Boston Othotics and Prosthetics
Boston Othotic and Prosthetics

Plagiocephaly

What is plagiocephaly?

Positional Deformational Plagiocephaly (pronounced Play-gee-oh-sef-ali), also called “Flat Head,” is a cranial deformation that occurs in babies. Learn more.

What causes plagiocephaly?

Cranial asymmetries can be caused by a number of factors that can occur before, during and after birth. Learn more.

How is plagiocephaly detected?

Starting at 3 months of age, as part of a well-child exam your child’s pediatrician will measure your child’s head and check for cranial symmetry. If there is an asymmetry of 8mm or more, your child needs to be examined by a certified orthotist, who will offer treatment options and track progress.

How is plagiocephaly treated?

Plagiocephaly can be treated with repositioning techniques, sleep cradling, tummy time, the PerfectNoggin infant sleep surface, or a corrective helmet such as the Boston Band. Learn more.

If my baby has been diagnosed with plagiocephaly, are there any concerns if we don't move forward with treatment?

There is no clear evidence that head shape asymmetry directly affects development, although there are studies that have shown links between head shape asymmetry and developmental delays. More practical concerns are how well helmets and hats will fit; this is usually an issue for heads with more substantial asymmetries.

Will my baby’s head round out on its own?

Repositioningtummy time and using the PerfectNoggin sleep surface are recommended prior to 4 months, depending on sleeping preference and level of asymmetry. Conservative methods can be effective at improving asymmetry while the head is still growing very fast and the baby is still sleeping in a fairly still position. For these reasons, we utilize the CHOA Plagiocephaly scale and the Hutchinson Brachycephaly scale, which recommend conservative treatment whenever possible.

What is the PerfectNoggin?

The PerfectNoggin is a contoured sleeping surface for infants under 4 months that encourages symmetrical head growth. In some cases, patients who use the PerfectNoggin can avoid having to wear a helmet.

When my child is being fit for a Boston Band, is the scanner safe to go over my baby's face?

The scanning process is safe for your baby. The clinician will take all necessary precautions to ensure the process is performed in the safest manner possible.

Does the Boston Band hurt babies?

The Boston Band should not be applying any pressure, just contact to redirect growth. The baby may be uncomfortable at first until they adapt, but there should not be any pain. When weaning into the Boston Band, it is important to follow the schedule to allow the skin to adjust, and be aware of any potential areas of redness due to excessive pressure that does not resolve in 30 minutes.

How much does the Boston Band weigh? Will it be heavy for my baby?

The average weight of the Boston Band is 9 ounces, so it is not a substantial amount of weight that would interfere with head control development. Sample Boston Bands are available for reference in the clinics.

How long would the Boston Band need to be worn?

The Boston Band must be worn for 23 hours per day, and the length of treatment depends on the baby's age, head circumference, and amount of growth needed. Typical treatment ranges from 2-5 months. In general, longer treatment times are needed with small heads, older babies, and large asymmetries. Shorter treatment times are needed with bigger heads, younger babies, and smaller asymmetries. For more information, see Boston O&P’s plagiocephaly outcomes chart.

Can babies wear the Boston Band only at night; does it have to be 23 hours per day?

The Boston Band works to re-direct growth; we don’t know exactly when the child will grow so the more it is on, the better opportunity we have to capture growth. If a child only wears the Boston Band at night, we may miss out on growth that occurs during the day. If significant growth is missed, it can lead to a poor fit, and follow-up may be needed sooner and overall treatment time may increase.

What are the side effects from wearing the Boston Band?

The most common side effect is skin irritation, most often caused by sweating. Most babies sweat in any head shape correcting device; some acclimate but others continue to sweat for extended periods of time. Cornstarch-based baby powder can be used to help absorb the moisture and lessen irritation. Parents can also dress the baby in lighter clothes and keep the climate control a little lower.

Will my baby’s hair fall out from wearing a helmet?

Sometimes if the Boston Band moves slightly on the baby’s head it will rub on the hair and weaken the follicles, however this is only temporary and does not happen very often. This is similar to what occurs when a baby rubs their head on the mattress.

What if my baby does not like the Boston Band?

Most of the time, it is more of an adjustment for the caregivers than it is for the baby. Babies usually adapt very quickly to wearing it and often forget that it’s there. Any discomfort that they feel usually stems from skin irritation, so it is important to follow the cleaning instructions and perform skin checks whenever the Boston Band is removed.

How often do we need to come in to the office with the Boston Band?

