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Helmet therapy for infants not effective UT researchers advise against helmet therapy for infants with positional skull deformation

Researchers of the University of Twente discourage helmet therapy for healthy babies suffering from moderate to severe positional skull deformation (‘flat head syndrome’). The therapy was found to be ineffective and expensive, and also caused several side effects. Helmet therapy is frequently prescribed in The Netherlands and was even covered by basic health insurance until recently. However, there has not been any studies providing information about the effectiveness of helmet therapy compared to the natural skull growth. The results of the new research are published today in the leading British Medical Journal. 

One in five babies in the Netherlands is diagnosed with skull deformation during their first months of life. Such deformation may occur because an infant's skull is still relatively soft, the head grows rapidly and babies often lie on their backs. Skull deformation is a cosmetic problem and may be treated using a so-called orthotic helmet. This helmet has to be worn for 23 hours per day from five to six months of age until their age 12 months. Until early 2013, this therapy was covered by basic health insurance and about 4,000 babies in the Netherlands were fitted with helmets each year. However, there was no proof of the therapy leading to better results than doing nothing. Research by Renske van Wijk of the University of Twente Health Technology and Services Research department has now revealed that helmet therapy has no added value compared to natural recovery over time. In addition, the therapy is expensive and often causes various side effects, including skin problems and excessive perspiration, and impedes cuddling. Based on the results of her research, van Wijk discourages having babies with moderate or severe skull deformation undergo this therapy.  

Two groups

The research involved follow-up of 84 healthy babies with moderate to severe skull deformation. These babies were divided into two groups at random. One group underwent helmet therapy while in the other group natural skull growth was awaited. The infants, aged five to six months at the start of the study, were monitored until they were 24 months of age. The average skull shape improved in both groups, but no relevant difference was found between the groups. Parents in both groups were very satisfied with the shape of their child's skull at 24 months of age. However, full recovery of the positional skull deformation at 24 months of age was diagnosed in only 25% of the infants, irrespective of the treatment provided. Therefore, it is important to prevent skull deformation and, should it occur anyway, to treat it from an early age by way of giving advice to parents about how to position and hold their child. Children suffering from very severe skull deformation, prematurely born children and children suffering from a special condition were not involved in the research.  


The research published in the British Medical Journal was performed by researchers of the Health Technology and Services Research department of the University of Twente Institute for Innovation and Governance Studies, in cooperation with researchers of the Netherlands Organisation for Applied Scientific Research and the Radboud university medical center. It was financially supported by ZonMw, the Netherlands Organisation for Health Research and Development. The study formed part of Renske van Wijk's doctoral research. She expects to obtain her doctoral degree in September. 

Note for the press

For more information, interview requests or a digital copy of the article Helmet therapy in infants with positional skull deformation: a randomized controlled trial, contact UT Press Officer Joost Bruysters (+31 (0)6 1048 8228).