a Baby Helmet
Again, none of this is to say that helmets are never beneficial. They can be useful in more severe cases, in cases when repositioning may not be feasible, and in situations where parents can’t or don’t follow physical therapy recommendations. Helmets can also help correct a flat spot relatively quickly, without as much pressure on parents to be diligent about repositioning or physical therapy. But it’s worth being aware of their study-backed uses and limitations.
Baby helmets are FDA-approved for infants 3 to 18 months of age and are typically worn for 23 hours per day for three to four months. They work as a sort of a template to guide the head’s growth and work best when the brain is expanding fastest and the fontanels haven’t yet closed – from about 4 to 9 months of age, says Mischnick. Any later and the benefits likely aren’t worth the cost. Before 4 months, repositioning alone is often enough. Plus, the weight of the helmet may delay the milestone of lifting the head during tummy time when babies are very little and have relatively little neck control, she adds.
An orthotist at a baby helmet company will fit your baby. Just be aware if they’re also measuring your baby’s head and making recommendations. Helmet manufacturers often categorize positional deformities as mild, moderate, or severe – but there’s no standard official classification. “It can be very misleading. Your baby’s severity might be rated as moderate by one company but only mild by another, which could mean the difference between a company recommending a helmet,” Mischnick says. You may want to start with measurements from a doctor, PT, or nurse practitioner who treats this issue, rather than someone affiliated with a baby helmet clinic.
For parents who do decide to use helmet therapy, there are few real risks. The main downsides of helmets are cost (expect to pay $1,500 to $3,000, which may be covered by your insurance) and time (you’ll have appointments with your care provider every two to four weeks, and you have to clean the helmet every day). Your baby will likely also sweat a lot and may have skin irritation, along with sores if the helmet doesn’t fit well. For kids with for torticollis, “it’s not unusual for the tilt to get worse in upright for a few weeks after getting a helmet,” Mischnick says.
Goodwin and Callari Casserly both say they are happy with the results. Still, if you’re considering a helmet, proceed with caution. “Be hyperaware of any claims that play on your emotions and prey on parental guilt,” Mischnick says. “Remember that this is purely a cosmetic issue and is never medically necessary.”
The information in this article is for informational purposes only and is not intended to serve as medical advice. You should always consult your doctor regarding matters pertaining to your and your family’s health.
Colleen de Bellefonds is a Paris-based journalist with two kids and a serious baguette habit. She covers science, health, parenting and French culture for US News & World Report, Well+Good, Women’s Health, Self, Healthline, and more.
