Flat Heads... #3 To Helmet or Not?

Series Information:

1 in 5 babies go through a period of having some flattening of their skull as a result of external forces (the position they are in) which is often called positional or deformational plagiocephaly. In a well baby without developmental concerns, the natural course of this presentation is normally very good. It is a condition though that can cause a lot of stress and worry for parents, therefore I have completed a 3 part series to provide some information and practical tips. If you are concerned, it is important to see your local relevant health professional to best understand exactly what is happening with your bub!

There are 3 articles in this series on Flat Spots / Plagiocephaly:

  1. Flat Heads… #1 Ask The right Questions!

  2. Flat Heads… #2 Simple Steps for Improvement

  3. Flat Heads… #3 To Helmet or Not?

What about Helmets?

One fairly common treatment option for head shape concerns are custom-made ‘remodelling’ helmets. It is not uncommon for parents to be very anxious about the prospect of this treatment and often parents arrive at therapy to report that their main goal is to avoid ‘needing’ a helmet.

The decision ‘to helmet or not to helmet’ is often perceived to be a critical one when some families see health professionals. We are only just starting to get enough good quality evidence to help parents and health professionals make well informed decisions about this treatment option.

A quick dip into the scientific evidence…

(*quick dip… not extensive literature review!)

A 2014 study which compared the broad long term outcomes from helmet therapy and conservative therapy in babies with moderate to severe positional head shape concerns (1) is a good one to consider for this purpose. The outcomes of this study combined with many previous studies allow clinicians to provide the following general advice to parents trying to decide whether or not to have a helmet made for their baby:

  • For most babies ‘Helmet Therapy’ does not appear to provide significant additional value to the treatment of positional head deformities.

The details:

  • Helmet therapy is considered a safe technique(4).

  • Helmet therapy does have a number of minor but common reported side effects including skin irritation and sweating, and parents have reported feeling hindered from cuddling their child(1).

  • Helmet therapy has no long term influence on a child’s motor skills or quality of life (1).

  • Helmet therapy is most commonly started at about 6 months of age and it is recommended that ‘re-positioning therapy’ be attempted for at least 6-8 weeks prior to considering a helmet (7).

So helmets are a realistic option for worried parents and health professionals to consider, however we do not have clear evidence to generically say it is a significantly better approach than conservative therapy (repositioning and developmental exercises).

So What’s the Answer? Helmet or Not??

This one is not for me to answer. That decision is one for each family to make. I will say however two things:

  1. Regardless of the severity of your child’s plagiocephaly, please consider helmet therapy as an optional therapy pathway rather than a must do. There are very good reasons that might lead you to choose to have a helmet, just as there are good reasons why not to. There is not evidence to generically say that the outcome from having a helmet will offer long term advantages over not having one.

  2. The changes to your babies head are not the head’s fault so I strongly recommend that you focus on helping your baby develop strong, mostly symmetrical neck strength and age appropriate motor skills regardless of other options! (this is an important one, so will get it’s own little section below:)

It’s Not the Heads Fault!

Regardless of whether you choose to go down the ‘helmet path’, it is worth remembering that the primary cause of this condition is not the head. The head is only impacted because of your baby’s sustained positioning. So the primary issues that need to be addressed are 1. where your baby spends a lot of time and 2. any preference that your baby has to turn their neck one way more than the other while in that position!

Key Thing!

This all means the real ‘bang for your buck’ comes from working on your child’s general development. The sooner they are looking both ways, rolling, sitting up and on the move, the more opportunity their head has to grow symmetrically!

It’s Not the End of the World!

Having concerns about your child’s health is stressful, worrying and can be confusing! With this condition however most of the story is very positive. If you are aware of the issue and have made sure that nothing more worrying is going on, then you are already on your way to fixing the problem.

We know that in most cases the normal and natural progression of this condition is very positive. This means even without significant intervention, things are very likely to improve and to improve well.

As always… this is general info, so if you are concerned, please see your local skilled health professional to receive personal assessment and advice.

Any questions or concerns, please email hi@themovementteam.com.au!

Kind Regards,




B.Phty (Hons), G.D. Paed. Neuro. Rehab.

Tim has 10 years of Physiotherapy experience and is experienced in Paediatric (Baby’s and Children’s) Physiotherapy. 

Tim is co-owner and director of The Movement Team. Tim also holds an Advanced Physiotherapist position within a Child Development Service in the public health sector.

Tim has worked across the breadth of paediatric health (acute hospital, disability care, developmental, community and private clinics) and has completed numerous national and internationally recognised education courses in topics including developmental orthopaedics, high risk infant management, respiratory functioning and infant movement.

Tim's formal training consists of:

Bachelor Physiotherapy (Hons) - University of Queensland

Graduate Diploma Paediatric Neurological Rehabilitation - University of Western Australia

Tim additionally holds the following positions and memberships:

Chairperson of the Queensland Paediatric Physiotherapy Clinical Network 2013 - 2016

Child Development Service Team Leader - 2016/2017. 

Australian Physiotherapy Association Member


Please note that the clinical information included in this article is of a general nature and might not apply to every family. Please see your local health professional for individualised developmental advice.

1. Van Wijk, R.M., et al., Helmet therapy in infants with positional skull deformation: randomised controlled trial. Vol. 348. 2014.

2. Robinson, S. and M. Proctor, Diagnosis and management of deformational plagiocephaly. J Neurosurg Pediatr, 2009. 3(4): p. 284-95.

3. Bialocerkowski, A., Physiotherapy reduces the risk of deformational plagiocephaly in infants who have a preferred head position when lying supine. Australian Journal of Physiotherapy, 2008. 54(4): p. 283.

4. Flannery, A.B., W.S. Looman, and K. Kemper, Evidence-based care of the child with deformational plagiocephaly, part II: management. J Pediatr Health Care, 2012. 26(5): p. 320-31.

5. Ehert, F.W., et al. Differential Diagnosis of the Trapezoid-Shaped Head. The Cleft Palate-Craniofacial Journal, 2004. 41: p13-19.

6. Looman, W.S. and A.B. Kack Flannery, Evidence-Based Care of the Child With Deformational Plagiocephaly, Part I: Assessment and Diagnosis. Journal of Pediatric Health Care, 2012. 26(4): p. 242-250.