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Cranial Remolding

Home Services Cranial Remolding

Parents, have you noticed asymmetry or a flat spot on your baby’s head, or facial asymmetry or ear shift, and you are not sure whether to be concerned or if you need to do anything to correct it?  Babies’ head shapes can change as they grow and there is a wide range of what is considered a “normal” head shape.   It can be confusing to know if treatment is needed and when it is appropriate.  Thankfully, there are now more studies showing consistency in treatment outcomes and recommendations, and cranial specialists with the clinical experience to provide you with information to assist you in making the best decision for you and your baby.

Level Four is proud to be an industry leader in cranial remolding orthotic treatment, guiding over 20 thousand families through repositioning and/or orthotic treatment to provide the best results for each patient.

For a free evaluation and information on repositioning and cranial remolding orthotic treatment, please Contact one of our locations specialized in treating infants with deformational and synostotic head shapes.

What are contributing Factors for Deformational Plagiocephaly?

  • Breech or transverse presentation in utero
  • Multiple-birth infants
  • Congenital Muscular Torticollis, neck weakness or restricted neck range of motion
  • Slower motor development particularly in gross motor skills
  • Prolonged exposure to the supine position
  • Lack of tummy time when the baby is awake
  • Visual field deficits
  • Bony abnormality in the cervical spine


What are the Types of Deformational Head Shapes?

Deformational Plagiocephaly (Play-gee-oh-sef-uh-lee)

  • The most common type of skull deformity in infants
  • Normally noticed by caregivers at about 6-10 weeks of age
  • Characterized by an asymmetrical skull shape
  • Flattening on one side of the back of the head
  • Ear is pushed forward on the side of the posterior flattening
  • Forehead may be asymmetrical and positioned more anterior on the side of posterior flattening
  • Facial asymmetry may be present
  • May be accompanied by torticollis, limited neck range of motion, weakness and preferential head positioning





Deformational Brachycephaly (Bray-kee-sef-uh-lee)

  • Central posterior flattening
  • High, sloped skull
  • Excessively wide compared to the length
  • May be accompanied by a prominent, bossed forehead





Deformational Brachycephaly with Asymmetry

  • Combination of brachycephalic and plagiocephalic characteristics
  • The shape is excessively wide compared to the length and is also asymmetric
  • May or may not include asymmetries to the forehead and facial structure





Deformational Scaphocephaly (Scaf-oh-sef-uh-lee)

  • Very elongated head shape that is excessively long for its width
  • Sometimes seen in premature infants who are often positioned side-lying, such as infants in the NICU
  • May be confused with sagittal craniosynostosis, a more serious deformity that usually requires surgery to correct





What is Craniosynostosis?

Craniosynostosis is the premature closure of the space between the cranial bones.  Craniosynostosis causes restriction of growth at the suture and abnormal growth perpendicular to the fused suture.  Treatment of craniosynostosis usually requires surgical intervention.  Early referral to a pediatric neurosurgeon or craniofacial specialist is always recommended.  There are different types of craniosynostosis, including: sagittal, coronal, metopic, and lambdoid.  Endoscopic surgeries are often recommended before 3 months of age.  Depending on the type of surgery a cranial remolding orthosis may be used post-surgically to correct the head shape once the sutures are open.

What is Torticollis?

A leading cause of deformational plagiocephaly is neck tightness caused by congenital muscular torticollis or neck/trunk muscle imbalance. Torticollis is usually caused by an imbalance in the sternocleidomastoid (SCM) and other neck muscles, which prevents full range of motion in the neck. It is estimated that about 85% of  babies with deformational plagiocephaly also have some level of torticollis. Typically, the head of a baby with torticollis is slightly tipped to one side and rotated to the opposite shoulder, causing the head to consistently rest in the same position. The constant positioning of the head to the same side causes it to become flat in the back. Torticollis can also pull abnormally on the base of the skull and cause the ear on the same side as the posterior flattening to be pushed forward. In severe cases, the forehead can also be pushed forward on the same side, and the facial features including the eyes, cheeks, and jaw may not be symmetrical.


If you recognize that your baby has a flat spot or abnormal head shape, the first thing you should do is talk to your pediatrician. The American Academy of Pediatrics suggests that pediatricians evaluate the baby’s head at each visit from the top, both sides, the front, and the back. The AAP also recommends that pediatricians discuss repositioning and the importance of “tummy time”.   Please check out our Patient Forms Library to receive more information on Tummy Time and Repositioning.

