Doubts over helmet cure for ‘flat head syndrome’ in babies

Clinics which charge £2,000 for helmets designed to correct a flat head in babies have been accused by paediatricians of preying on the anxieties of parents.

Several companies in the UK sell the helmets which they claim cure plagiocephaly (from the Greek for oblique head), or “flat head syndrome”, which occurs in young babies. Because their skulls are soft, prolonged periods of time spent in the same position can result in them developing a flat spot on the side they prefer to lie on. While the problem can be avoided by making sure the baby is moved regularly, or at least repositioned, most parents don’t hear about it until their child already has a misshapen head.

Claire Gibb started to be concerned about her son Laurence when he was four months old. “One side of his face was bigger than the other, one eye was bulging out and his ears were out of sync,” she said. “We went to see the GP but she didn’t even touch his head. She said it was very common and that it would right itself and that was that.”

However, the Gibbs remained uneasy and some research online led them to the Technology in Motion clinic in Wimbledon where Laurence had an examination and 3-D scan. When the results came back it was suggested they buy a helmet. “Once you’ve seen a 3-D picture of your child’s head and it looks all out of shape, you want to do anything you can to right it,” Gibb said. “Kids have a tough time when they go to school even without this type of problem; it just wasn’t worth not doing.”

She said none of the eight parenting books they owned mentioned anything on avoiding the problem, and they were given no guidance by health visitors. Advice on repositioning only came up when they Googled flat head syndrome, along with details of clinics offering to sort it out.

Consultations and the production of a bespoke helmet cost around £2,000, and parents of affected children are scrimping and holding fundraisers to raise the money. Online parenting forums contain the testimonies of many who say their children have been cured by the devices, worn 23 hours a day for up to 12 months.

No control trials

But paediatricians say there is no proof they work and that companies are taking advantage of parents’ desire to do the best for their children. Dr Martin Ward-Platt, a consultant paediatrician at Royal Victoria Infirmary, Newcastle, said: “Flattened heads get better by themselves, and the makers of helmets prey on the anxieties of mothers, society’s focus on perfection, and the lack of any proper trial of the devices (which would almost certainly show they have no added value).”

“No one has investigated the potential downsides on other aspects of a baby’s development either – one can’t assume that orthotic devices such as these come without unintended consequences.”

Last year Dr Ian Wacogne, a consultant in general paediatrics and clinical director at Birmingham Children’s Hospital, looked into evidence surrounding the use of helmets. “There were no randomised control trials,” he said. “If you are going to do something as aggressive as putting a child in a helmet for 23 hours a day, and mould the shape of its skull, then you ought to be sure there’s a good reason. The impression we are left with is that families are being exploited by the need for perfection.”

Stephen Mottram, a clinical specialist orthotist for Ossur, the company behind Technology in Motion, said that while the Dutch health service approved the helmet and one in 70 children used it, the attitude of UK doctors was “very sniffy”. Asked about testing, he said doctors had refused his request to put up a control group with which he could compare his results.

He said the vast majority of the 3,500 cases brought to the company’s UK clinics over the five years since they opened had been self-referrals, because the NHS was refusing to tell people that helmets were an option. “The argument we have with the advice being given by the NHS is that children are being ignored and parents are being ignored, and that this is not a culturally acceptable head shape,” he said, adding that in some other regions such as the Middle East, flat heads were preferred.

The clinical director of the London Orthotic Consultancy, Jo Drake, said she would also welcome paediatricians’ help in testing whether the helmets made a difference in the long term. But she believed there were cases in which the problem did not correct itself. “I see children who are around the age of 10 who still have a head shape that is not in the normal range.”

‘It has made a difference’

Philip Saich co-founded the charity Headstart4Babies in 2004 after his son Ben was diagnosed with plagiocephaly. His ears were 21mm out of line, but after he was treated with a helmet he had a perfectly round head. Saich and his wife now offer advice and fundraising to other parents in the same position.

“We would like to get to the position where no babies are in helmets by telling parents what they can do to avoid it, but we find ourselves in a firefighting role,” he said. “We can’t prove helmets are the only way to cure this, but what we can say is that, for several hundred families we’ve seen go through the treatment, it has made a difference.”

The prevalence of the syndrome in recent years has been linked to the success of the Back to Sleep campaign, launched in 1991 to reduce the victims of sudden infant death syndrome, or cot death, by encouraging parents to lie babies on their backs. As a result, some parents think it is too early to be sure plagiocephaly will right itself.

However, Dr Ward-Platt said people who thought it a new thing “have short memories”. “Placing infants prone was a fad of the 1970s and 1980s, and caused a lot of cot deaths; before that, most babies were placed on their backs. How many children of those baby-boom years are now adults in their 40s to 60s with flattened heads? Well, look around. Many of the men are now bald, so you would soon see if it was a problem – and it clearly isn’t.”