# Factors Associated with Helmet Therapy Outcomes in Positional Plagiocephaly

## TL;DR

This study finds that helmet therapy for infant head shape issues works best when started before 6 months, but the size of the baby's soft spot doesn't affect the outcome.

## Contribution

Shows that anterior fontanelle size does not predict helmet therapy success, emphasizing early treatment as key.

## Key findings

- Infants ≤6 months had significantly better cranial asymmetry improvements than older infants.
- Anterior fontanelle size had no significant impact on treatment outcomes in any age group.
- Early helmet therapy initiation is the most critical factor for optimal results.

## Abstract

Background: Helmet therapy is considered to be a treatment for infants with positional plagiocephaly. Although some studies suggest that anterior fontanelle (AF) size may also affect treatment outcomes, evidence and influence remain unclear. The aim of this study is to assess the impact of anterior fontanelle size on the effectiveness of helmet therapy, with the goal of determining the optimal timing and patient criteria for treatment. Methods: We conducted a retrospective study of 94 infants treated with helmet therapy for positional plagiocephaly at Kwangju Christian Hospital between January 2020 and December 2021. Patients were divided into two age groups (≤6 months and >6 months) and three SAF quartiles (≤25%, 25–75%, ≥75%). Parameters reflecting the degree of cranial asymmetry correction, including cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI), were recorded at the start and end of treatment. Results: Infants aged ≤6 months showed significantly greater improvements in cranial vault asymmetry (CVA) and cranial vault asymmetry index (CVAI) compared to older infants (CVA: 4.57 ± 2.30 mm vs. 7.04 ± 3.85 mm, p = 0.003; CVAI: 3.10 ± 1.55% vs. 4.45 ± 2.44%, p = 0.011). When analyzed by anterior fontanelle (AF) size quartiles (≤25%, 25–75%, ≥75%), no significant differences in treatment outcomes were observed at the end of therapy for CVA (p = 0.88) or CVAI (p = 0.91). In infants ≤6 months, SAF quartile analysis also showed no significant differences in CVA (p = 0.97) or CVAI (p = 0.98) improvements. Conclusions: Our findings indicate that anterior fontanelle size is not a predictor of helmet therapy outcomes in positional plagiocephaly. Early initiation of helmet therapy (≤6 months) remains the most critical factor for achieving optimal results.