Deformational Plagiocephaly. That is the technical term for my infant son Leroy’s flat spot. It is also the reason that he is now going to wear a helmet 23 hours a day, 7 days a week for the next 3 months. When I found out he would be needing a helmet for a flat spot, I sat down and did what I always do when faced with the unknown: I researched as much as I possibly could. While I found a lot of medical information, I wanted more personal stories. So now that my baby is comfortably in his helmet, I wanted to share our story, the information we have learned so far, and answer some of the questions I had before we got the helmet.

Leroy’s Story

When we went in for Leroy’s 2 month checkup, the doctor noticed that he had a flat spot and told us to do as much tummy time as we could to help it. I wasn’t too worried about it because when my daughter was a baby, the same thing happened. She had a flat spot at her 2 month checkup, we pushed tummy time, and when we went back for her 4 month checkup, it had sorted itself out.

See, as a Montessori mama, I try not to strap my babies into seats too often. Yes, Leroy would occasionally sit in the swing and obviously he had to be in a car seat when we went places. But otherwise I try to just give him time to explore on the floor. I figured I’d just be extra vigilant in pushing tummy time and it would also sort itself out. I even had him lay on the boppy when he was on his back (and supervised) thinking at least it had a little more give than the hard floor.

Except it didn’t. Well, part of it did. The part of his head that he actually laid on rounded out, but the biggest chunk of his flat spot was high enough on his head that it was unaffected by the amount of tummy time. When we went to his 4 month appointment, his pediatrician noticed it was still there and asked my opinion if it was getting better.

And I had to be honest and say that no, I didn’t think it was getting better. The flat bit wasn’t still flat because it was being laid on. It was just the way his head was currently shaped. Tummy time wasn’t going to make it better.

So our pediatrician recommended that we have Leroy assessed at Gillette Children’s Hospital to see if a helmet would be the right way to go.

We went to our evaluation appointment and after they took a look and measured his head, they recommended we get a helmet. We were measured that same day and two weeks later (or three days before I’m writing this) we had the helmet fitted and took it home.

The Emotional Bit

Let me just pause for a moment and tell you that I never thought I would have a baby that needed a helmet. I was even a bit judgmental, thinking that babies in helmets were caused by parents who continually left their baby strapped into chairs, swings, car seats, etc. Not that these parents meant any harm, but they just didn’t know. And I did know better, so I thought it would never be something I had to deal with. But then I found myself in the position of having a baby who needed a helmet for a flat spot.

Have you ever had something like that? I didn’t realize I was judgmental in that way until it happened to me. And not I feel bad for any parent of a helmet baby that I’ve ever judged. But, the most important bit of realizing you are wrong is changing your viewpoint, forgiving yourself, and moving on from it.

I also had the mom guilt emotions. Whenever there is something that happens to your child that is out of your control, it is completely normal to feel guilty. Give yourself some grace and come to terms with the fact that while you couldn’t stop it from happening, you can make a plan to help it get better.

How a Flat Spot Happens

Technically Leroy’s flat spot is called deformational plagiocephaly. There are numerous different reasons that it can show up and not correct itself.

It can happen before birth if baby is in a very low position or if it is a multiple pregnancy with limited space. While I was pregnant with Leroy, he dropped really low, pretty early on. My theory is that his head rested too long against my pelvic bones.

It can also happen after birth. If baby spends a lot of time on their back with their head in the same position, it can cause the flat spot. The reason you see more babies with flat spots and helmets is partially because the AAP now recommends that babies sleep on their back. Obviously, back sleeping is much more important than preventing a flat spot, so please, please continue to put baby to sleep on their back.

How Do They Determine If They Need a Helmet for a Flat Spot?

When we went in for Leroy’s evaluation, we spent about a half hour with a doctor who questioned us about things like tummy time. Then he measured Leroy’s head.

They used a wooden tool to measure Leroy’s head from different angles. They told us numbers, but I had to do a little research to figure out what they meant. So with plagiocephaly, they measure on the diagonal. (The measurements I am using here is what I was told by the doctor. I’m sure it may vary slightly for other doctors.) If there is a difference of over 6 millimeters between the diagonals, then plagiocephaly is present. If the difference is over 12 millimeters, they are in the severe category. Leroy’s measurement was 18 millimeters.

How Do They Measure for a Helmet?

