Why would a child need a helmet after surgery for craniosynostosis?
A child who has endoscopic surgery for craniosynostosis has very little bone removed – the surgical team re-opens the closed suture, which allows the natural growth of the brain to expand the skull over the following months. To provide guidance as that happens, and to ensure the best head shape, babies who have the endoscopic surgery wear a helmet until about one year of age.
Pre-Operative Helmet Evaluation Before the surgery the child will have a helmet evaluation by a trained orthotist. The orthotics company will obtain insurance authorization for your child’s helmet in advance of surgery.
About three days after surgery, your child will be scanned for the helmet, which is usually delivered and applied within seven to ten days. Over the next week you will gradually increase the time your child wears it (see typical schedule below, but discuss your child’s schedule with your orthotist). You should monitor your child’s incision and skin every day while in the helmet and immediately report any concerns about redness, or problems with contact points of the helmet.
A helmet should not be uncomfortable after a few days of wearing it. If your child seems uncomfortable the helmet may need to be re-fit, which is common with the first helmet.
Sample Helmet Introduction Schedule Note that many parents use meal times as the break Day 1: Wear 1 to 2 hours, remove for 3 hours, repeat until bedtime Day 2: Wear 2 to 3 hours, remove for 2 hours, repeat 4 to 5 times until bedtime Day 3: Wear 3 hours, remove for 1 hour, repeat 3 to 4 times Day 4: Wear 4 hours on, 1 hour off, repeating until bedtime, then wear to bed overnight Day 5: Take off helmet in morning, wipe clean, check for redness, leave off 1 hour, wear 4 hours. Take another one-hour break, then wear another 4 hours, and repeat. Take a one-hour break before bed, then wear to bed overnight. Day 6: Wear full time, 21 to 23 hours a day. Remember to take the helmet off in the morning to wipe it clean and take a break, and then remove it again for an hour for bathing and cleaning the helmet.
The helmet needs to be worn for 21 to 23 hours a day until the child reaches 9 to 12 months of age.
(Although the baby’s head shape is corrected within the first three or four months after surgery, the skull shape can regress if helmet therapy is discontinued too early.) Your child will have no special precautions or significant limitations on activities during this time.
The orthotist and craniofacial team will work together to determine when helmet therapy should be stopped.