Initial follow-up should be 1-2 weeks, then additional follow-ups will take place every 2-4 weeks, depending upon age and growth.

Can the Boston Band be safely worn in the car seat and stroller?

Yes, it will not affect the safety of the car seat or function of the stroller. If there is built-in head protection, ensure there is proper clearance.

Does the Boston Band restrict head growth?

Head growth is not restricted, it is redirected. The goal is to prevent further growth in certain areas, while promoting it in others. Head growth is how cranial remolding works; the more growth, the more improvement.

Will the Boston Band affect how my baby sleeps?

Initially, there may be a brief period of adjustment, but if fitted properly the Boston Band should not affect their sleep and should not lead to any discomfort. They can sleep in any position that they normally would.

What do I do if the Boston Band smells?

There is a standard cleaning process described in the Boston Band Wear and Care Guide that every parent receives. With exceptional odors, clean the Boston Band thoroughly with rubbing alcohol and allow for it to dry. Repeat this process at least once daily. Cornstarch-based baby powder can be used to keep the baby’s skin dry and help with the smell.

Does insurance cover the Boston Band?

Insurance coverage varies, but our billing specialists will confirm coverage prior to your baby being fit.

Can the “Flat Head” come back after graduation?

Before your baby is discharged, the orthotist should confirm that he/she is no longer sleeping on the flattened area, and can maintain independent sitting, to prevent the possibility of regression. This is most important when babies finish treatment at a younger age. With that being said, it is extremely rare for regression to occur if properly screened prior to being discharged.

How old is too old to start helmet therapy?

The Boston Band is approved to be used between the ages of 3 to 18 months, however, the ideal range for treatment is between 3-9 months, due to the fast rate of cranial growth in that time. Helmets become less and less effective the older the infant is because the rate of growth continues to slow down and the plates of the skull begin to fuse together. When babies start treatment after 9 months old, there is still positive change, it just takes longer due to the growth rate being slower, and occasionally, the baby does not tolerate it as well. Another factor to consider is whether or not the baby is pre- or full-term. Adjusted age will affect anticipated growth.

Will helmet adjustments (holes, how it fits, sits) be required?

Adjustments will be necessary throughout the course of treatment. If there is anything that is concerning, contact your orthotist and email pictures to illustrate your concern. Ventilation holes can be added to allow for additional airflow as needed. As far as proper position, it should sit just above the brow line, not blocking vision at all, and it should not push on the ears from any direction.

I'm confused by all these numbers (break-in schedule, wear time, CR, CVA, CVAI), what do they mean?

Regarding the break-in schedule, it is not necessary to stick to the guide exactly; the point is to increase wear time gradually over the first 4-5 days after the Boston Band is fit.

The outcome numbers, such as the Cephalic Ratio (CR) and Cranial Vault Asymmetry Index (CVAI), should be explained in detail during the initial evaluation by the orthotist. We want to make sure you understand your child's treatment completely, so if there is any confusion, contact your orthotist for clarification.

For more information on Cranial Vault Asymmetry, see this video from Boston O&P:

My child needs other medical/corrective devices in addition to the plagiocephaly helmet. Can they coexist?

Yes, accommodations can be made for other medical devices, such as glasses or hearing aids. This should be done when your baby is fit with the Boston Band; however, adjustments may need to be made throughout the course of treatment.

My child has red marks and a rash when we remove the helmet. Is this normal?

If there is any redness or irritation that lasts for more than 30-40 minutes, leave the Boston Band off and contact your orthotist for further instructions. Redness or irritation can be caused by various factors; most commonly, adjustments may be required to reduce excessive contact, or your baby may be experiencing heat rash. Sending pictures via email can also help your orthotist determine the cause of the issue.

My child hates Tummy Time, any advice?

Instead of having your baby completely flat for Tummy Time, use a pillow or some other form of wedge to prop your baby up on an angle. The resistance from gravity is not as strong, and Tummy Time is usually tolerated better in this position. If there is still an issue, simply remove the Boston Band for any extended periods of Tummy Time.

Can we schedule an appointment for a helmet evaluation directly with Boston O&P, or does our pediatrician need to refer us?

You are able to schedule an evaluation without a prescription or referral from your pediatrician or specialist. We would, however, need a prescription if you choose to move forward with cranial remolding treatment. This prescription typically comes from the pediatrician. If you would like to schedule an evaluation with us, find the Boston O&P clinic near you and use the Request An Appointment form or call the clinic directly.