Patient Information

Positional Molding Helmet Band Therapy

February, 2007

Positional plagiocephaly is a condition in which specific areas of an infant’s head develop an abnormally flattened shape and appearance. An infant’s skull is soft and pliable to be able to pass through the birth canal, thus, this condition occurs very early, usually in the first several weeks after birth. In the majority of cases, positional therapy can effectively resolve the infant’s condition. However, if this approach does not work, helmet or band therapy may be recommended.

Cranial remolding bands or helmets are custom-made orthotic devices, manufactured out of a hard outer shell with an inner foam lining. They are designed to provide contact over the prominent areas of the baby’s skull to discourage additional growth. The inside of the band is modified to provide extra space in the areas of the head that are flat or depressed.

The original molding helmet, introduced in 1979, utilized the basic concept of surrounding the asymmetrical infant head with a symmetrical (normal) mold. This helped the skull resume a normal shape. An alternative technique, Dynamic Orthotic CranioplastySM (DOC Band®), was developed as a more proactive approach in treating positional plagiocephaly. In 1998, the DOC Band® became the first device approved by the Food and Drug Administration for the treatment of plagiocephaly. It weighs about 6 ounces, is painless for the baby, and customized for the specific type of plagiocephaly. There are other similar devices utilized, but all of them work on the same basic principles.

Treatment guidelines

Your pediatrician will make the initial diagnosis and usually recommend a course of positional therapy. If this fails to resolve the problem, you will be given a referral to see a specialist, such as a pediatric neurosurgeon. The specialist will review the pediatrician’s referral, perform a thorough evaluation, talk to you about your baby’s history, and discuss the treatment program. If a cranial remolding helmet is recommended, you will then be referred to an orthotist for fitting of the helmet. The orthotist may choose to take clinical photographs and a series of measurements with calipers or a scan to assess the shape of your baby’s skull. These pictures and measurements will serve as a point of reference throughout the course of treatment. The orthotist will create a duplicate of your baby’s head using a plaster impression or a 3-D scan. The band will be precisely fabricated and customized to your baby’s head to achieve improved symmetry and proportion.

Adjustments to the helmet need to be made every 1-2 weeks because a baby’s head grows very quickly. This involves adjusting the foam lining and/or portions of the outside plastic helmet. A second helmet may be required if the baby grows out of the first helmet prior to completion of treatment.

  • Do not purchase helmets on your own without first consulting a physician specialist.

  • When treatment starts at the optimum age of 3 to 6 months, it usually can be completed within 12 weeks.

  • Correction is still possible in babies up to age 18 months, but will take longer.

  • The baby will wear the helmet/band 23.5 hours per day with the exception of one-half hour set aside for bathing and cleaning.

The AANS has additional information on positional plagiocephaly under Conditions & Treatments.

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