No helmet,” I said emphatically to my husband. “I am not putting the baby in a helmet.”
We had just left the neurologist, who had determined that our 8-month-old daughter indeed had “positional brachycephaly” – a flat back of the head, just as my husband had suspected. Her face was “symmetrical,” the neurologist assured us, unlike in cases of plagiocephaly, where the head is flattened on one side and can look misshapen.
“It’s entirely cosmetic, but it can still be corrected with a helmet,” the neurologist said, giving us a referral to a neurosurgeon who could prescribe a molding helmet that would be covered by insurance.
Insurance or no insurance, I didn’t care. I did not want to put my daughter in a helmet.
“You heard what the doctor said: In another few months, the bones of her head will be fused, and it will be too late,” my husband, Solomon, implored. “Besides, this is entirely our fault.”
By “our fault,” he meant “my fault.”
I was the one who wouldn’t move the baby to a crib. Since birth, she’d been sleeping in a “Snugapuppy,” a sloped device that cradled her entire body like a soft hug and the thing I credited with getting her to sleep through the night almost from the start. I’d intended to move her out after our travels to visit family abroad while she was 4 months and 5 months old. But then she had jet lag and howled like a werewolf when I tried to move her into the flat bassinet.
“Let’s just get her sleeping through the night again,” I told my husband, feeling guilty that I’d schlepped her across the world to see her grandmother. Was I now going to deny her only place of comfort? It had been good for a newborn, but now that she was an 8-month old – how did time fly so fast? – it restricted her movement, thereby resulting in a flat head because she couldn’t turn it.
We’d finally moved her to the crib, and after a few long nights of weeping – hers and mine – she was again sleeping like the baby she had been.
Let it be said – because that neurologist did not say – that my daughter is gorgeous. She has sparkling, dark eyes framed by long lashes, a button nose and a delightful smile indicative of her curious, intelligent and, most importantly, happy nature. After four years of infertility, we are overjoyed at her every day and grateful for her fabulous health.
But her head was still flat.
Like most loving parents, my husband wanted to give her every advantage possible. So we went to the neurosurgeon.
“I see patients all the time with this problem,” said Mark A. Mittler, co-chief of the pediatric neurosurgery division at the Steven and Alexandra Cohen Children’s Medical Center. He said the problem has been common since 1992, when the American Academy of Pediatrics recommended that newborns be put to sleep on their backs and not their stomachs to reduce the incidence of SIDS.
“The reason the skull is shaped that way is that it grows to accommodate the brain,” the doctor said, noting that a flat spot can result when babies spend too much time in one position, such as in a swing or restricted in a swaddle. Gulp.
Our daughter, he evaluated, did have a “relatively mild flattening of the head.” He held her on her stomach on the examining table as she squirmed and reached, as usual, for my cellphone. “Overall she is neurologically, developmentally normal, albeit reaching her milestones a bit more slowly due to her limited early movement,” he dictated in a letter to the neurologist.
I kicked myself. Kids in molding helmets did look cute – I’d met a dad in the park with an adorable 11-month-old daughter who needed a helmet because she’d been sleeping in the swing most of her life due to colic. He’d said she didn’t mind, but I knew it would probably bother my opinionated daughter.
“Putting this all together, it appears that the baby has positional brachycephaly, which I anticipate will improve dramatically over the next six months to a year,” he said. “There is no reason to place her in a molding helmet at this age,” he said.
Wait – what?
“A molding helmet would provide no benefit,” he reiterated.
I almost jumped up for joy. But Solomon looked skeptical. “So why did the other doctor recommend it?”
“It really depends on the judgment of the practitioner,” Mittner said. Helmet companies have “really become an industry,” he said, charging thousands of dollars for the custom-made head gear. Some babies may need one, and there are responsible providers, he said, but “everyone’s under the assumption that’s the best solution, but it’s not.” He referred me to a recent randomized control trial in the British Medical Journal that concluded: “We discourage the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation.”
“I’ve seen thousands of these patients. I never had a parent come back to me later and say, ‘I wish I had helmeted.’ ”
So what to do?
He said most heads can be fixed with lifestyle and positioning changes, and the earlier you can do it, the better, but the head takes shape by the time a child is 18 months old.
Our daughter needed to do as much tummy time as possible, which would help her develop her abdominal and neck muscles and would also take pressure off the flat spot. As she became more mobile and her brain grew, her head would grow, too, he said.
The doctor turned to me and my husband: “Look, you don’t know what each other’s skulls look like, right?” he pointed out. Thankfully, we both still have our hair, and so would our daughter soon.
But one day in the distant future, if she becomes a rebellious teenager, we might have to have an awkward conversation with her, beginning with, “Look, before you go shaving your head, there’s something you need to know. . . .”