Specialized helmets remold baby heads

Babies look adorable — like tiny linebackers — in the colorful helmets fitted by Stan Gautier of Northern Care Orthotics and Prosthetics.

Though cute, the headgear performs a service far beyond fashion flair. During a critical three- to four-month period, the open-on-top helmets, sometimes called a band, correct cranial deformities without pain or discomfort.

“It happens benignly,” Gautier said. “It allows the head to grow into a nice round shape.”

No baby has a perfect head, but a few become so misshapen that the child’s vision, hearing or jaw function can be affected. Gautier said about 3 percent develop plagiocephaly, a flattening or other asymmetrical shaping of the head.

In severe cases, they may need help from an orthotist like Gautier who specializes in fitting babies with a customized cranial-remolding orthoses. He began practicing 12 years ago in Missoula then moved to the Kalispell area where he has a broad-based practice covering back braces to prosthetic limbs along with the specialized cranial helmets.

“A lot of people don’t know about this,” he said.

So far this year, Gautier has worked with five babies who developed a problematic head shape from one of several causes. He pointed to multiples, prematurity and breech position as risks for head malformation in the womb or during birth.

 Once born, babies may spend too much time in one position like on their back to avoid sudden infant death syndrome.

“The ‘Back to Sleep” program has increased the number of babies with it,” Gautier said. “This cranial deformity is typically a flattening of the back of the head.”

Babies with developmental delay, tight neck muscles from a condition called torticollis or just a natural propensity to lie on one side, have a risk of developing one of four classes of deformities. Modern day baby accessories such as car seats, swings and strollers may also contribute to potential cranial problems as the head rests in one position for prolonged periods.

“More boys have it than girls,” Gautier said. “There’s no one reason why it happens.”

All babies have a risk because their skull at birth consists of several plates connected with pliable fibrous sutures. This allows the head to squeeze through the birth canal and then to grow.

After about 18 months, head growth slows and the skull thickens making it more resistant to change. Gautier said that remolding has the best outcomes when babies are three to six months old.

“That’s when the cranium grows the most,” he said. “If we miss that period, the chance of success is less. It’s better with a younger baby.”

According to Gautier, parents should first check with their pediatricians to determine if their baby has a cranial deformity. Physicians and pediatric physical therapists provide the first line of treatment with methods like giving a baby “tummy time” while awake and under supervision during the first four months of their lives.

“If it gets so bad that they need a helmet, that’s when I step in,” he said. “I work closely with physical therapists.”

Gautier offers a free initial consultation in which he takes a bevy of measurements of the baby’s head. He then classifies the deformity and  the severity from mild to severe.

“If it’s mild, it’s better to go back to tummy time,” he said. “In more severe cases, the head can become shaped like a parallelogram with ear shift and forehead bossing. Hearing and vision can become affected if it is left untreated.”

For those with a severe problem, Gautier takes photographs of the infant and then makes a plaster impression of the baby’s head for a custom remolding helmet. He accomplishes this with a series of plaster bandages applied from the eyebrows to the base of the neck, over the ears and along the sides of the face.

Most babies cooperate, according to Gautier.

“It depends on how anxious the parent it,” he said. “If the parent takes it quietly, the baby does too.”

When the plaster dries, a release agent allows the plaster impression to lift off the baby’s head. He then sends the cast by overnight mail to Orthoamerica to fabricate the helmet, called a STARband for symmetry through active remolding.

Speed is important since a baby’s head grows in spurts. If the head changes significantly, Gautier would have to start over.

“It usually works out OK with overnight shipment each way,” he said.

Parents have a wide choice of designs for their baby’s first headgear. It’s a nice feature since some parents suffer anxiety, worrying about how other people may perceive the helmet.

“You can get different patterns — footballs, butterflies — colors,” he said. “That makes it fun, so it doesn’t look so orthopedic.”

When the helmet returns, the baby comes back for a crucial first fitting of the device made of plastic and lined with foam. Gautier said he may make quite a few adjustments at first then follows up for monitoring about every three weeks.

Gautier said parents need to keep an eye out for skin or other health problems that could make it unsafe to continue the helmet. They leave his office with a complete set of instructions and precautions.

“If a problem develops, I want them to come right in,” he said. “Most parents are pretty good about that.”

After a break-in period, babies wear their helmets 23 hours a day. It comes off just for cleaning the baby and the device.

“It’s not fun for the parents but it’s not that hard for the baby,” he said. “Most babies get used to it to where they feel naked without it.”

Typically, a baby wears the helmet for three to four months until Gautier and the baby’s medical team determine that cranial deformity has been corrected.

The price, including monitoring appointments, is about $1,500. Gautier works with insurance companies to determine coverage.

He hopes through this article to develop more awareness in parents of cranial deformities.

“Early treatment is always best and a helmet may not even be needed if it is caught early,” he said. “Repositioning simply does not work once the deformity has progressed too far.”

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.