When your baby is awake and supervised, “tummy time” is a good way to take pressure off the flattened areas, build strong neck and trunk muscles, and will help your baby learn to roll, sit, and crawl when the time comes. If there is a neck muscle imbalance or a delay in development, your pediatrician may refer your baby to a therapist for physical or occupational therapy. The pediatrician may also recommend that a pediatric neurosurgeon or craniofacial specialist assess your baby’s head shape to ensure that the sutures are all open and to check for any other skull shape disorders.

If the head shape does not improve between the ages of four to six months, it may be time to consider a cranial remolding orthosis, better known as a helmet or band.

Contact one of our clinics today to set up an appointment to have your child’s condition evaluated.


Level Four Experience

Cranial Remolding Orthotic treatment has 3 major components in making sure your child receives the best care for their diagnosis.

  1. Clinician experience and expertise
  2. Assessment tools for proper diagnosis and continued documentation of treatment efficacy
  3. Proper fabrication and modification of the orthosis for best fit throughout treatment


Our Cranial Specialists

Level Four Orthotics and Prosthetics’ clinicians are certified, licensed professionals.   They have specific training and continuing education to focus on the demands of this specialty and the needs their patients.  Our reputation in the markets we serve is one of excellence.  We are the preferred provider for neuro and plastic surgeons across the East Coast and Texas with a history of shorter and more effective treatment outcomes than other cranial providers.  Effective treatment is not just about fitting the orthosis, it is about close follow-up and adjustments as needed throughout treatment to ensure the orthosis continues to fit appropriately as your child grows.  Our clinical protocols are designed for the best outcomes in mind for each patient.


About the STARscanner

Level Four Orthotics and Prosthetics utilizes state of the art imaging and data collection to obtain the best outcomes for every family.

The STARscanner is an effective and trusted system, used by leading practitioners and children’s hospitals since 2001 to provide the fastest and most accurate head-shape data collection in the industry. The STARscanner utilizes Class I eye-safe lasers, takes less than 2 seconds to complete, and eliminates the need for the traditional and sometimes traumatic plaster casting when ordering a custom headband for your baby. The STARscanner’s software produces detailed reports with measurements that help determine a patient’s severity of deformational plagiocephaly and the need for cranial remolding orthosis treatment. These scan reports also provide an analytical comparison of the patient’s head shape changes and are a more accurate form of documentation than traditional photography and manual measurements.

The STARscanner was the first scanning system to receive approval from the United States Food and Drug Administration (FDA) for use in capturing infant head shape data. The STARscanner is classified and cleared by the FDA as a Class I laser-scanning device because it emits very low-power laser energy. Other examples of Class I laser products include laser printers, CD players and CD-ROM devices. Many other scanning technologies, however, are Class II, which means their lasers are stronger and may not be as safe for infants.

The STARscanner remains the only scanning technology that has a published clinical paper that proves the efficacy of treatment for both the scanner and STARband cranial remolding orthosis.


STARscanner Benefits: 

  • Replaces the traditional plaster casting process
  • Scanning process is eye-safe and takes less than two seconds to complete
  • Software reports detail head shape measurements and calculates craniofacial indices including volumes, symmetry ratios, circumference, and linear measurements
  • Measures efficacy of cranial remolding orthosis treatment by documenting outcomes for physicians and parents
  • Documents effectiveness of physical therapy and repositioning efforts
  • Produces three-dimensional documentation of pre and post-operative head shape changes
  • Provides insurance companies with specific measurements, information, and quantitative outcome analysis


About the STARband

Since receiving 510k clearance from the FDA in 2000, more than 50,000 infants have been treated with the STARband. The STARband is the most widely used cranial remolding orthosis in the world.

The STARband cranial remolding orthosis redirects head growth to improve proportion and symmetry and derives their name from it’s purpose—Symmetry Through Active Remolding. The STARband is designed to provide total contact over the prominent or bossed areas of the baby’s head to discourage additional growth. The inside of the band is modified to provide extra space over the areas of the head where growth is needed. The baby’s rapid head growth, especially during the first year of life and the shape of the band direct growth into the areas of least resistance and create a precise pathway for growth to occur. As your baby’s head shape improves, the practitioner will make adjustments to further accommodate these improvements.

A wide variety of STARband patterns and color options are available  for parents to choose from (to view options, download pdf).  Please note there is no additional charge for this customization, and availability of transfer pattern designs may be subject to change.



Please see our Patient Forms Library for more information on tummy time, STARband treatment and studies supporting appropriate use and success with the STARscanner and STARband treatment.

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