Back is Best

The Safe to Sleep campaign (formerly known as Back to Sleep) was launched in 1994 by the American Academy of Pediatrics, which recommended that parents put their babies to sleep on their backs in order to reduce the occurrence of SIDS (Sudden Infant Death Syndrome). This recommendation was made based on physiological evidence and lower rates of SIDS cases in other countries where this was practiced more often. Since then, the incidence of SIDS has decreased more than half!

However, babies sleeping and laying on their backs for prolonged periods of time inevitably leads to more instances of developing flat spots. This is obviously a much better trade-off than SIDS, but it is an issue that can cause problems later in life. Although no evidence has been found linking a misshapen head to brain, vision, or hearing impairment, other concerns must be taken into consideration: jaw misalignment, hat/helmet fit, wearing glasses, facial asymmetry, etc.


At Elijah’s 3 month appointment, his pediatrician noticed his flat spot. It was mostly due to him always favoring one side when he slept and a slight case of torticollis (tightening of muscles in the neck which can restrict range of motion). She referred us to Cranial Technologies to get his head evaluated. I really didn’t want my son to be one of those babies who had to wear a helmet. I didn’t want him to have to endure months of discomfort (although most babies get used to it after a few days). I didn’t want to have to possibly spend thousands of dollars on the helmet. And I didn’t want people to see him wearing the helmet and assume that there was something wrong with him.

Where did this stigma come from? Why do people associate headgear on children with mental disabilities?

I did extensive research on helmet use in children. I read about studies that indicated that there was no evidence that helmets actually improved head shape. Others said that over time, especially once the baby is mobile, the baby’s head will round out naturally by 18 months of age. Our pediatrician said in order for the helmet to work the most efficiently, it should be fitted before 6 months of age. So, I put off taking him to be evaluated and took it upon myself to make sure he spent as little time on his back as possible, when awake. I also tried to re-position him when he was sleeping, on the side of his head that he did not favor.

At his 6 month appointment, his pediatrician said that the flat spot had significantly improved but that she believes he would still benefit from wearing a helmet.

As his mom, I felt like I had failed him.

We took him to get his head evaluated, holding out hope that there was still a chance that the specialists would tell us that his case was so mild that no intervention was necessary.

After his evaluation, we were told that he has a moderate case and that he would need to wear the helmet for ~3 months. I asked if it was possible that his head shape would resolve itself over time and was told that it most likely wouldn’t get worse, but it probably wouldn’t completely fix itself. I knew that even if there was a chance, once he got old enough for us to know for sure, it would be too late to correct. We did not think that was worth the gamble.

Insurance Coverage

The next step was figuring out if insurance would cover the costs. The full price of the helmet is $4000. Cranial Technologies has a deal with our insurance company where we would only have to pay $2500 out of pocket if it wasn’t covered. If it was covered, we would pay $250. Which price we would be paying depended solely on whether or not there was an exclusion for helmets in our insurance plan.

A few weeks later, we got the call that the helmet would NOT be covered by insurance because it was considered an aesthetic treatment. Needless to say, my husband and I were not very happy about this news. It seemed ridiculous to us that the insurance company could justify that we were putting him through this treatment just for looks.

After getting this news, I scoured the internet forums for any options we had left to get coverage for his treatment. Some people suggested appealing, while others said appeals were typically fruitless if an exclusion was spelled out in the plan. One person mentioned that the exclusions are specific to the employer’s agreement with the insurance company and that they were successful in getting coverage after contacting their HR department. I figured it was worth a try and emailed my HR representative. She forwarded the email to the Benefits group, and they said they would look into the matter and get back to me. I didn’t hear back from them after a week and figured that was a dead end. However, 3 weeks later, I received an email stating they had reviewed the case and will make an exception and cover the treatment. The insurance company paid $3600 of the $4000 total, which was a huge help.

If your insurance is denying you coverage, contact your employer’s HR department and see if they can make an exception!


At his 3 week checkup, they saw a lot of progress on head growth. He’s been working hard growing that noggin and he may be able to get it taken off sooner than expected. They say that he will only need to wear it another 4-6 weeks!

See the final before & after comparison here!


  1. Regarding SIDS in Germany and Finland they do not see any connection any longer regarding to the sleeping position. We had kids on both countries and it was adviced to let the kids sleep however they want. The studies which are applied here for SIDS is connected more to too high temperatures (too thick blanket, too thick clothes etc) and also to suffocated due to blankets coming over the head. Nathan who was born in Finland in February barely ever wore clothes in the first months besides his diapers and a body, and for the nights just a very thin sleeping bag as the babies can’t regulate the temperatures yet.
    Here in Germany a friend had at the same time a child as we had this year. She is also Chinese and her mother forced her to let the boy sleep always on his back (you know, sign of beauty to have a flat back of the head in China…). Well doctors weren’t too happy about it as he developed a flat spot as well, thankfully those helmets are covered 100% in Germany by insurances so they did not have the troubles you had thus far.
    All the best for your child! Our friend’s son has a perfectly round head once again (that is till he will be couple of months in China in a few days…)

    • That’s very funny that you mentioned how many people in China value a flat head. This is very true, especially in the North. I have a flat head, and so does the entire side of my mom’s family. My grandmother actually commented on how silly my brother’s round head was. My flat head never affected my brain development or intelligence (as far as I know), but it does make wearing hats, helmets, and eyeglasses very difficult. It’s also less noticeable on me since I have long hair.

      That’s great that the helmets are covered by insurance in Germany! For some reason, many insurance companies in the U.S. consider it to be “aesthetic” when it is actually a medical need.


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