I often see kids around my hospital wearing orthotic helmets, designed to make their heads more round (some of them ex-preterms), and I often wondered if they really work. A new RCT from the Netherlands shows no effect . Renske MvW, Leo AvV, Catharina GMG-O, Catharina PBVdP, Maarten JI, Magda MB-B. Helmet therapy in infants with positional skull deformation: randomised controlled trial. BMJ. 2014;348. A multicenter RCT randomized 84 infants to helmet or no helmet. No differences in the outcomes were found at 24 months of age on a blinded evaluation. The improvement scores in the 2 groups were identical and about 1/4 of infants had ‘complete recovery’ in each group.

The inimitable Richard Lehmann discusses the article on his blog; as he notes :

 The investigators argue that this shows that helmets are a useless encumbrance. They cannot be the “helmet of salvation” famously alluded to by St Paul the Apostle. Ah, but not so fast, reply the advocates of baby headwear in the Rapid Responses. Can you guess their arguments? Yes, that this study proves that skull deformities persist, so more not fewer treatments are need. Parents should flock to clinics like their own to be assured of better fitting-helmets. And the helmets need to be fitted in the first weeks of life. You have this on the authority of (inter alia) Timothy R Littlefield , MSEng, Vice President, Research and Regulatory Affairs, Cranial Technologies, Inc., Tempe, Arizona, USA.