Helmets for Flat Spots: What Does a “Good Fit” Look Like?
In order to get optimal results from a Cranial Remolding Orthosis (CRO), aka “helmet,” we need to have a good fit. There are so many pictures of CROs floating around the internet that show not-so-great fits, leading to frustrated parents dealing with helmet movement, redness, rubbing, and unscheduled appointments with their orthotist for adjustments.
What Determines a Great Fit?
A good fitting helmet should:
Sit on, or just above the brow line. At Baby Bear Clinic, we often use a heart shaped trim to allow for a little higher trim above the eyes but maintain contact in the central area. This trim line will “rise up” as the baby’s head grows both in circumference and height so we need to start low at the beginning of treatment so that we still have adequate contact on the frontal bone, or forehead, at the end of treatment.
Sit flush with the top of the head. There should not be an excessive gap at the top of the helmet. In the first few weeks, this gap might appear when the baby lies on his or her back but this should settle as growth fills in the helmet.
Sit as close to the ears as possible without rubbing or causing the ears to fold. The seam should be snug with no gapping, and it should lay evenly on the inside of the foam where it contacts the head.
Sit snug with the contour of the back of the neck without digging into the shoulders. Contact with the shoulders when the baby is sitting or playing on their tummy can cause rubbing on the shoulders, as well as movement in the helmet.
The Ears Aren’t Lining Up Perfectly - Why Not?
In more severe cases of plagiocephaly, the ears may not align perfectly in the early days or weeks of helmet wear. This is because there is likely a shifting of the ear on the flat side. Since helmets accommodate some ear shift, it is is common to have one ear align perfectly while the other doesn’t sit quite as good.
This is no cause of concern unless there is covering of the ear and/or redness into the crease at the front of the ear. We will work closely with you to make adjustments that improve the fit but don’t lose integrity of the helmet.
A Few Other Things to Note
A cranial remolding helmet should fit snug but not overly tight, this will cause red marks similar to when you take off a tight watch or hat.
We are creating contact over the prominent areas and space is built into the helmet over the flattened areas to allow the head to grow into a more symmetrical shape. So some redness on the non-flat areas is a good thing - it means the helmet is contacting those areas adequately.
The helmet may fit slightly loose in the first few weeks as the head grows into the space and there may be necessary adjustments such as adding pads or grinding away foam.