Helmeting Therapy in Children with Plagiocephaly: Who Receives Helmets?

Abstract

Objectives: Plagiocephaly is a flattening or asymmetry of the skull in infants that –while benign– can be distressing to parents. There are no standardized treatment recommendations, but helmeting therapy (HT) can be pursued. However, there is no strong evidence for the effectiveness of HT, leading to ambiguity for who should be offered this intervention. In this study, we aim to evaluate any differences in the proportion of patients being offered HT based on race/ethnicity, sex, or insurance type. Methods: A retrospective review from January 12th, 2017, to April 30th, 2022, of all patients with a plagiocephaly diagnosis under 18 months of age was conducted. A one-way analysis of variance was used to assess significance with differences <0.05 considered significant. Results: Of the 1667 patients identified with plagiocephaly, 807 (48.4%) patients were offered HT, and 501 (30.1%) subsequently received a helmet. Patients with public insurance represented a significantly lower proportion of patients offered HT compared to their respective proportion within all patients diagnosed with plagiocephaly (26.9% vs 31.8%, P = .01). Additionally, patients who identified as Black or African American represented a significantly lower proportion of patients offered HT compared to their respective proportion within all patients diagnosed with plagiocephaly (8.1% vs 10.6%, P = .04). Conclusion: Our study demonstrates that the proportions of patients with plagiocephaly who were offered HT compared to their overall proportion within all patients diagnosed with plagiocephaly were different for patients with public insurance and patients who identified as Black or African American. This highlights the need for standardized recommendations for HT.