What is craniosynostosis?

Craniosynostosis is the premature and abnormal fusion of 1 or more of the 6 cranial suture lines, often resulting in abnormal skull shape and restricted brain growth. This condition is corrected by cranial surgery followed by post operative helmet therapy.

What is positional or deformational plagiocephaly?

Positional or deformational plagiocephaly (play-gee-oh-seff-a-lee) is the term used to describe a flattened or misshapen head that may result from crowding within the womb or from an infant being placed in the same position (such as on the back) for long periods of time.

Positional plagiocephaly does not require surgery and can usually be treated with a cranial orthosis (a custom-made brace or helmet for the skull).Mild positional plagiocephaly may correct itself within the first six weeks of life; if not, treatment may be appropriate when properly diagnosed. If untreated, problems that may be associated with positional plagiocephaly include vision and hearing problems, temporomandibular joint disorder (TMJ), etc.

What causes positional plagiocephaly?

The most common cause of positional plagiocephaly is an infant spending long periods of time in one position. This is due to one of the following factors:

  1. Muscular Torticollis

    1. A congenital (present at birth) finding in which one or more of the neck muscles is extremely tight, causing the head to tilt and/or turn in the same direction. This result in the infant holding his/her head against the mattress in the same position


    2. Infants who sleep on their backs or in car seats without alternating positions for extended periods of time are also at a higher risk for deformational plagiocephaly.

Occasionally, a baby is born with this flattening because of a tight intrauterine environment (i.e., in multiple births, small maternal pelvis, or with a breech position).

Who experiences positional plagiocephaly?

Positional plagiocephaly used to occur in one of every 300 babies, including synostotic and non-synostotic cases. Recent figures for non-synostotic cases are up to 40% of healthy babies. The increase in the incidence or diagnosis of non-synostotic plagiocephaly has been attributed to two reasons:

  • Increased incidence of multiple births

  • The "Back to Sleep" campaign by the American Academy of Pediatrics in 1994 to place infants on their backs while sleeping to decrease incidence of Sudden Infant Death Syndrome (SIDS).

What are the current treatments?

The primary treatment for positional plagiocephaly is the cranial orthosis.  Optimally an infant can begin wearing an orthosis between the ages of four to eight months. The orthosis gently reshapes the head as it continues to grow.  A child can be fit for a helmet up to 10-11 months, but the expectancy for a positive outcome decreases as the child becomes older due to:   
1.) rate of head growth decreasing   2.) Child becomes more aware of helmet and may learn to remove it on his/her own.


Does my insurance pay for the Ballert Molding Helmet?

Insurance varies on types of coverage however helmet therapy is covered as medically necessary under certain guidelines. Ballert will contact your insurance company and employer benefits coordinator to determine the type and level of coverage and what documents are needed from your physician.

Are all cranial molding helmets and bands alike?

The general concept and products are similar, although we feel that it is extremely important to get complete coverage of the cranium to promote the best outcome and quickest result. Most providers are usually only concerned about the upper cranial vault, and bands really only address that aspect. Your baby has sutures over and around the ears and over the top of the head. Since the helmet works by inhibiting growth in the direction of the bulge while allowing growth in the direction of the flattening, a band which does not give good coverage in the area of the sutures around and above the ears could allow growth or bulging in that area, thereby creating a deformation. It is own experience that only a complete helmet will insure against this albeit relatively uncommon side effect. It is nevertheless a possibility that the Ballert Helmet guards against. Where the window of opportunity can be numbered in a few short months, we feel that it is necessary to ensure the best results possible.

How quickly will my child receive the Ballert Helmet after casting?

Ideally, your child will be wearing his/her helmet within 7 to 10 days of the casting date to assure proper fit and function. However, insurance approval is typically required before an orthotist can order a cranial remolding orthosis. If the insurance verification process begins after the casting, this will delay the turn-around time. Completing the insurance approval process before casting will expedite the time it takes to get your child in a helmet.

What is a certified orthotist?

A certified orthotist is an allied health professional who is specifically trained and educated to provide or manage the provision of custom-designed, fabricated, modified and fitted external orthoses (braces) to orthotic patients. The selection of the orthosis is based on clinical assessment and the physician’s prescription, in order to restore physiological function and/or cosmesis. The strong background in patient care using medical biomechanical principles and materials gives these professionals the skills to manage infants with positional plagiocephaly. Orthotists have been fitting braces including cranial helmets for over 100 years in the United States.

What special training do certified orthotist have that prepares them for taking care of children with positional plagiocephaly?

A certified orthotist go through extensive training to learn how to evaluate, cast, fabricate and fit orthoses (braces). There are only a handful of universities in the United States that have programs for the field of orthotics and these programs must meet stringent criteria set by the American Board for Certification. Once an orthotist finishes the formal educational portion of training, he or she begins a residency program under the supervision of a certified practitioner to gain practical experience. A year’s experience and references are required before the resident can submit an application to take both a written and a practical examination. When a resident passes the exam he can use the credentials of C.O. (certified orthotist)

How long does it take the Ballert Helmet to work?

This varies but some parents have seen improvement after only two weeks of the Ballert Helmet. Average helmet is typically worn for 4-6 months based on the rate at which the child’s head grows and the severity of the flattening.

Will my infant experience any discomfort wearing the Ballert Helmet?

In most cases, children adapt quite easily to the orthosis. With younger children and infants, it even becomes something like a security blanket. As your infant begins to wear the orthosis, any concerns you may have can be addressed by your orthotist.

How do I keep the Ballert Helmet clean?

In some cases, a mild unpleasant scalp odor may develop. It is easily controlled with daily washing of the head with baby shampoo, rinse and dry thoroughly. The Ballert Helmet should be wiped clean with alcohol and allowed to dry. The Ballert Helmet may also have a mild yet harmless chemical smell that dissipates in a day or two.

Ballert Molding Helmet Instructions

Do we need follow up?

Yes. Your child’s helmet will need to be checked and adjusted by the orthotist. Contact your orthotist sooner if you notice any problems. The referring physician may wish to see the child after several weeks of treatment to evaluate progress.

Ballert Molding Helmet Instructions

Who tells us when to stop wearing it?

The decision to discontinue wearing the Ballert Helmet should be made by the physician in conjunction with the orthotist. This decision is made after visual symmetry and measurements achieving an acceptable cephalic index.

Will we need more than one Ballert Helmet for treatment?

No. Most often a single helmet is all that is needed throughout the course of treatment. In cases of severe positional plagiocephaly, it is possible to outgrow the Ballert Helmet before all possible correction may be achieved. If this happens, the physician, orthotist and parents play an active role in determining if another orthosis is appropriate.

Will the head revert back to the flat shape if the Ballert Helmet is discontinued?

It is not common for the head shape to revert back to its original shape. As children get older, they spend more time sitting, crawling and walking, which minimizes the amount of time they spend on their backs. With maturity the number of open sutures diminishes and therefore the risk of positional deformation. If your child was diagnosed with torticollis, it may be necessary to continue the stretching program to maintain correction achieved by the Ballert Helmet.