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One Size Doesn’t Fit All

Updated: Feb 26, 2021

In this post we will address some of the common questions parents have regarding the fit of their child's helmet. We also discuss the customization process and list signs that your little ones helmet may need to be adjusted.

Why one size does not fit all!

So you may have noticed that all of those super cute helmets have completely different shapes. I’m here to tell you… there is a method behind the madness. Helmets are custom made to manage the pressure placed on your baby’s head which is why they are monitored by the FDA.

Let’s go over the basics

Helmets have an opening for the eyes, ears, and the very top of the head. All helmets are supposed to fit low over the eyes and close to the ears. The outside is made of plastic and the inside is a variant of foam (it depends on who’s manufacturing the helmet and what option is best for your baby). Many helmets open from the side and can be equipped with a hinge or not on the counter side. Some helmets also open on both sides (bi-valve).

"D" Opening At Top Of Helmet

Helmets can have an oval opening at the top or a “D” shape. The top opening of the helmet is meant to influence the head shape as well. Babies with plagiocephaly have an oval opening and babies with brachycephaly (broadening) tend to have a “D” opening to help manage the “height” or area of the head that has been pushed up.

Heads with asymmetries on top of the head might not touch the top of their helmet because there is room for the head to grow more symmetrically. It is also possible as the head corrects to see the head make less contact with the top of the helmet.

Nothing with these helmets is random; every detail is intentional. Cranial remolding helmets are regulated through the FDA and must be customized for each baby.

"Why doesn’t the helmet fit my baby perfectly if it’s custom?"

The helmet is created by making a perfected head mold based on your baby’s scan (see scan post) and projected growth. This head mold is then used to make the helmet so that the helmet makes contact with areas of your babies head that are pushed out and leaves space for your baby’s head to grow into. When we first put your baby’s helmet on, it will not fit perfectly because the helmet is meant to be grown into. This is why your little one can have redness and more contact on some sides at first.

"His eye is closing"

Parents are often alarmed that their baby’s eye seems to look closed. We often hear that it looks like baby is scowling or “mean mugging” or “scrunching”. This is typically what happens when the baby has moderate plagiocephaly, greater than 10mm of cranial vault asymmetry. The pressure over the eye is actually caused by the flattening in the back!

As the head becomes flatter in the back on one side, the forehead can be pushed forward on that same side. The helmet will appear tighter on this side in the front because the helmet is holding the forehead that’s been pushed forward. This allows the other side to grow and catch up so that we can decrease facial asymmetry. This is also the reason why the helmet has to sit so low over the eyes.

If your baby’s eye looks closed, undo the strap on the helmet and open the helmet wide with your hand. Dip the helmet down low over the eye brows and then refasten it. This helps scoop the forehead back up into the helmet like instant baby botox. Contact your provider if this continues to be an issue and you are having to frequently adjust the helmet.

"The helmet is pushing her ear"

Remember how we talked about the symmetrical helmet not wanting to fit well on the asymmetrical head? It also can fit close to their ear because the ear on the flatter side has been pushed forward. One of our goals with the helmet is to get that ear back in line with the other ear by keeping it securely held with a close fit.

The helmet should fit right up against the ear. It should not shift to cover the ear and should not be causing redness to the ear. If this occurs, please contact your provider. If you suspect an ear infection or baby seems to be excessively pulling at the ear you may want to speak to your pediatrician. The helmet is not meant to cause pain. It is also possible you may see discharge from the ear as the ears become more aligned which is normal.

"It’s crooked"

Parents will often report that they feel the helmet is trying to turn or looks crooked. This is usually because the helmet is trying to fit on the longer diagonal of the head. The helmet thinks that the diagonal is the front of the head and puts pressure on one cheek to stay in place (typically the side with the opening). As long as the helmet isn’t turning to cover the patient’s ears and face, it is fitting correctly. In severe cases of facial asymmetry, you will also see redness over the patient’s forehead on the same side of the flattening because this side of the face has been pushed forward.

Alert your cranial practitioner if the redness isn’t going away after 45 minutes of removing the helmet and if redness doesn’t improve with diaper cream. Also alert your practitioner if the helmet seems to be shifting. We are able to help stabilize the helmet and decrease redness with a few quick adjustments

"I’m concerned that the head mold is not how I want my babies head to look."

The helmet is made for modification. As the baby’s head corrects we shave out the inside of the helmet for continued correction. Sometimes, with severe head shapes we are unable to fully correct the head mold because it would put too much pressure on your baby’s head. This does not mean we cannot get full correction. The molds and the helmets are strictly monitored by the FDA to prevent adverse effects from the helmet which is why the initial shape of the mold is customized your little ones current head. If you are concerned about the goals for your little one’s head shape, this is something you should bring up with your practitioner.

"Basically, what do I need to know?"

All of the variables that go in to customizing your helmet are meant to best manage the displaced cranial tissue for your baby. The helmet is going to have the most awkward fit the first week but then as the baby’s head corrects, the helmet fit improves. The helmet is never meant to cause pain or sores and is made to be adjusted throughout the process. Frequent adjustments are signs that your baby’s head is changing or growing quickly. For more before and after scans, see our post.

Signs that you need to contact your provider for an adjustment include:

  • The helmet is shifting to cover the baby’s ears or eyes

  • There is redness lasting longer than 45-60 minutes after removing the helmet

  • Your baby is unconsolable and unable to tolerate wearing the helmet which is unusual for your child

  • It is getting more difficult to strap the helmet in place on the mark indicated and you feel the helmet is too small

  • You have questions about the baby’s progress, wear schedule, and how to take on/off the helmet


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