Hamilton Health Sciences

Whether you require a protective helmet or cranial re-molding helmet, our cranial team can custom fabricate an orthsis that will best suit your needs. We have been providing custom protective helmets since 1988 and cranial re-molding services since 2004. If you wish to know more about our custom helmet services, please contact Mike Hall C.O. at or call 905-521-2607. 

  plagio staff photo

Mike Hall, Christa Orschel, and Patrick Reilly are members of the cranial remolding team

Cranial Remolding Program

What causes Plagiocephaly or Flat Head Syndrome?

At birth, the plates of the infant's head are very soft and pliable to allow the baby to pass through the birth canal. This process itself can result in altering the shape of the baby's head.  Normally this altered shape corrects itself in a few weeks after birth.

In addition, in the early 1990s, a national campaign was started to have parents place healthy babies on their backs while sleeping to reduce the risk of Sudden Infant Death Syndrome (SIDS) or crib death. This move to have our babies sleep exclusively on their backs has resulted in an increase in cranial asymmetry as the weight of the infant's head on the firm crib mattress causes the plates to shift and a flat spot to develop. This becomes more of an issue if the child has torticollis as they will then tend to favor one particular side when they sleep. This problem is compounded when the child moves from the crib into a reclined bouncy chair, stroller, or car seat as their head never gets a break from the pressure being applied on the flattened side. The two most common types of cranial deformities that we see are children with plagiocephaly or brachiocephaly.

Plagiocephaly: Plagiocephaly presents with the flattening of one side of the occiput.  There can also be a flattening of the opposite frontal lobe resulting in a parallelogram shape to the head.  When viewing from above, the ears will not be aligned opposite each other.  The un-affected frontal lobe may appear to bulge outwards more than the affected side.

Brachiocephaly: With brachiocephaly, the occipital area is completely flat across the back of the head.  The facial area is relatively normal looking and the ears are very close in equal alignment with each other. The width of the head may be equal to or greater than the length of the cranial vault.

Other causes of cranial deformities may include:
-Multiple births
-Reduced movement in utero
-Premature births requiring prolonged ICU time

Treatment Options:

Repositioning can be useful for some children in correcting their head shape if started early enough (within the first few weeks of birth).  At this time the child is more likely to remain in one position while sleeping and a number of methods can be used to prevent the child from resting on the flattened side. If you are considering repositioning then you will need some method by which you can assess changes to your child's head. One option would be to take digital photographs from a 'birds eye' view above your child's head while their hair is wet from a bath. This will allow you to see the contours of the head very clearly and assess the improvement on a weekly basis. The other option is to contact a local certified orthotist who provides cranial remolding services and ask if they would measure your child every two weeks to monitor the correction.  As the child begins to roll more while sleeping, repositioning becomes less effective as the child requires constant repositioning. This usually occurs around the age of 3 to 4 months. Increased tummy time is also important to help reduce the risk of further deformity. Our program offers early assessment and measurement information so that parents can then assess if a repositioning program is working. This information also allows parents the ability to research whether a cranial orthosis is an option they should consider. There is no charge or obligation for this early assessment.

When is the best time to consider treating with a cranial orthosis?

The early months are when children have the greatest changes in the growth development related to the head. Our clinic has seen the best correction for cranial deformities when treatment is started at a very early age of 3 to 4 months.  Treatment is a very time sensitive situation and any delay in waiting for orthopedic or neurological assessments could mean that the child misses out on some of the (best developmental) optimal treatment months. This chart lists the typical treatment timelines that should be observed when thinking about re-positioning VS treatment with a cranial orthosis.

Child's Age 

Treatments Timelines to Consider 

0 to 3 months of age 

  • Identify flat spot
  • Take base line measurements or photos
  • Begin repositioning
  • Be prepared and investigate your helmet options
  • Begin investigating the possible need to use a helmet to help complete correction

3 to 4 months of age 

  • Evaluate repositioning efforts
  • Compare base line measurements to 3 month old dimensions

If repositioning has not corrected the child's head then perhaps a cranial remolding assessment is needed 

4 to 6 months of age 

  • Begin treatment with cranial orthosis and continue monitoring until desired changes achieved

13 to 15 months of age 

  • Treatment typically finishes when desired correction is obtained or child's head fails to develop further over 3 consecutive follow up appointments.

While the best correction is achieved before the child is 1 year of age, children beyond 1 year of age can continue to correct but the process is longer and the results are not as great due to the slow growth changes to the head. 

How to get your child assessed

Chances are if you have identified a flat area on your child's head that is a concern for you, then it will most likely be larger than what typical repositioning efforts will be able to correct. If this is the case, speak to your family physician right away and see what options are available to you and your child in your area. Your family physician may refer you to a pediatrician, pediatric neurosurgeon or plastic surgeon to be assessed further for treatment options.

In addition to these important appointments, you may also want to consider booking an appointment to have your child assessed at a cranial remolding clinic so that you have a better idea as to your child's severity and what your corrective time line will be. 


Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

Disclaimer: Hamilton Health Sciences (HHS) offers Google Translate to better facilitate access for our community. However, HHS makes no claims regarding the accuracy of translations. Any and all health information should be verified by a health care professional.