Helmet and cranial band options for plagiocephaly and brachycephaly

There are numerous brands of cranial orthotics (helmets and bands) on the market today. Primarily, these devices can be categorized into two types: active and passive. Active helmets are occasionally referred to as “dynamic” orthotics, and are the most common variety available. There is much debate among physicians and orthotists as to the actual value of the terms passive and active in helmet therapy. General consensus is that helmets and bands are passive treatment methods, depending on the skull’s natural growth to affect change. The primary difference in the two categories is the snugness of the helmet or band’s fit, which affects the overall amount of pressure applied to the baby’s skull at any point. Passive helmets and bands are not as snug as active orthotics.

The following list of orthotic devices is not exhaustive, but it should give you an idea of some of the options available. Your doctor may have a preference for a particular brand, as well. Ask for his or her input when looking for a device, and make sure to contact your insurance company to see what brand they cover, and to obtain pre-authorization if necessary. Some insurance companies still not recognize positional plagiocephaly, brachycephaly or scaphocephaly as medical conditions that require treatment, but rather as cosmetic conditions. Advice on dealing with insurance companies can be found in this other article.

Orthomerica currently has the largest and most popular product line for cranial remolding. The STAR line of bands and the Clarren helmet are all produced by this company. Orthomerica products are made to order using either a mold or more commonly a STARscan (laser-acquired image) of your child’s skull. Another company called Cranial Tech is the manufacturer of the DOC Band, another popular cranial remodeling orthosis. Both companies’ websites provide excellent resources for parents.

Active Helmets and Bands

STARband. The side-opening STARband is the most popular orthotic device made by Orthomerica. The device is comprised of ½” of foam below a hard copolymer coating which can be customized with different available designs and colors. Your orthotist will most likely want to see your baby at least every two weeks to adjust the STARband as needed if you choose this option. The appointment interval will depend on the growth of your baby’s head. Extra foam can be shaved out of the orthosis to adjust the fit as necessary to accommodate your child’s skull growth. There is an opening in the top of this band. The device is appropriate for moderate to severe cranial deformities.

STARlight Band. This design is lightweight, made of ¼” clear plastic, and can be molded using heat. It is very similar to Orthomerica’s STARband in design and function, and has openings on the side and top. This device is an excellent choice for young infants who are still learning to rotate and lift their heads and may find heavier orthoses too cumbersome. This device is suitable for moderate and mild brachycephaly and plagiocephaly, but is not the best design for use with scaphocephaly, although it can be used to treat the condition.

STARband Bi-valve. This device is made of the same materials as the STARband, but follows the design pattern of the STARlight Bivalve. It is ideal for use with scaphocephaly and is the most popular device manufactured by Orthomerica for this condition. Despite its design for scaphocephaly, this orthotic band can be used to treat brachycephaly and plagiocephaly as well. Like the original STARband, it can be customized for your baby with different colors and patterns available.

STARlight Bi-valve. This orthosis was originally designed for the treatment of scaphocephlay, but can be modified to treat other head shapes. It is lightweight, made from ¼” clear plastic, and can be heat-molded by your orthotist. The device is comprised of front and back shells which are fastened together at the top of the skull. An additional Velcro fastener is located on the back of the orthosis. This design is excellent for post-operative patients, and provides contact with the skull from its base in the back to the eyebrows in the front.

STARlight Cap. The STARlight cap is a one-piece, clear plastic orthosis. Padding can be added in necessary locations prior to the cap’s fabrication. Lightweight and ideal for younger infants, the device can be used to treat mild brachycephaly, plagiocephaly and scaphocephaly. Because it is a single-piece, a second device may be needed during the course of treatment as your baby’s head grows. Additionally, follow up visits may be more frequent with this particular device, in order to accommodate skull growth. Your orthotist can mold this device with heat. This device is not recommended for infants with cranial shunts, and is a good choice for the correction of mild deformities.

