Joey Wahler (Host): It's a treatment that corrects the shape of a baby's head. So, we're discussing Baby Helmet Therapy. Our guests, India Jacobson, a Certified Prosthetist and Orthotist, and Marisa Foss. Both are with Shriners Children's Chicago. This is Pediatric Specialty Care Spotlight with Shriners Children's Chicago. Thanks for listening. I'm Joey Wahler. Hi there India and Marisa, thanks so much for joining us.

Marissa Foss: Thanks for having us.

India Jacobson: Thank you.

Host: First for you India, what exactly does a Prosthetist, Orthotist do?

India Jacobson: So a Prosthetist works with artificial arms and legs, but an Orthotist works with braces, so leg braces, back braces, neck braces, and in this case, head shaped helmets.

Host: Right. And so that being said, Marisa, when a baby's head is mis-shapened, what exactly do we mean by that? And what's typically the cause of it?

Marissa Foss: On our initial evaluation, actually, we're trying to figure out what we mean by that. Is it just related to positioning or is it related to another underlying problem that may be more involved? When it's positioning, it's usually related to a baby being in one position for extended periods of time. So, for example, we have the Back to Sleep campaign, which is putting babies on their back to sleep for the safest airway during sleep. And as a result of that campaign, we see a lot of babies with a flat back of their head or brachycephaly. Some babies may be in a similar situation, but they tend to turn their head to one side or the other. Maybe they have a tight neck that is restricting their motion. But for whatever reason, they have a flat back of their head that is more flat on one side or the other, which we would call a positional plagiocephaly.

Host: So to be clear, these are things that are normally caused by positioning of the baby, not during pregnancy, but after they're born then. Yeah?

Marissa Foss: Usually yes, but it can be during the pregnancy, but I think more frequently if it was during the pregnancy, by the time they reach several months of age, it may have already worked its way out. Their skulls are very soft and they're in many segments. The sutures we call them, that separate the different segments of the skull have not yet fused. And so, as their brain grows, their body naturally wants to kind of round things out. So when we see that early, or flattening, oftentimes that can be evened out with regular growth and development.

Host: So back to you, India, how common an issue is this in babies, and how do parents usually know there might be an issue with their baby's head shape and when should they see a pediatrician as a result?

India Jacobson: So usually the head shape deformity is found by the pediatrician at one of the appointments. And at that point, the pediatrician will refer the patient to Shriners or another outside provider.

Joey Wahler (Host): So, it's usually the doctor, not the parents then, that notice it first.

India Jacobson: Yes

Joey Wahler (Host): Marisa, what happens during that first baby appointment at Shriners Children's Chicago when there is a shape issue with an infant's head?

Marissa Foss: Sure, so for the baby's first initial visit with us, we always schedule them at an appointment where they might see a surgeon if need be. Again, as I mentioned, head shape problems can stem from a variety of causes. And one of those might be a condition called craniosynostosis, which might be a surgical problem. So again, we have a surgeon available if need be. That is much less common. And we can usually tell pretty easily just by looking at the baby, that we can rule that out, and when that is the case, the baby is seen by one of the nurse practitioners, and then we will request a scan from one of the prosthetists, orthotists, like India, and they will do in our situation is called a star scan and it involves a laser basically doing a surface mapping of the baby's head. It's not anything that uses radiation or is in any way harmful to the baby. And then the bracing specialists, I'll call them, for simplicity's sake, but they will kind of crunch the numbers. They look at a section of that surface mapping and will crunch some numbers that basically compare different quadrants of the head with the average or the typical infant at that stage. And, that will give us numerical data to support our physical exam and determine if a baby qualifies for a helmet. And typically we're seeing babies ideally we would like to see them before six months of age. Sometimes we'll see them sooner. I think we've seen babies as young as maybe two or three months. And in those cases, we usually recommend watchful waiting until closer to about five, six months of age. And then if the head shape persists after repositioning and tummy time, then we might make a recommendation for a helmet at that point.

Host: And so, just to follow up on that, India, I presume that the earlier the intervention here, the better, like with many medical conditions. Yes?

India Jacobson: Yes, because it's really time sensitive. With these helmets, we're trying to capture the baby's growth. We're not pushing on the head to push the skull into a better position. We're just holding that outward part and there are voids inside the helmet, so that way when the skull grows, it kind of fills in those voids and gets to be the better shape.

Host: Gotcha. So, India, what is exactly the purpose of a helmet for a baby? We are of course, talking about helmet therapy. What is the helmet actually doing here?

India Jacobson: The helmet is trying to correct the baby's head shape. If it's a severe deformity or more of a mild deformity, we're trying to get that head shape numbers to go back into like a category of normal limits, if that makes sense.

