Bust the Helmet Stigma! And Let’s Restart This Conversation .
Stop Feeling Guilty About Your Baby’s Head, You Are Doing Your Best.
5 Misconceptions About Helmeting to Fight Helmet Stigma
Let's address a problem, HELMET STIGMA! This is a large elephant that sneaks it’s way into our examination room during evaluations. Our mothers, fathers, caregivers and babies are getting shamed for needing helmets. Because we mostly see moms in our evaluation rooms, we will specifically address mom-shaming and the stigma that surrounds baby helmets.
First, we need to clear up a few things. Helmets are used to mold a baby’s head while it is still soft. The helmet does not squish or push the head, it makes contact where the head is sticking out and acts as a mold for the rest of the head to grow into. The child is never meant to be in pain or unconsolable during this process. It does not interfere with development and is the noninvasive solution to plagiocephaly or brachycephaly (deformational asymmetry and flattening of the head). By noninvasive, I mean non surgical, because yes continued plagiocephaly can require surgery if it remains severe.
Helmeting is not some new fad. Cranial bands are an FDA approved treatment and were first documented to be used in 1979. Historically, many cultures have their own methods of head shaping based on their own traditions and child rearing practices. Some cultures also use a head mold similar to a helmet, while others practice massage, head wrapping, strap boards to baby’s head, or tie baby down in a position to correct the head shape.
We know that in the United States, we saw a huge rise in head flattening when the Back to Sleep Campaign was publicized. Pediatricians recommend placing infants on their back for sleep and this has resulted in a large reduction in the incidence of Sudden Infant Death Syndrome (SIDS). Many countries that have since adopted “Back to Sleep” have also seen a similar drop in SIDS and increase in plagiocephaly. Despite the strong correlation, the Back to Sleep campaign is not solely to blame for increased rates of plagiocephaly. Most articles that examine the rise in plagiocephaly also blame extra time in carseats, swings, and bouncers for this increase. Not enough tummy time is also a popular scapegoat. Popular pins on Pinterest advertise “How to avoid the helmet!” or “How we improved our flat spot and you can too!”
All of these place blame, intentionally or not, on the fact that mom didn’t do something or was somehow lacking. We mom’s feel guilt and shame so easily because we are so passionate about wanting what is best for our babies. Let’s just back up a second here and restart the conversation.
As a mom myself, I know that I have exhausted myself with trying to do what is best for my baby. I have read books, blogs, journals, warning labels, and instructions. I also specialize in baby development! I have done more research as a mom than I did in my doctoral program. I read an article that says “How you are ruining your baby’s sleep?” And just the title made me cry. Because of course, I am not really ruining anything! I am the mom and you are too. We want what is best for our babies, that is where we will restart this conversation.
We want what is best for our babies. Is a round symmetrical head better than a flat, asymmetrical one? Yes. Why? Because studies show that there are less craniofacial complications from having increased symmetry. We also don’t need studies to tell us that a round head does look better. There are also associated developmental delays in children with plagiocephaly. This is a highly debated topic that we will address in a future blog post but for now please see resources from the American Association of Pediatrics on developmental and cognitive delay on persistent plagiocephaly.
Now here’s where the stinky stigma comes along… We want what is best for our babies. We know that we need to treat plagiocephaly, but we don’t want to be taken advantage of or be seen as doing the wrong thing. So we try our hardest to do positioning, tummy time, and use special pillows but at a certain age and severity, it just doesn’t work anymore (see post on positioning strategies). We then listen to everybody else’s subjective opinion. We consult what are seemingly reputable resources. Now we have made ourselves crazy trying everything and are resistive to the helmet because we don’t want to be judged as doing something radical or shameful. We also don’t want to feel like we “failed”.
