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Three types of deformation exist with plagiocephaly.

  • Plagiocephaly: Refers to the one side of the back of the head flat and bossing of the forehead on the flat side. 
  • Brachycephaly: Refers to the entire back of the head flat.
  • Scaphocephaly: Refers to the condition where the head is long and narrow.

For all the above deformations the ears might be shifted as well as a facial asymmetry.  Many treatment options exist.  Repositioning techniques might be needed to avoid the child leaning on his flattened side.  Also physical therapy will stretch the weakened muscles and/or tightened neck muscles. Finally, the cranial orthosis treatment.

What happens during the first visit?

The initial visit includes a complete evaluation, the infant’s history, clinical pictures and information on the treatment process.  The moulding/imprint can also be done during this first visit.

This step takes approximately 20 minutes.  This process is harmless and painless for the infants, even though they might cry. They are only uncomfortable. Cotton stocking, open at the face, is placed of the child’s head.  A series of plaster strips are applied from the eyebrows to the back of the neck, from the side of the head, including over the ears, along the face.  Within the following 2 weeks the orthotist will have received the helmet and will be ready for the fitting.

How soon will we see improvement?

This varies, but some parents have seen improvement after only 2 weeks of orthosis use.  Correction continues over time, and requires complete compliance to achieve the greatest degree of symmetry.

Will my infant experience any discomfort wearing the orthosis?

In most cases, children adapt quite easily to the orthosis.  As your infant begins to wear the orthosis, any concerns you may have can be addressed by your orthotist.

How do we keep the orthosis clean?

In some cases, a mild unpleasant scalp odour may develop.  It is easily controlled with daily washing of the head and orthosis.  You may also remove the orthosis for a couple of minutes during the day to towel or blow-dry your child's head and the orthosis.  The orthosis may also have a mild chemical smell that dissipates within a day or two.

Do we need follow up?

Yes, your child will need frequent orthosis adjustments by the orthotist due to his quick growth.  Contact your orthotist sooner if the orthosis seems tight or you notice any problems.  The referring physician may wish to see the child periodically during the orthosis treatment to evaluate progress.

How long is the treatment?

Usually the treatment last approximately 8 to 16 weeks for infants between 4 to 7 months of age.  Older children may need more time since the growth is slower as they get older.  Research indicates the best results for symmetry are achieved while the child is younger. 

During this period, the child may need to meet with a physiotherapist to make sure the helmet does not affect his motor skills or posture.

Who will tell us when to stop wearing the helmet?

The decision to continue wearing the orthosis should be made by the physician in conjunction with the orthotist. The orthosis has done its job when the head rounds into the symmetrical shape of the orthosis, or when the head shape has changed to an acceptable degree of symmetry and has outgrown the orthosis.

Will the head revert back to the flat shape when the orthosis is discontinued?

It is not common for the head shape to revert back to its original.  As children get older, they spend more time sitting, crawling and walking, which minimizes the amount of time they spent on their backs.  In fact, further skull shape improvement may occur over time. If your child was diagnosed with torticollis, it may be necessary to continue the stretching program to maintain correction achieved by orthosis.

Does my insurance pay for cranial remoulding orthosis/helmets?

Each insurance company has different coverage and medical policy guidelines.  It is best to contact your insurance company and employer benefits coordinator to determine the type and level of coverage for durable medical equipment (DME) and orthotics and prosthetics (O&P).  It is not uncommon for insurance companies to require a letter of medical necessity from your referring physician stating that the orthosis (a cranial remolding orthosis) is medically necessary and is not being prescribed for cosmetic reasons. 

Where can I get more information?

There is a wonderful discussion group that is primarily composed of parents at a web site called www.plagiocephaly.org. Additional information is available by searching the internet with the keyword “plagiocephaly”.

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