Roughly one baby in five under the age of 6
months develops a skull deformation caused by lying in a supine
position. Now a study has found that a common remedy for the problem, an
expensive custom-made helmet worn by infants, in most cases produces no
more improvement in skull shape than doing nothing at all.
The new report,
published Thursday in the journal BMJ, is the first randomized trial of
the helmets. The authors found “virtually no treatment effect,” said
Brent R. Collett, an investigator at Seattle Children’s Research
Institute and author of an accompanying editorial.
Skull flatness at back of the head may be
accompanied by facial asymmetry; one ear may be slightly farther back
than the other, and sometimes the side of the head can flatten. Until
now, less rigorous studies had mostly shown helmets did help normalize
head shape.
The helmets are sometimes adorned with
stickers, and are sometimes painted to resemble a pilot’s helmet or with
the logo of a beloved football team. “I was very surprised at the
results,” Dr. Mark R. Proctor, an associate professor of neurosurgery at
Boston Children’s Hospital, said of the new study, adding that it was
“rigorous.”
Still, the study leaves open the possibility
that the helmets may still be useful for infants with severe skull
flattening and those with tight neck muscles, which make it hard for
infants to turn their heads, so they remain in one position.
Renske M. van Wijk and researchers at the
University of Twente in the Netherlands assigned 42 babies who had
misshapen skulls, aged 5 to 6 months old, to wear a custom-designed
helmet that allows flattened areas room to round out as the infant’s
skull expands.
Parents were instructed to have infants wear
the helmets 23 hours a day for six months or so. Another 42 babies with
similar deformities received no treatment. Infants with the most severe
deformities were excluded.
After two years, a researcher who did not
know which babies had worn helmets evaluated skull shape in the infants.
The improvements were not significantly different between the
helmet-wearers and the infants not wearing helmets.
“There are definitely cases of infants with
mild to moderate skull deformation who are treated with helmet therapy,
and this study confirms and reaffirms that this is not necessary,” said
Dr. James J. Laughlin, an author of the policy statement on skull deformities for the American Academy of Pediatrics.
Helmets to treat flattened skulls range in
price from $1,300 to $3,000, and parents are told to make sure infants
wear them around the clock. Dr. Laughlin said the paper provides
pediatricians and worried parents “reassurance that not doing helmet
therapy will give you the same results as doing helmet therapy, which is
expensive” and can be “stressful for the family.”
Makers of custom helmets questioned the
study’s results. Tim Littlefield, a spokesman for Cranial Technologies,
called it “inherently flawed.” William Gustavson, a spokesman for
Orthomerica, called it “alarming” that nearly three-quarters of parents
whose children received helmets in the study reported that the helmets
shifted or rotated on their infants’ heads.
“The value of this research is fully reliant
upon the quality of the fit,” said James Campbell, the vice president of
the American Orthotic and Prosthetic Association, a trade group.
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