What you should know is the helmet is only as radical and shameful as others make it out to be. Putting your baby in a helmet:
Does not mean you “failed” positioning
Does not mean you let them lay too long
Does not mean you neglected them by having to go to work and leave them with a sitter
Does not mean that because they had reflux you weren’t able to care for them better
Does not mean you should have placed them on their belly for sleeping or held them all night
It can be difficult if one parent or the grandparents are especially resistive to the helmet when you feel it is best for your baby. Here are my recommendations for combating Helmet Stigma:
Objective Measurements vs. Subjective Observation: Have you been arguing with someone close to you and your baby about how your baby’s head looks? Can you not agree on if you think the head is normal or severely misshapen? Have others told you your baby needs a helmet but you think their head is looking better? Here’s an idea. Let’s get a measurement to determine if the head shape is within normal limits, mildly asymmetrical, moderately disproportionate, or severe. That way we can track progress and take the stress out of constantly debating a sensitive topic and possibly damaging relationships. If you don’t feel comfortable going in for a measurement, track with photos and discuss with your pediatrician. Plagiocephaly is not a subjective opinion. It is an objective, diagnosis based on measurements.
“I don’t want my baby to be suffering for cosmetic reasons”: The major downsides to helmets are that they are hot, stinky, and cost money. They are not meant to cause inner cranial pressure, head aches, or unconsolable discomfort. We typically only recommend cranial remolding if your baby has an asymmetry beyond cosmetic difference. In other words only if your baby is significantly asymmetrical and in the area where research says it is unlikely your baby will continue to correct on their own without the assistance of a helmet. We deem this as being medically necessary and so do insurance companies.
“I never wore a helmet and neither did my parents, why would my baby need one?”: I once had a dad say to me, “Cavemen didn’t have helmets”. While this is true, what does it even mean for helmeting today? The proposed, underlying, implied argument is that helmets are a superfluous creation of 21st century baby perfectionism because the human race has somehow survived without helmets. This argument is way oversimplified; cavemen didn’t have a lot of things we have including expected infant survival, advanced healthcare, men/women with careers, infant carriers, and AAP guidelines for preventing other health complications. The simplified answer is, past generations did not have this prevalence of plagiocephaly.
“Helmets Are A Scam”: Believe it or not, I don’t get a kick back for recommending a helmet. Many of our local pediatricians send patients to us early for monitoring with our 3D scanner because they trust us. As a doctor of occupational therapy I recommend positioning strategies, stretches, and home modifications to make as appropriate. Some of our patients improve “avoiding the helmet” and some of them don’t. We like to observe progress whether it leads us to a helmet or not because it helps us better inform patients that are potentially looking at needing to fund a helmet. I now can very confidently inform a patient based on their measurements, developmental status, and age on whether or not they will eventually improve without the helmet or if they are better to get started early. Based on measurements and 3D scans we are then almost always able to get them covered by insurance as medically necessary (there are few exceptions). Worried your baby will be charged for multiple helmets? Not really possible as we do now have a one helmet garauntee.
“Helmets Don’t Work": Helmets 100% do work. They do. If I’m lying, I must be dreaming the majority of the day where I see our patients achieve correction and amazing results when they are compliant. I not only see them work, I explicitly can measure with a 3 dimensional scanner that they do. I am not out selling anyone snake venom to treat 100 ailments or a youth tonic made of exotic beans. It’s simply biomechanics- you put a mold on a malleable substance and that substance (the cranial tissue surrounding the nonsutured cranial bones) will take the shape of that mold (the helmet). What determines how much the mold can influence depends on how much growth the baby has left to do and how compliant the caregivers are with the schedule. There are currently some studies out there that claim helmets don’t make much of a difference (AAP Publication). The validity of these studies is something that you can see questioned by the cranial and pediatric community (to be more specifically addressed in a future post).
Finally, with a resounding support to all of our cranial moms out there. If your baby has a flat head that is medically concerning or if they have a little flattening that is considered “cosmetic difference” and YOU want want to change it, we can help you. YOUR baby’s head, YOUR choice to get the resources for what you think is best for YOUR baby.
And Bust the Helmet Stigma!
Mom, it is not your fault that your kid has flat head.
Dad, do not blame yourself, thinking you could have done something to change the way the shape is now.
Grandma, yes babies were placed on their bellies to sleep back in your day, but things are different and actually better/safer now.
Grandpa, yes, there is a flat spot, even though you only see those chubby cheeks.
Stranger, don't pass judgement.
Pediatrician don't block doors to resources some parents are seeking.
Therapist, speak up if you think there is a problem.