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Research Spotlight: Age and Severity Matter

Age and severity at the beginning of helmet treatment have a definite impact on duration and effectiveness of molding orthosis therapy.

Who's Saying This? Today we are specifically looking at the article Head Orthosis Therapy in Positional Plagiocephaly: Influence of Age and Severity of Asymmetry on Effect and Duration of Therapy. This is an article published by Kunz et al. (2017) in the Plastic and Reconstruction Surgery Journal.

What Does This Article Say?

Cranial remolding was found to be effective for all 144 children included in the study! While helmet therapy decreased head asymmetry, the efficacy of correction decreased with age. What do researchers mean by efficacy? The older the child was at the start of treatment, the longer they had to wear the helmet. Researchers found the duration of treatment to increase with age.

How much longer did they have to wear it compared to the younger age group? Average treatment times for the three groups were as follows:

  • Less than 6 months of age, wear time 18.6 ± 5.3 weeks

  • 6-8 months of age, wear time 20.0 ± 5.7 weeks

  • Greater than 6 months of age, wear time 25.3 ± 7.6 weeks

Researchers found that the success rate of achieving 3.5 CVAI (cranial vault asymmetry index) also decreased with increased age at start of treatment. It is noted that all participants did demonstrate improvement in asymmetry with helmet therapy.

How Did Researchers Prove It?

Patients were grouped by age and severity. Their results were analyzed using three-dimensional sterophotogrammetry. Researchers found time in the helmet and degree of correction was dependent on severity and age at start of treatment.

For severity, researchers used "mild to moderate" to describe CVA (cranial vault asymmetry) of 3 to 12 mm and "moderate to severe" to describe a CVA greater than 12 mm. For age, researchers grouped infants less than 6 months, infants 6-8 months, and infants older than 8 months. Successful treatment was defined as CVAI (cranial vault asymmetry index) less than 3.5 (we have details on what this measurement is as it differs from cranial vault asymmetry. See our post here or scroll down for pictures to get an idea of what these numbers actually look like).

What Does This Mean for My Baby?

This research strengthens our current recommendations. We recommend that if your baby has a concerning head shape and flattening, you should get measurements as early as 3-4 months. Early measurements allow us to track your baby's head shape to see if it improves with repositioning or if we need to start talking to your insurance about getting a helmet covered. Starting early can also prevent the head from getting so severe that your child will need a longer treatment time.

What Does This Mean for Me As A Caregiver?

Be proactive! If you have a concern absolutely speak up. Speak to your pediatrician or call us with questions. Or set up and evaluation! If you have mentioned your concerns and don't feel you are getting the support you need, then amplify your voice by reading our post on Busting Helmet Stigma. Early action could help prevent the helmet or shorten time in the helmet.

What Does This Mean for the Medical Community?

Many insurance companies prefer patients to trial positioning or physical therapy prior to covering the helmet. This research can help us advocate for babies that don't have documented repositioning attempts but are at a certain age/severity and needing to start cranial remolding now!

The implications from this article also reach out to pediatricians to refer patients for early cranial monitoring. Some pediatricians prefer to watch the head up to 8 months of age before referring for a helmet, which we now know can decrease the efficacy. We are advocating that the more appropriate time frame for referral is 4-6 months of age.

Who Else Should Know About This?

Many popular websites and journals state that 1) heads correct on their own and that helmets are 2) expensive medical devices that are not covered by insurance and 3) worn for up to a year. These sources are completely WRONG.

1) This article not only shows that helmets correct asymmetry but it also shows that heads at a certain point of severity might not get full correction, especially without a helmet.

2) We know that early action can help get these helmets covered by insurance. For more information on if helmets are covered by insurance click here.time

3) Helmets in this case and our experience were only worn for weeks.

So What's Next Researchers?! Check out our Helmet Research Center

More Questions?

Do you have more questions that you want answered by our staff of experts? Head on over to our Q&A brunch. That's right, we like to think of our mom forum as a friendly trendy cafe where you can connect with others about the helmet journey.


Kunz, F., Schweitzer, T., Kunz, J., Waßmuth, N., Stellzig-Eisenhauer, A., Böhm, H., . . . Linz, C. (2017). Head Orthosis Therapy in Positional Plagiocephaly: Influence of Age and Severity of Asymmetry on Effect and Duration of Therapy. Plastic and Reconstructive Surgery, 140(2), 349-358. doi:10.1097/prs.0000000000003517

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