Host: And so, if a helmet is needed, does Shriners Children's Chicago provide one?

India Jacobson: We do. We'll get the prescription from the clinic, and then I'll do the scan with the star scanner, and if the patient is a candidate for a helmet, then yes, we do provide the helmet. We do bill insurance, but we provide the helmets regardless of the family's ability to pay.

Host: Okay. Back to you, Marisa. How long do these babies typically wear such a helmet?

Marissa Foss: So there's a lot of variability there, and it's very dependent on monitoring that we do. Once the baby is in a helmet, we'll have the initial scan or perhaps a follow up scan if we, delayed to, see if positioning might be suffixient. But, in either case, we would have a scan, and two weeks later, the delivery and the fitting of the helmet, and then, we would follow the patient about every four to six weeks after that, and I would say probably an average duration of treatment is probably four to six months, but again, it's based on what the results look like at those follow up scans, and again, trying to get them as close to quote unquote normal values as possible.

Host: India, after therapy and use of a helmet, what would you say are the results that families can typically expect?

India Jacobson: A lot of it does depend on family compliance. The helmet doesn't work if the family is non-compliant with it. So generally in the cases where we can get the patients in at a younger age and the families are very compliant with full time wear, it's 23 out of 24 hours a day wear, generally we do get the results that we want. We get that skull back within the normal head shape range. Unfortunately, some families aren't as great as making the patients wear it for whatever reason. Unfortunately, sometimes we do get started a little later, like the patient is 10 or 11 months old. We're not going to get the correction that we see if we can get started around maybe six months old with the patient.

Host: And you mentioned there 23 out of 24 hours is what's usually recommended that the baby wear this helmet. Are they ever adverse to it or do they get used to it after a reasonable amount of time?

India Jacobson: So there is a weaning in period that we do stress at the delivery of the helmet. You shouldn't just rush in and make the patient wear it full time on the second day. There is a five to seven day weaning in period. But honestly, the kids take to it a lot easier than what you might expect. At first, here in the hospital, during the fitting, they may be a little fussy. They're in this hospital. But once you get them home with their home toys and their home environment and food and other distraction methods, generally the families come back saying how surprised that they were how easy the patient took to the helmet.

Marissa Foss: I would add to that that many parents, tell us that the patients actually reach for the helmet when it's time to take it off and give them a break or give them a bath, and so they, really actually come to like it, and then parents as well, when we'll suggest that it's time to graduate; many parents express that they're kind of nervous to do without the helmet because they've grown used to it and they almost like having the baby in a helmet as an extra layer of protection as the babies are starting to toddle around. So, not something we recommend using it for, but I will say that generally it is much better tolerated than, than people think. And that goes back to India's point about how the helmet isn't pushing on the baby's skull. It should be only allowing the baby's skull to grow and fill in the voids rather than putting pressure on any points of the skull.

Host: Okay. And then, Marisa, in summary here, what common questions or concerns would you say new parents typically have about babies with head shape issues and how do you and yours address those?

Marissa Foss: We always reassure parents that this should not have any bearing on baby's intelligence or learning or development. So that's one big concern that many parents will express. Another is a point we've made, but will the helmet hurt? And we certainly reassure them that if it's fitting properly, it shouldn't, and that if it isn't fitting properly, that's why we, bring them back for such regular visits. One of the many reasons we bring them back for such regular visits is so that the helmet could be adjusted as necessary. I think those are two of the bigger points that parents have concerns about, and I will also add that the grandparents seem to be even more concerned than parents in many cases, and so in cases where we have issues with compliance, in my experience, at least, it's often been that grandparent is watching the baby and they're worried that the baby's uncomfortable and they take the helmet off, so parents kind of, there's room for education of grandparents there as well to reassure them that we're not hurting the baby, we're just giving them their head space to grow, so that they grow a little more round and a little more symmetric.

Host: Indeed, we love devoted grandparents, but leave the helmets on. Let them do their job, Grandma and Grandpa, right? Absolutely. Well, folks, we trust you're now more familiar with helmet therapy for babies. If you've ever seen a baby wearing a helmet, you probably have at some point in your life and wondered, what's that for? Now you know. India and Marisa, great information. Thanks so much again.

Marissa Foss: Thank you, Joey.

India Jacobson: Thank you.

Host: And for more information, please visit ShrinersChildrens.org/nen/pediatric-care/craniofacial which is c-r-a-n-i-o-f-a-c-i-a-l. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for listening to Pediatric Specialty Care Spotlight with Shriners Children's Chicago.