Cranial Remolding at Shriners Children’s New England

Shriners Children’s New England in Springfield, Massachusetts, is proud to introduce a new cranial remolding program, designed to treat infants with acquired head shape abnormalities through experienced, customized care. This innovative service is a collaboration between Jonathan Lee, M.D., MPH, director of cleft and craniofacial surgery, and the Pediatric Orthotic and Prosthetic Services (POPS) team, which includes certified orthotists with specialized pediatric training.

The program offers a seamless and efficient approach to correcting acquired conditions such as plagiocephaly (asymmetry), brachycephaly (flattening of the back of the head), and scaphocephaly (elongation of the head). Using state-of-the-art scanning technology and custom-made cranial remolding orthoses, the team provides exceptional care for infants during critical growth stages.

Understanding Cranial Remolding

Cranial remolding therapy, also referred to as helmet therapy, addresses the unintentional effects of sustained pressure on a baby’s skull, which can lead to acquired abnormal head shapes. These conditions are often caused by:

• Limited space in the womb, especially for firstborns or multiples (e.g., twins or triplets).
• Birth trauma from the labor and delivery process.
• Torticollis, a condition where tight neck muscles pull the head into a tilted position.
• Prolonged positioning, such as time spent in the NICU or frequent back-sleeping, which, while important for reducing SIDS, can contribute to head shape abnormalities.
• Neurodevelopmental delays, which may limit a baby’s ability to move independently.

Without treatment, these abnormalities can lead to facial asymmetry, jaw misalignment, visual challenges, potential self-esteem issues, and difficulty properly fitting a protective helmet as the child grows. Cranial remolding therapy provides a safe, effective way to guide natural skull growth, improving both appearance and function.

Not all abnormal head shapes are appropriate for remolding. Rare congenital conditions that involve premature fusion of the skull bones can look similar but require surgery. It is important to have an experienced craniofacial specialist evaluate prior to starting remolding therapy.

How the Treatment Works

A cranial remolding helmet gently redirects head growth by creating space in areas where growth is needed while applying contact in areas where growth should be restricted. The helmet works with the baby’s natural growth, which occurs most rapidly in the first year of life when the anterior fontanelle (soft spot) on the top of the head is still open.

Treatment typically begins between 4 and 6 months of age, when growth is fastest, and lasts three to six months depending on the severity of the condition and the baby’s growth rate. Families are encouraged to try conservative measures, such as repositioning and/or physical therapy, before starting helmet therapy. Once treatment begins, the helmet is worn for 23 hours a day to achieve optimal results.

State-of-the-Art Technology

Shriners Children’s New England uses innovative scanning technology to create precise 3D models of a baby’s head. The scanning process is quick and comfortable, and allows the baby to remain seated in a parent’s lap. Once the scan is complete, a custom helmet is sent off for fabrication and fitted on-site. Families can personalize the helmet’s design by choosing from a variety of patterns and colors.

Unlike other orthotic treatments, the helmet does not usually need to be replaced as the baby grows. Adjustments are made to the interior of the helmet to accommodate growth and ensure comfort. Regular follow-up appointments allow the care team to monitor progress and make necessary modifications.

Results and Success

When treatment begins early and the helmet is worn as prescribed, families often see significant improvements in their baby’s head shape. The team closely monitors growth and makes necessary adjustments to ensure the best possible outcomes.

Treatment is most effective when started before 12 months of age, ideally between the ages of 4 to 6 months, while the skull is still growing rapidly. By 18 months, the soft spot closes, and head growth slows, reducing the potential for successful correction.

Getting Started

Most referrals to the cranial remolding program come from pediatricians or primary care providers. Once a baby is evaluated by Dr. Lee to ensure that remolding is appropriate, they are referred to the POPS team for a 3D scan and helmet fitting. Families can expect regular follow-up appointments every few weeks to track progress and make adjustments as needed.

With a focus on specialized care and convenience, the Shriners Children’s New England staff is committed to helping families achieve the best outcomes for their children. If you have concerns about your baby’s head shape, the team at Shriners Children’s is here to help.