Helmeting from a physical therapist’s perspective

Parenting holding a baby wearing a therapeutic helmet

Cropped image. Marie-Claire Camp, Flickr. CC License.

The Back to Sleep initiative (always placing babies on their backs when laying them down to sleep) started with the goal of educating parents, caregivers and health care providers about ways to reduce the risk of SIDS. Thankfully, this program, per the American Association of Pediatrics, decreased the number of deaths associated with SIDS by 50 percent since 1994. This being said, with the frequency that newborns sleep and the significant amount of time on their backs, there now appears to be an increased number of children who have plagiocephaly (abnormal head shape). Plagiocephaly is most often seen as a flat spot on the back or one side of the head generally caused by remaining in a specific position for too long.

Tummy Time

If you have concerns regarding your baby and an increasing flat spot to his head, the most important step to start with is to promote tummy time. Positioning your child on his tummy while you are with him for periods of play throughout your day will encourage time spent off the back of his head. It will also increase important shoulder girdle, neck, and back muscles. Continue to encourage tummy time even if your child fusses; it’s a difficult position at first, but will get easier as baby practices.

You can also spend time playing in a supported sitting position or increase carrying time as opposed to keeping your baby in his car seat to sleep or nap when not traveling in your car. Essentially, work to decrease the excessive amount of time your child spends on his back throughout the day. Although some equipment or supported seating devices on the market keep the baby off of the back of his head, tummy time is still the best in promoting overall motor development.


Some babies form a tendency to turn their heads in only one direction. This can sometimes lead to a tight neck muscle called torticollis. As a parent, be on the lookout for this limitation in neck movement, and encourage your child to turn his head in both directions, especially in the first six weeks. This time frame is recommended as the child hasn’t yet developed good head control and can comfortably be moved in various positions.

Therapeutic Helmets

If tummy time isn’t enough to correct a moderate plagiocephaly, a therapist or physician may recommend a therapeutic molding helmet to help correct the flatness. A special scan can be performed at the orthotist’s office (where the helmet is made) to assess your child to determine if the flatness is severe enough to warrant a helmet.

Typically a helmet isn’t recommended prior to 3 – 4 months of age, as little ones are just beginning to build the neck strength necessary to hold up their own heads, let alone the weight of a helmet (though the helmets are incredibly lightweight). An optimal age is generally 4 – 8 months; however, a therapist or physician can recommend a helmet up to a year old. After this point in time, your baby’s soft spot or fontanels are closing up and minimal progress will be made with a molding helmet.

If you have questions regarding your child’s flat spot, or believe a molding helmet will be of benefit to your child, contact your physician to obtain a prescription for a therapeutic molding helmet consult.

– Kristen Bielecki, MPT and Holly Timmreck, PT, DPT are with Pediatric Rehabilitation at Beaumont Children’s Hospital

1 Response to “Helmeting from a physical therapist’s perspective”

  1. 1 Anonymous October 13, 2015 at 9:49 am

    GREAT information! Thank you!

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