I was reading my journals the other day and came across a gem of an article about cranial helmets that are designed to prevent a baby’s head from becoming flat during infancy. All that back-laying can do a number on a baby’s head, you know. This idea of putting a rigid helmet on a baby during infancy to prevent deformation of their skull actually started with a group of neurosurgeons in Charlotte. I remember the grand rounds when they tried to convince the pediatric community that this was a big health problem. The pediatricians in the room, myself included, believed that heads do get lopsided in many babies, but that after a child gets up and starts crawling this usually disappears. They persisted, however, and helmets became common in children around Charlotte; an industry grew up around the technology. The thinking had a great story line…effective therapy, preventing future problems, earlier is better.
Now, let’s fast forward to a recent article I saw in the British Medical Journal. The researchers studied a large number of children for 2 years, dividing them into helmet and non-helmet groups. Their conclusion after two years of watching and measuring? The helmet group’s heads weren’t really any better shaped than the non-helmet group. Maybe the helmet wasn’t really necessary after all. In addition, they found a number of side effects from the helmets that I really never considered: pressure sores on the head, skin infections on the scalp, sleep difficulties, not to mention the cost. This is only one study, and I know it will start a stir among parents who feel these helmets are effective and necessary, as well as among the providers of the cranial band services. The study certainly needs duplication before we can make too much of the results, but the information presented in this study from the BMJ seems to be a strong argument against helmets. And here are the lessons I learned from this study:
- Just because a therapy is logical doesn’t mean it is effective.
- Just because things improve with a therapy doesn’t mean that the therapy is causing the improvement.
- Sometimes the most effective treatment costs nothing… tummy time: use it!
- The natural history of a lot of things in pediatrics is that conditions get better with time… like otitis media with effusion, many developmental delays, eczema, etc.
- Every once in a while it’s good to put our therapies to the test.
- And, that time tested truism…”Doctor, do no harm.”
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