This page is directed at the medical profession, so do not be concerned if you don't understand all the terminology! If you are interested in an explanation, do give us a call. We are always happy to run you through the medical terms. 

First of all it is most important to establish the cause of head deformity. In principle, the cause can be so called synostotic or non-synostotic changes. The former are relatively rare, and they sometimes occur as part of syndromes. In these cases cranial sutures ossify prematurely, and a further growth of the skull in the affected area is impossible. This can lead to unusual head shapes- some of them rather bizarre.

In contrast to this condition, there is no premature closure of cranial sutures in non-synostotic deformities, which are diagnosed much more frequently. Open cranial sutures are the matter of shifting bones. These deformities usually occur through external influences. For example, birth related complications or changes due to the positioning of infants´ heads can result in a variety of deformities. Also, intrauterine restrictions e.g. in multiple births have been described as a cause.

Since 1994, many pediatric associations world-wide have been propagating back sleeping positioning as means of avoiding Sudden Infant Death Syndrome (SIDS). Positional Deformities have increasingly been recorded since. They account for the majority of cases of head deformities. Muscular imbalances- predominantly in the neck area- occur in most cases; they are probably intensified by the one sided positioning of heads. In the case of minor deformities, these muscular imbalances render a simple therapy of attempting to reposition the head impossible. Due to shortening of muscles in the area of the neck (Torticollis), forced positions may occur, which can be adverse to a symmetric growth of the skull. A shift of the skull base- visible in differently positioned ears or other asymmetries of the face- may be caused by harmful sleeping positions.

An asymmetric growth of the skull base and face may have negative bearings on the growth of jaws. In most cases these visible deformities make it possible to find the pertinent diagnosis without resorting to invasive or X-ray examinations. Thus nonsynostotic deformities due to the positioning of infants´heads - looked at from a "birds eye view"- appear shifted in a parallelogram fashion (fig.1). In contrast to this, the deformitiy caused by prematurely ossified cranial sutures often appears trapeze- shaped (fig.2).

	fig.1: Deformity due to the positioning of infant´s head not caused by premature ossifiaction of cranial sutures (parallelogram-shaped head shift).
	fig.2: Synostosis of the left coronal suture characterised by a trapeze-shaped deformity. Alternatively, in case of a synostosis of the lambda suture, a one -sided occipital flattening may occur.

After the diagnosis of a premature ossification (synostosis), only an early operative correction is indicated as a therapy. By this a normal growth of the brain is facilitated, and aesthetic aspects are taken care of. In case of a shift of cranial bones without premature ossification, however, an alteration in the positioning of infant patients can result in a correction of the deformity in less severe cases.

In cases of more severe deformities, which have already resulted in an asymmetry of base of the skull, physio-therapy is indicated. Additionally, a so called helmet therapy may be appropriate. This therapy makes use of the natural growth of the infant´s head, which is at its maximum in the first year of life. The correction of head deformities in this way does not work by the pushing-in of prominent areas of the head. By hindering the growth of these parts at this stage the flattened parts are made to expand through their own growth. The so-called head orthesis (or helmet) is constructed in such a way that it can precisely suppress the growth of the prominent areas for a time, until the flattened parts have caught up in growth.

As has been shown repeatedly, a child´s overall head growth is not being restricted during helmet therapy, but follows exactly the course of the original growth curve (percentile curve). This therapy makes it possible to treat widely varying deformities, and it has been shown that the correction once achieved at a young age remains stable for life.

This method is by no means new, but was already known in antiquity, e.g. to the Egyptians, who aimed at reaching fashionable beauty ideals by bandaging their children´s heads accordingly.

Even today, this is a common practice in some African and South American tribes. For medical use, new materials are available today, which renders such a treatment less complicated and less inconvenient for the children. As maximum head growth only occurs during a child´s one and a half year, a conservative treatment of deformities makes sense during this period only. Essential therefore is an early treatment, which should in optimum start at an age up to five months. With moderate deformities a change in positioning the infant and physio-therapy will be sufficiant. If these methods fail, or in case of more severe deformities showing an asymmetric base of the skull, a head orthesis (helmet) should be fitted at an early age in order to reach a satisfying correction. Thus, a conservative treatment is possible, saving the small patient and his family greater inconvenience, and an operative correction can be avoided altogether.

1) Will every deformity need to be treated?

Not at all. If they are noticed early (1-3 months), less developed deformities may well be treated easily by positioning the baby differently and by additional physiotherapy (stretching exercises of the neck muscles). This way, one is waiting for the head to even out by normal growth.
If there is no improvement within 6 months, the child ought to be seen by a specialist.
Moderately severe and severe deformities should be treated with a head band (helmet) at an age of 4-6 months, because a spontaneous correction is not likely to occur.

Obviously a precise diagnosis of the deformity must precede treatment.

Classification of deformities:

 - An asymmetry of less than 1cm (0.4 inches):
Mild deformity, no further therapy except, possibly, repositioning the child, or/and physiotherapy. These minor deformities gradually diminish later as the head continues to grow, they will become less apparent relative to the size of the head.

 - An asymmetry up to 1.0 cm to 2.0 cm (0.4 to 0.8 inches):
Moderate deformity. Treatment by head band (helmet) is advised, since these deformities lead to considerable stigmatization of the child. These deformities will be clearly visible in adults, too.

 - An asymmetry from more than 2.0 cm (more than 0.8 inches):
Severe deformity, this should definitely be treated.

 2) What functional reasons are there to treat a deformity?

 Major asymmetries of the base of the scull can influence the further growth of the lower jaw in a negative way. Thus, malocclusion and anomalies of the lower jaw may result. Some doctors report headaches or migraines. A link has not been proven, however. A retarded development has also not been proven yet, but is not likely.

3) Which other reasons are there for a treatment?

 To call the treatment merely a "cosmetic" one, has angered many parents and therapists for years. It is rather an aesthetic problem, which can have psychosocial consequences in later life. Children and adolescents could be teased because of their unusual head shape.

4) Up to what age is treatment effective?

As long as the skull is still growing, this growth can be made use of, and so will be directed towards a correct shape. This is highly effective in the first year of life. Even in cases of severe deformities, a complete correction can be achieved if treatment starts early enough.

5) What time does a head orthesis (head band or helmet) therapy take?

 Either as long as it takes to level out the infirmity, or until further growth is not to be expected. Obviously, the seriousness of the deformity plays a decisive role: the more serious the deformity, the longer the treatment. Also: the younger the patient, treatment time is much less.

 6) Up to what age is treatment feasible?

From the twelfth month, head growth is minimal, so treatment after that period would be limited to exceptional cases only. Especially in cases of facial asymmetry treatment may be advisable. Individual cases must be discussed in detail.

7) How do children accept the helmet?

 No need to worry! Children get used to the helmet in no time and accept it as their own. In general, one can say: the younger the child, the quicker the acceptance. By the way, children dislike caps because they do not wear them regularly and do not really get used to them.

8) Is there any pressure on the head?

 By no means! Pressure on the skin of the head would result in pressure marks or even bruises. Obviously this applies to the sensitive skin of babies in particular. If the helmet fits well, it is very unlikely for pressure marks to occur.

 9) Does the helmet restrict brain growth?

 Not at all, since the increase in circumference during treatment happens along the percentile curve . There are no restrictions in further growth.

10) How does the helmet work?

 Prominent areas of the head are stopped from growing further during treatment, while normal growth is first directed to the flattened areas. When these have "caught up" with the prominent areas, the treatment has reached its aim, a beautifully "round" head.