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Monday, 17 September 2012 15:00

Cranial Remolding


Overview of Plagiocephaly


Since 1992, when the American Academy of Pediatricians made the recommendation for infants to be positioned on their sides or back for sleeping, to decrease the incidence of Sudden Infant Death Syndrome (SIDS), the occurance of deformational plagiocephaly has risen to estimates as high as 40% of healthy infants. Positional plagiocephaly is characterized by flattening of one side of the occiput, forward progression of the ear on the same side, and bossing of the ipsilateral forehead.

PlagiocephalySample of Plagiocephaly

For those infants who do not make progress with therapy or positioning by three months of age, the prescription of a custom orthosis is recommended.  At Boston Brace, we manufacture a cranial remolding helmet known as the Boston Band.  We utilize a unique layering technique for our helmets which gives the Orthotist the ability to remove layers whenever necessary thereby allowing the infants head to grow in a normal fashion.

PlagiocephalyBoston Band

Protocol for Treatment

The following guidelines are provided to ensure that the identification of Plagiocephaly and the referral for treatment, are managed to provide optimal results for each patient.

· It is recommended that at three months of age, as a standard of practice, each child be evaluated and measured for cranial symmetry.  Anthropometric calipers may be used for manual measurement taking.

· If it is determined that a cranial asymmetry of 8mm or greater is present, the child needs to be referred to a trained specialist in cranial remolding for treatment, care, and tracking of progress.



Treatment with the Boston Band

The treatment of plagiocephaly with a cranial remolding orthosis should commence at approximately 3 months of age.  The Boston Band is a lightweight, plastic and foam orthosis made from a cast impression or a 3-D scan of the infant’s head.  It is made of a plastic flexible shell lined with polyethylene foam.  The foam can be modified over time to allow for growth and will provide a pathway for the infant’s head to grow into a more symmetrical shape.  The Boston Band allows the baby to sleep in any position he or she wants, yet keeps pressure off the flat spots and constrains head growth along the axis of the prominent parts.  It offers a simple and direct solution to the problem of positional plagiocephaly and brachycephaly.  Correction usually occurs within 2 to 3 months for patients beginning Boston Band treatment at 3 months of age.  In older patients, longer treatment time is necessary.


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