When Mary Carrasquillo first saw a baby wearing a helmet, she wondered, “What’s wrong with him?” Then her son, Matthew, needed one.
She got a second opinion. But doctors agreed — Matthew had plagiocephaly, or head flattening, which can occur when babies are constrained in the womb or as a result of constant head pressure from babies lying on their backs.
So they fitted 8-month-old Matthew with a light blue helmet to reshape his head.
“I remember being out in public, and wherever I went, people would make a comment, ‘Oh look how cute he is in the helmet. What’s that for? Why does he have that on his head?’” Carrasquillo said. “They felt almost pity for him. It’s hard to see your kid go through that.”
As a nurse, Carrasquillo, of Coral Springs, knew that placing babies on their backs to sleep can lessen the chance of sudden infant death syndrome. In 1992, the American Academy of Pediatrics started the “Back to Sleep” campaign to educate parents and lower the risk of SIDS, and it has by 50 percent, according to the AAP.
While SIDS decreased, plagiocephaly increased.
“We started to see nearly an epidemic increase in plagiocephaly,” said Tim Littlefield, vice president of Cranial Technologies, which estimates to have treated about 55,000 babies in the past two decades.
Before 1992, plagiocephaly occurred in 1 in 300 babies. A few years later, it had risen to 1 in 50 babies, and now it is estimated that 1 in 10 or 1 in 15 babies has some degree of it, Littlefield said from the Arizona-based company.
It’s like a catch-22, said Parkland resident Jennifer Koenig, whose son, Zachary, now 5, wore a helmet for about six months until he was about a year.
“We put the kids on their backs because they’re not allowed to sleep on their stomachs, but we put them on their backs, and their heads are flat,” she said.
Perhaps because of fear of SIDS, parents began reducing the amount of supervised tummy time for kids instead placing them for extended periods in bouncy seats, swings and car seats, creating more continuous pressure on the backs of their heads, said Eric Stelnicki, M.D., a pediatric plastic surgeon in Fort Lauderdale.
“We’ve become a society where children are on the back of their heads all the time for convenience,” said Stelnicki, who said he sees about 75 children monthly with plagiocephaly.
In addition to limiting babies’ time lying on their backs, parents can also help by alternating feeding positions, said Gabriel Somarriba, a physical therapist and assistant professor of clinical pediatrics at the University of Miami.
And while some heads naturally may round out on their own, physical therapy can help children who have a common accompanying diagnosis of torticollis, which involves tightening of neck muscles. This causes babies to favor and tilt to one side, resulting in persistent pressure in the same spot on the head, Somarriba said.
When Apollo Ramon was 9 months old, he underwent physical therapy several times a week for torticollis while he underwent helmet treatment, said his mother, Liz Ramon.
“I was very fearful of putting [the helmet] on him at first,” said Ramon, of Sunrise. “Babies are so small and can’t tell you if it hurts. But after two or three days, he didn’t care that it was on his head. I think the parent really feels it more than the child … because the appearance of it makes it seem they have had a massive cranial accident.”
Despite initial reservations, Ramon said, “If you look at him now, you would’ve never known that his head was completely flat.”
“People should know helmets aren’t there because there is something wrong with kids’ brains,” Stelnicki said. “Don’t assume the child has a neurological problem. It’s just there for repositioning just like a child wearing braces on the teeth.”
Just as braces are worn constantly, so, too, are helmets, which are removed only one hour a day for bathing, because brains are constantly growing.
Helmets can range in price from $2,000 to about $4,000 and are not always covered by insurance.Here’s how they work: Children are custom-fitted and then frequently adjusted [often weekly] so the devices direct growth and prevent the child from lying directly on a flat spot.
“As the brain starts to grow or continues to grow, it will follow the path of least resistance and naturally fill in those voided areas,” Littlefield said. “If you think that a force on the baby’s head is what originally deformed it, our product is an equal and opposite force, if you will.”
Because plagiocephaly can be mistaken for craniosynostosis, a more serious condition that can require surgery, proper diagnosis is key, Stelnicki said.
So, too, is early detection of plagiocephaly because only kids between the ages of about 4 months to 18 months have heads still soft enough to reshape.
JoAnn Snyder, of Royal Palm Beach, said her three children — Justin, 5, Emma, 2, and her youngest child, Olivia, who recently outgrew one band and is finishing treatment with another — have had successful results with helmets.
“You always want your child to be perfect,” said Erricka Beattie, who said her son, Aiden, also had positive results from his helmet.
“In my eyes, he’s perfect,” she said. “Then they put [the helmet] on, and you think something’s wrong, and when you go to the stores, everybody’s looking at you.”
Each week for eight weeks, Beattie drove 244 miles roundtrip from her Fort Pierce home to Miami, spending $10 in tolls and a tank of gas for Aiden’s helmet adjustments.
“Every trip was worth it,” Beattie said. “I know that I did what was important for him. That’s all we ever want as parents … to make sure we do everything possible for them.”