First-time parents promote the benefits of cranial remolding

Harper Riley completed successful cranial remolding with the use of a therapy helmet.


Four months into their daughter’s life, Heather and Callum Riley found themselves at a crossroads.

Harper Riley’s head shape was wide and short rather than symmetrical and oval, the likely result of her head being pressed against her mother’s pelvis before she was born. According to the American Academy of Pediatrics, this occurs in approximately 20 percent of babies born naturally.

After months of “tummy time,” placing Harper on her stomach to strengthen her neck muscles and repositioning her head while she slept, her head shape was not correcting itself. At Harper’s four-month checkup, the family’s pediatrician suggested a therapy helmet to correct her head’s shape and referred the family to Jim Brookshier, MPO, CLPO, FAAOP, a cranial specialist with the UT Health San Antonio Cranial Remolding Program.

“I thought the world was ending,” Heather Riley said. “I thought, what have I done? This is my fault.”

Deformities that may require helmet therapy

There are three positional deformities for which babies may need helmet therapy to correct their head shape:

  • Plagiocephaly occurs when the head is flattened on one side or corner because the baby favors that side when lying down.
  • Brachycephaly is when the back of the head is flattened and short in length, often because of lying on the back.
  • Sometimes, babies develop both a flattening of one side and a flattening of the back of the head. This is called asymmetrical brachycephaly.

Harper Riley developed brachycephaly, which is centralized flattening, Brookshier said.

According to Brookshier, babies developing flat heads became more prominent after the 1994 Back to Sleep campaign encouraging parents to place their sleeping babies on their backs to reduce the incidents of Sudden Infant Death Syndrome, or SIDS. The campaign was successful in reducing the number of deaths, but it led to some babies developing flat heads — a less dire consequence of sleeping on their backs.

Brookshier said head shape does not affect the brain or its neuropathways and that treatment for the condition is purely cosmetic.

“The brain does not have a certain shape. It’s like a blob of jello,” he said. “There is no relationship between development and head shape.”

However, Brookshier said the shape of the head does impact lives in other ways.

“For instance, we put things on our heads like bike helmets. If it doesn’t fit on your head, it does not work efficiently and protect your head. Also, people don’t want their children to be bullied as a result of having a particular head shape, so the psychosocial aspects must be factored in as well,” said Brookshier.

How helmet therapy works

Other than neurological concerns for their daughter, the Rileys were concerned about how the helmet would affect their baby, who was sleeping well and had a happy disposition.

“We were worried about the impact it would have on her quality of life and her happiness,” Callum Riley said.

During their first meeting with Brookshier, a radiation-free digital laser scanner was used to create a digital image of Harper’s head shape. The couple was shown measurements of her head compared to normal proportions of a four-month-old’s head.

“We were able to put it into some context and see data points next to each other to understand how this journey would go,” said Callum Riley.

After deliberating for two weeks, the couple chose to use the therapy helmet. The helmet was custom made for her using the digital scan of the then four-month-old’s skull.

Inside the helmet is soft foam. Brookshier said the helmet is designed to allow an infant’s head to grow into it. Unlike braces, the helmet does not press and manipulate the shape but is a mold for the still-growing skull to grow into. He said four to six months is the ideal time to begin helmet therapy.

“Usually, at four months, if the skull shape was going to correct itself naturally, it would.” Brookshier said the biggest challenge is ensuring the patient is in the helmet 23 hours per day, even through warmer months. He explains to parents that babies adapt to the helmet much like they adapt to anything new in their world.

“I always tell parents that four to six months ago, [their babies] weren’t wearing clothes, but you didn’t give them a choice, and they didn’t complain. They adapt to the helmets very easily as long as they are cool and the fit is appropriate.”

Adjusting to the helmet

To the relief of Heather and Callum Riley, Harper adapted to her helmet easily. Her sleep patterns and general disposition didn’t change. In fact, the family discovered several advantages to having their active baby wear a helmet.

“No one tells you this from the start of this process, but it’s a brilliant crash helmet,” said Callum Riley. “She was invincible.”

The couple said the helmet was a conversation starter and allowed them to talk about the benefits of cranial remolding when asked about the helmet.

One drawback: “The helmet can get stinky if you don’t take care of it,” Heather Riley said.

“The helmet makes the ambient temperature about four degrees warmer,” said Brookshier. “Also, babies have a higher metabolism, so their temperature is boosted as a result of growing.”

While Heather Riley said she felt overwhelmed initially, the couple quickly learned to add cleaning and maintaining Harper’s helmet to their everyday routine of caring for their daughter.

During this time, the Rileys traveled overseas to Britain twice and were given additional instructions to look for signs of distress from their daughter. Brookshier said the change in air pressure on planes can cause babies to be uncomfortable. He encourages parents to remove the helmet if they see any signs of distress, but usually the helmet can remain on throughout travel.

Life after Harper’s helmet

After six months, Harper completed her helmet therapy, with her head showing a more symmetrical and normalized shape. While their daughter quickly transitioned, her parents weren’t ready for the change.

“This is going to sound very weird, but I was actually kind of sad. It was super exciting, but I was sadder and more emotional about it than anything,” said Heather Riley. “She had that helmet for more than half of her life. It became part of her, so seeing her without it was strange.”

Harper’s helmet is now a keepsake and sits on a stuffed bear’s head. After their experience, the Rileys now encourage other parents to consider helmet therapy.

“If we have another child that requires a helmet, I wouldn’t think twice about having it done,” Heather Riley said.



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