DOC Band. The DOC band is a 6-ounce orthotic that is customized to the reshaping needs of each child. It consists of a hard plastic shell with a foam liner. The DOC band is open at the top, making contact with your baby’s skull only in the areas necessary to help adjust the cranial shape. Frequent (weekly to bi-weekly) follow up visits are required to adjust the band’s fit. The DOC band was the first FDA approved post-operative cranial remolding orthotic and the first marketed and approved cranial band. It has been used to treat over 55,000 children, but is only available through CranialTech clinics.

Hanger Cranial Band. The Hanger cranial band is used in the treatment of deformational plagiocephaly, brachycephaly and scaphocephaly. The device can be customized with patterns, colors, or even hand-paintings to reflect your child’s personality. Air holes can be placed in the device by your orthotist to make your child more comfortable. The device is made to order based on a laser measurement of your child’s skull. The device is available only through Hanger’s 670 clinics.

Passive Helmets and Bands

Clarren Helmet. The Clarren helmet has been in use since 1979, and was the orthotic studied in the first investigation of cranial orthosis for the treatment of deformational plagiocephaly. It is an appropriate device for infants ranging from 6-18 months of age with mild to severe cranial deformations. This orthotic does not have any side or top openings apart from air holes, and is a full helmet, reaching to the skull’s base in the back, covering the ears, and extending to the eyebrows in the front. It is fastened with a chin strap. The helmet is comprised of a 3/8” polypropylene cover with a 1/8”aliplast liner. The device does not require frequent follow-up visits, and only minimal adjustments can be made to the liner. It can be used in combination with cranial shunts and following surgery due to the loose fit it provides.

Boston Band. The Boston band is a lightweight orthotic comprised of a flexible plastic outer shell and a foam liner. The fit is based on a mold or 3D scan of your child’s head. This orthotic is acceptable for the treatment of scaphocephaly, plagiocephaly and brachycephaly. It has both side and top holes, and is a side opening band. The Boston band is available only through Boston Brace and their partner programs (NOPCO Clinical Network and other partners, as listed on the Boston Brace website). The Boston band’s manufacturers claim that the device requires less time for successful treatment than other available options.

Treatment time

The ideal onset time for cranial remodeling treatments is 4-6 months of age, but treatment can begin at any point before one year of age and still produce decent results. Orthotics manufacturers provide guidelines for the use of their individual products based on studies that they have conducted and reports from parents and care providers. These guidelines also suggest the amount of treatment time that should be needed to obtain good results from cranial remolding therapy. Results will vary from child to child and depend on the severity of the condition.

All Orthomerica (STAR) active devices are designed for children between 3-18 months of age. The Orthomerica Clarren helmet is designed for children 6-18 months of age. Boston Bands are optimal for use between 4 and 12 months of age, but can be used until a child is 18 months old. The makers of Boston bands claim that their device is capable of reversing cranial deformities within 2-3 months of treatment. Orthomerica’s products are designed for 3-4 months of therapy on average.

Helmet cost

The information in this section is derived from forum and post responses from parents of children with cranial deformities. Keep in mind that your child’s orthosis may vary in cost based on your family’s insurance policy, the type of helmet or band that you choose, the complexity of your child’s case, and the duration of treatment required.

Exact pricing information for STAR orthotics and the Clarren Helmet varied widely, between $2300 and $4000. Parents generally reported positive outcomes, however, and insurance companies seem to work fairly well with Orthamerica.

Hanger bands usually cost about $2000 without insurance, but many insurance companies seem to cover Hanger orthosis more readily than other cranial remodeling devices. According to some reports, Hanger doesn’t charge for second helmets if they are necessary, and the decoration and customization of your child’s helmet are free.

Boston Bands run around $3000 without insurance. They appear to be newer on the market, and there aren’t many comments as to how insurance companies interact with them yet, although some posters have reported that their insurance covered this company’s device in full.

Reports of the cost of Cranial Technologies’ DOC band suggest that the device costs $3600 on average, and although there were reports of insurance companies refusing to cover this device, many parents were able to obtain coverage following the submission of appeal letters.