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Updated: Jun 2, 2026
A Test Bed to Examine Helmet Fit and Retention and Biomechanical Measures of Head and Neck Injury in Simulated Impact
Published on: September 21, 2017
Is helmet therapy effective in positional plagiocephaly? A systematic review and proposal for an updated management
Daniela Castaño-Bustos1,2, Mariana Agudelo-Arrieta3,4, Maria Isabel Ocampo-Navia3,4
1Neurosurgery Department and Research Group, Pontificia Universidad Javeriana, Bogotá, Colombia. castanodaniela@javeriana.edu.co.
Insights
Positional plagiocephaly management in infants shows helmet therapy may speed early correction for severe cases. However, long-term outcomes are similar to conservative treatments, suggesting helmets accelerate rather than alter final head shape.
Area of Science:
- Pediatrics
- Cranial Morphology
- Infant Health
Background:
- Positional plagiocephaly is a common infant cranial deformity linked to supine sleep recommendations.
- Management strategies, especially cranial orthotic therapy, lack definitive evidence for optimal use.
- Uncertainty exists regarding the timing and effectiveness of interventions for this condition.
Purpose of the Study:
- To systematically review current evidence on therapeutic interventions for positional plagiocephaly.
- To evaluate cranial shape outcomes, treatment response modifiers, and safety profiles.
- To propose an updated management algorithm for individualized clinical decision-making.
Main Methods:
- Systematic review of existing literature on positional plagiocephaly treatments.
- Analysis of studies focusing on cranial asymmetry correction and treatment efficacy.
- Assessment of safety data and factors influencing treatment outcomes.
Main Results:
- Helmet therapy shows faster early correction of cranial asymmetry in moderate-to-severe infant cases.
- Long-term data do not indicate clear superiority of helmet therapy over conservative management.
- Differences in cranial morphology between treatments diminish over time.
Conclusions:
- Cranial orthotic therapy may accelerate correction rate but not fundamentally alter long-term cranial morphology.
- Conservative management remains a viable option, with outcomes comparable to helmet therapy over time.
- An age- and severity-based algorithm is proposed to guide evidence-informed treatment decisions for positional plagiocephaly.
Abstract:
Positional plagiocephaly, also known as deformational or non-synostotic plagiocephaly, is a common cranial deformity in infancy resulting from sustained external mechanical forces acting on the developing skull. Its prevalence has increased in recent decades, paralleling widespread adoption of supine sleep positioning recommendations. Although generally considered a benign condition, uncertainty persists regarding optimal management strategies, particularly the role and timing of cranial orthotic therapy. Conservative approaches, including repositioning techniques and physical therapy, are frequently employed, while helmet therapy is typically considered for moderate to severe cases or when initial treatments fail. This systematic review summarizes current evidence on therapeutic interventions for positional plagiocephaly, focusing on cranial shape outcomes, modifiers of treatment response, and safety profiles. The available evidence suggests that helmet therapy appears to be associated with faster early correction of cranial asymmetry, particularly in infants with moderate-to-severe deformity. However, current data do not demonstrate clear long-term superiority over conservative management, as differences between treatment modalities tend to diminish over time. These findings support the interpretation that cranial orthotic therapy may primarily accelerate the rate of correction rather than fundamentally alter long-term cranial morphology. An updated, age- and severity-based diagnostic and management algorithm is proposed to support individualized, evidence-informed clinical decision-making. These findings should be interpreted in the context of the limited number of included studies and the observational nature of the available evidence.
