HNY Policy and Pathway Repository - North East Lincolnshire

Positional plagiocephaly/brachycephaly (flattening to the side or back of the head) in children

This intervention is not commissioned and therefore should not be routinely offered to patients. Application for funding approval can be made, using the IFR process, by the clinician recommending the intervention, if their assessment is that there are exceptional reasons why their patient could benefit from it.

There is clear evidence and expert consensus that a helmet does not affect the natural course of skull growth and should not be used. The flattened area of the head usually self-corrects naturally, as a baby grows, develops and becomes more mobile with increased muscle strength, and spends less time lying in one position. Helmets may be associated with significant risks such as pain, pressure sores and may adversely affect the bond between baby and parents. They are also expensive.

To reduce pressure on the flattened part of the head and encourage remoulding, the following simple interventions are suggested:

• ‘Tummy time’ – Allow baby to spend time lying on their front while awake, supervised and playing
• Change the position of toys / mobiles / cot in the room to encourage baby to move their head away from the flattened side
• Use a sling or a front carrier to reduce the amount of time baby spends lying on a firm flat surface
• Modify Parental lap “nursing” position to promote contact with less flattened side to parental chest.

All babies including those with non-synostotic/positional plagiocephaly or brachycephaly must be laid to sleep on their back. Sleeping in positions other than this is associated with an increased risk of Sudden Infant Death Syndrome or SIDS (formerly known as Cot Death). For the same reason, no pillows or props should be used to change a baby’s sleeping position.

Helmet therapy for treatment of positional plagiocephaly/brachycephaly in children (EBI)