We’re happy to answer any questions you might have, with no commitment to proceed with treatment.
09 May 2014
Response to BMJ
The London Orthotic Consultancy response to a recent published study in the British Medical Journal
For years we have been asking for a randomised blind controlled study on the effect of cranial remoulding treatment versus no therapy. And last week finally this was published, so why now all the bad press about cranial helmets?
We welcome research in this field. We are evidence-based practitioners and as healthcare professionals, we are continually learning and developing our care pathways and treatment regimes.
Whilst evidence is good, one study is unfortunately not enough. The fundamental limitations of this study are its size and that the subjects in the comparison study had moderate-severe head shape deformities.
This is not our patient group. At The London Orthotic Consultancy, we mostly treat babies with severe head shape deformities where other treatments such as repositioning and manual therapies have failed.
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Brent Collett, a craniofacial specialist at the Seattle Children’s Research Institute wrote in an editorial in the BMJ that future studies, including larger samples, would be helpful in determining whether some infants respond more favourably than others. In particular, it would be of interest to learn whether children with the most severe positional plagiocephaly and brachycephaly, who were excluded from this trial, show meaningful improvement.
Ari Brown, a paediatrician from Texas said she sees an area for future research on children with more severe plagiocephaly. ‘This is where helmets make the most difference’.
The study reports that no infants with torticollis or dysmorphic features were included. However, many of the babies we see in our assessments have these clinical presentations and once again have not responded to repositioning and manual therapy techniques.
We also assess infants who have moderate-severe head shape deformities. Following assessment of each infant, correct repositioning advice is provided so that many of this group goes onto achieve natural correction without orthotic intervention.
It is reported that in neither group did the head shape normalise at the end of the trial and at 2 years old only about a quarter in both groups reached a normal head shape. We disagree, all infants we treat achieve statistically significant improvements to their head shapes and many progress to a head shape within the normal range at the end of their treatment.
Much was reported on the side effects of helmet treatment. Side effects of helmets are minimal and temporary. Skin irritation reported as the major side effect in the study is usually nothing more than a mild sweat rash where Sudocrem is all that is required to treat it. We discuss all possible side effects with parents at the beginning of the treatment so they are fully aware of what can happen before making a decision. Unfortunately, this has been hugely exaggerated in the press surrounding the research last week.
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This is very much dependent on how fast your baby is growing. The faster the growth, the more frequently your baby will be seen so that the helmet can be adjusted. In general, reviews will happen at two to four-week intervals.
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The price of treatment covers:
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Yes – All babies that have completed their course of treatment with us have achieved a measurable improvement in head shape. However, you don’t have to take our word for it. Recent independent research conducted by a University Hospital in Germany has endorsed the treatment for babies with moderate or severe plagiocephaly. A larger, retrospective study has just been published that found complete correction was achieved in 94.4% of babies treated with helmet therapy. The results were conclusive: repositioning achieved acceptable correction in 77.1% of cases, but 15.8% were moved onto helmet therapy because re-positioning was not working. Meanwhile, 94.4% of the infants who started in the helmet-treated group achieved full correction, as did 96.1% of those who were transferred from the repositioning group into the helmet-treated group. Further information can be found on our Plagiocephaly Research page.
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If your baby has a temperature or a fever due to illness you must remove the band. The band can be put back on once the temperature has returned to normal.
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The optimum age for treatment is between four and seven months. This is because the skull is most malleable at this age and improvements to head shape tend to take less time and are more dramatic. That is not to say that helmet therapy should be ruled out if the baby is older than seven months. Routinely, babies up to the age of 16 months can be treated very successfully. The cut off age is around 18 months when the fontanelles (soft spots on the head) are no longer malleable. As babies grow and develop at different rates, it is always worth checking if you are not sure. There have been cases where a baby’s fontanelles have not fused yet by the age of 18 months, who have achieved successful, but less-marked results with cranial remoulding therapy.
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Torticollis is a condition in which a tight or shortened muscle in one side of the neck causes the head to tilt or turn to one side, resulting in the infant resting its head in the same position. In 2013, we analysed the data from all first appointments in our Kingston clinic and found that 20% of the babies examined had some kind of neck condition that was causing head immobility.