Many orphan children come home with misshapen head and have to go through “helmet therapy.” Can you explain why this occurs?

Thank you for your question. I take it to mean that you are seeing many children with heads, which are asymmetric. This is not necessarily a problem but it is a common complaint for the practicing pediatrician.

When the AAP (American Academy of Pediatrics) recommended that all children sleep on their back, a lot of children spent most of their time on their back day and night and the gravitational force on the skull forced their heads to flatten in the back. This does not happen in all children but of course children who internationally adopted are a higher risk for just being left on their backs all day long.

Many times flattening of the head can be due to a neck problem and if that is taken care of with physical therapy, this problem resolves.  This can be caused by trauma during delivery; this usually should be easily diagnosed by a pediatrician. Almost all international adoptees benefit from early referral to physical therapy so this is not usually a problem.
Patients who do not respond to change in positioning, are/or are too old to be effectively treated by positioning, and have a significant asymmetric skull may benefit from a referral to a specialist in this area these tend to be the craniofacial surgeons or neurosurgeons.
The use of helmet therapy for this problem is still controversial whether it is helpful since the majority of children seem to get better even if conservative therapies are done and as they start to move around and the pressure is removed from their skull.

All of these therapies depend on having a compliant parent and depend on the age of the child.The use of helmets is an interesting question in studies it seems that cosmetic result is at least as good in patients who are managed by positioning if the children are young and the deformity is mild to moderate. If the deformity is severe and the child has failed conservative therapy or the patient is older then the helmets have their place.
Children may also be referred rarely for surgery if the deformity is recalcitrant to treatment or is due to an abnormality in the growth of the bones. This usually is detected by the pediatrician.

Hopefully this has been helpful the following reference is available free on the internet and talks in detail on the position of the AAP on the subject.

James Reilly MD

Prevention and Management of Positional Skull Deformities in Infants PEDIATRICS Vol. John Persing, MD, Hector James, MD, Jack Swanson, MD, John Kattwinkel, MD, Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery
112 No. 1 July 2003, pp. 199-202