As I said, we are treating Leroy’s flat spot at Gillette Children’s and they have a helmet they call a CranioCap. We had no idea how they were going to measure for it or what they were going to do. They put a white sleeve thing with a face hole over Leroy’s head and cut small holes so that his ears would stick out and put a small piece of velcro loosely around his neck to make sure it was defined.

Then they stuck a little black electronic cube on top of his head that was a sort of receiver. As I held Leroy on my lap and Andrew tried his hardest to distract Leroy so that he would sit still enough, the technician used a scanner to scan his head. It looked almost like a barcode scanner. She would start at the black cube and scan down his head and as she did it, it populated a model onto the computer screen. It was actually really cool.

4 month olds are wiggly, so we had to actually do it twice before we got a good scan of him. Once the technician determined it was good, we were able to go.

How Did They Fit It?

Two weeks after they took the measurements, we went back in to have the helmet fitting. They purposely made the helmet a little bit bigger so that they could fit it to his head. So we spent 40 minutes or so fitting the helmet. We would put the helmet on Leroy and the doctor would look at it from all angles, marking it with a marker in places where he needed to shave it down a bit.

So if it was a bit too long at the neck, the doctor would mark where he wanted to make it smaller and then he would leave and come back to fit it again. It took us about 4 fittings until we got it all fit right. We have another appointment scheduled for a week later to make sure it is all right.

How Does a Helmet for a Flat Spot Even Work?

So, I’m sure most of you assumed the same thing I did: that a helmet would be tight and force the head into the desired, rounded shape. WRONG. The helmet itself is actually snug against every area of the head except where the flat spot is. It isn’t tight, but it is snug. The bit over the flat spot is actually slightly bubbled out. See, a baby’s head grows so fast that they simply try to direct that growth to the area that needs it: the flat spot. Isn’t that cool?

Wearing the Helmet

When we learned Leroy would need a helmet, there were plenty of things I worried about. Would it bother him? Was it heavy? Would it inhibit his movement? Is it hard to put on or take off? Will it hurt him at all? Do you just put it on one day and not take it off for 3 months? Here are the answers I have so far.

• So far, Leroy doesn’t even seem to notice he is wearing the helmet. He HATED the fitting, but only because he was tired and hungry and having a strange man putting things on his head was not how he wanted to spend his morning. But once we were home and I put it on him again, he didn’t even notice.
• The helmet we have is incredibly lightweight. I haven’t weighed it, but it isn’t thick or heavy like a bike helmet. It isn’t meant for protection, so it doesn’t need thick layers. It is a thing plastic with some softer, spongy stuff on the inside.
• It has definitely not limited his movement. Leroy was just perfecting his back to front roll when he got the helmet. I worried it would really slow him down, but it didn’t. It took him one play session on the floor to figure it out.
• It is not hard to put on, take off, or adjust. The helmet we have has a big velcro strap on one side that we simply undo when we need to move the helmet around. It slips on and off really easily and so far, it doesn’t take a lot of adjusting.
• The helmet doesn’t hurt him at all. As I mentioned, the helmet isn’t meant to be tight. It just fits snugly, like a hat. The inside is spongy and cushions his head to keep him comfortable.

Phase In Schedule

Obviously you don’t want to just put the helmet on and leave it on for the next 23 hours. We had a four-day phase in schedule that we followed. This is what our doctor told us to do. (Obviously, you may have a different sort of phase-in schedule. Make sure to consult with your doctor.)

• Day 1: 1 hour on, 30 minutes off. No helmet during naptime or nighttime. During each break, we were to check to make sure there weren’t any red marks that didn’t go away.
• Day 2: 1 1/2 hours on, 30 minutes off. Try it during a naptime. Keep checking for red marks.
• Day 3: 2 hours on, 30 minutes off. Keep it on for naptime and try nighttime.
• Day 4: Keep it on for 22-23 hours, but check every 3-4 hours to make sure there are no red marks.

For the phase-in, I set alarms on my phone to make sure I wouldn’t forget to take the helmet off or put it back on.

What Happens Next?

Well, now we have Leroy wear the helmet 23/7 and we go to our appointments. The nice thing about the clinic we go to is that they automatically schedule your appointments once you find a time that works for you. We go in one week after the helmet fitting and then every two weeks after that until we are done with the helmet.

Does your baby wear a helmet for a flat spot? Was your experience any different from ours has been?