My son is one of many babies you see out and about wearing a helmet. Until a few months ago, I had no idea why these babies were sporting this rather unusual headgear in such numbers. Now I know. Plagiocephaly.

It's a relatively modern problem, and a side effect of the ‘Back to Sleep' campaign introduced in the 1990s to reduce the risk of SIDS. In the US, SIDS reduced from 2.6 cases in 1000 babies in 1986 to 1 in a thousand in 1998. However, as a result of babies sleeping on their back, plagiocephaly cases rose from one in three hundred in 1974 to one in sixty by 1996.

In very severe cases, plagiocephaly sufferers have a higher risk of vision, hearing and dental problems. In most cases it is purely a cosmetic issue, and a common line in the UK is that ‘hair will cover it in later life' (helmet therapy is not available on the NHS). Luckily, tackling the issue is mainstream in the Netherlands. However, there isn't much information out there about helmet therapy for the "lay-mother" or father in the Netherlands; only a lot of medical and scientific study blurb. So I want to share our journey through the maze of helmet therapy.

The first player in our case was the consultatiebureau. At two months old it was already clear that my baby had a strong positional preference and we were advised, as was the case with my first son, to first try repositioning. For my first child, this was enough to correct the preference. For my second child it helped but didn't eradicate the preference.

At the third month check up there was visible improvement but my son's head was clearly asymmetrical and the consultatiebureau referred us through to a physiotherapist.

Our first appointment with the therapist involved a thorough medical question and answer session, as well as a physical examination to ensure that his positional preference was not related to hip, back or neck problems. That proved not to be the case.  We heard the words ‘helmet therapy' (helmtherapie or redressiehelm therapie) for the first time and got to hear that the physiotherapist felt that the consultatiebureau had referred us through late in the process; to fully benefit from helmet therapy, babies with serious plagiocephaly should start between the age of five and six months.

During the second appointment, the physiotherapist measured the severity of the skew of my son's head. The diagonals of the head from the front lobes are measured and after some calculator work a percentage is established. Plagiocephaly with a percentage of 108 percent or more is automatically referred through to the paediatrician for helmet therapy consideration.

In our case, no sensible figure could be established. We were told that the percentage did not match the visual picture. Confusion reigned and we were referred to the kinderarts. However, to get to the kinderarts, we needed a referral from a third party in the process, our huisarts.

Our GP thought the plagiocephaly was certainly not severe enough for a helmet. The cases she had seen were much worse. The GP referred us through but said there was nothing to worry about - which matched our gut feeling.

The kinderarts, the fourth medical professional we saw confirmed that there was a clear skew but not one that warranted anything as dramatic as helmet therapy. We went back to the physiotherapist.

A month later, the positional preference completely eradicated, the physiotherapist declared that we had come to the end of the physiotherapy road. Good news, only my son's head was still asymmetrical, albeit, we felt, better than it once was. That was a matter for the kinderarts we heard. I requested a new measurement so that we had something concrete to take back to the kinderarts. The results felt like a blow to the stomach.

In fact, the situation had worsened. Three sides of the head had been correcting itself but the section of the head with the worst skew had not moved at all so the overall effect was not positive. The figure of 107 percent came back. It was over to the kinderarts to rule out craniosynostosis and helmet therapy was back on the agenda.

A couple of x-rays later we were referred through to the revalidatiearts (rehabilitation specialist). Sat in the fifth different office in a matter of weeks, we were told that helmet therapy would be beneficial, and we had to make a decision quickly. We made it there and then.

We were then referred to the sixth and final player on the helmet therapy journey - an orthopaedic specialist in Rotterdam - where we took our son to be measured for the helmet. The measuring process was amazing. Sitting in a swivel activity chair, material was placed over my son's head (it reminded me of a thick stocking) that was covered in tiny sensors. A camera captured these sensors and a 3D doll like image of my son appeared on the PC screen. From this a polystyrene mould was made which reflected my son's head in a state of perfect symmetry. The helmet was then created to fit this ‘perfect' form.

As my son's skull grows, the helmet redirects the growth of his head - into the gaps of the helmet. The end result should be a rounded shape. In little more than a month the results are already measureable. He will wear the headpiece until he is one year old - longer if it is necessary so long as the fontanels are not closed up. The journey to this point has been a complicated, stressful one. But the end is in sight.

Top Tips

• Trust your instincts throughout the process
• Your medical insurer will likely cover the associated costs, but check first. You may need a letter from the kinderarts
• Parents have more of a problem with the helmet than the babies but trust that you will get used to it fast
• For once, Dutch bluntness comes in useful as many people just ask the reason for the helmet - be open to questions
• Be prepared for monthly check ups at the orthopaedic specialist
• Think of the plus sides: the helmet also prevents lots of bumps and bruises when babies start to find their feet!

Links

• Westland Orthopaedic shop folder on helmet http://www.woshop.nl/
• Plagiocephaly Care UK http://www.plagiocephalycare.org/plagiocephaly-faqs.php
• A Dutch forum for families going through helmet therapy http://www.redressiehelm.tk/

Amanda van Mulligen, British born, moved to The Netherlands in 2000 and runs The Writing Well, an English language writing and translation business. She is married to a Dutchman and has one son. Amanda writes about life as an expatriate in Holland as well as travel articles. For more information visit her website at www.TheWritingWell.eu