Cranial molding helmet therapy and establishment of practical criteria for management in Asian infant positional head deformity



The growing number of infants with deformational plagiocephaly (DP) has raised clinical questions about which children, at what age, and how molding helmet therapy (MHT) should be performed especially in Japan.


A total of 1,011 Japanese pediatric head deformity infants had undergone MHT after being diagnosed with non-synostotic DP. Three ratios of left to right comparison (anterior, posterior, and overall) were created and analyzed comparing age of starting treatment, helmet wearing period, and severity of skull deformity before with after MHT.


The averages of head symmetry ratios after treatment in all groups (for the occipital region) showed apparent improvement; t(930) = −60.86, p = 0.000. (t(932) = −57.8, p = 0.000.) In the “severe” deformation group, the earlier the treatment was started, the higher symmetry ratio recovery was obtained. Treatment was especially effective when started in 4-month-old infants. In contrast to the “severe” group, the “mild” deformation group showed that MHT was most effective if treatment started before 6 months of age. Again, the earlier the treatment was started, the higher symmetry ratio was achieved, but compared to the “severe” group, it had a modest effect when treatment was started in infants older than 8 months.


This is the first large-scale molding helmet study reporting the method and efficacy in Japanese infants. It demonstrated that despite the structural and physiological differences from infants of other races, molding helmet therapy is effective in Asian-born infants, provided that intervention timing and recognition conditions are met.

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We thank Dr. Kostadin Karagiozov for his advice and manuscript review and David Huang for his guidance, and we gratefully acknowledge the radiological technologists, nurses, and staff of the Departments of Neurosurgery, Tokyo Women’s Medical University, in preparing this paper.

Disclose financial relationships for all authors

The authors have no financial relationships relevant to this article to disclose.

Conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.



Contributors’ statement page

Yasuo Aihara—Dr. Aihara conceptualized and designed the study and drafted the initial manuscript.

Kana Komatsu Osami Kubo, Tomokatsu Hori—Ms. Komatsu and Dr. Kubo and Dr. Hori carried out the initial analyses and reviewed the manuscript.

Hitoshi Dairoku Yoshikazu Okada—Mr Dairoku designed the data collection instruments and coordinated and supervised data collection. Dr. Okada critically reviewed the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Yasuo Aihara.

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Aihara, Y., Komatsu, K., Dairoku, H. et al. Cranial molding helmet therapy and establishment of practical criteria for management in Asian infant positional head deformity. Childs Nerv Syst 30, 1499–1509 (2014).

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  • Positional plagiocephaly
  • Brachycephaly
  • Scaphocephaly
  • Cranial molding helmet therapy
  • Non-synostotic
  • Japanese infants