Saturday, May 28, 2022

Dermatitis and plagiocephaly summary

Nerida Warren

Dear all,

Here is a posting of the responses I received to my query about dermatitis

and plagiocephaly. Thanks again to all who replied.

Nerida Warren, Orthotist

Princess Margaret Hospital for Children

Perth, Australia


What is the helmet liner made of? Was it possibly cleaned w/ any chemical or

strong soap that left a residue? We use thick Pelite, and I have fit

approx. 35 Deformational Plagiocephaly helmets, and have followed up many

more than that and have not encountered this problem. The helmets have a

very large hole at the top, perhaps 3 1/2 inches and several small 1/8 inch

holes around the side for limited air


Steve Baum, C.O.

Rehabilitation Technology and Therapy Center


What type of lining are you currently using, and is the top of your helmet


Scott Saunders


what kind of padding did you use?

I have had prolems on occasion with plastizote

rneider co


Yes we have experienced some infants with the same reaction. We use

several layers of 1/8 inch aliplast to create a reverse onion affect so we

can remove layers in the flattened area so only one cast is necessary.

Dr.Clarren described this technique in his original paper on plagiocephaly.

We have done two things to help the babies with this reaction. Sometimes we

line the helmet with moleskin. It makes future adjustments difficult and

time consuming, but it works. Also, we have tried using either surlyn or

optivack(sp) with out any linning and have fit the clear helmet. You could

also suggest using pure corn starch (just a dusting ) both inside the helmet

and on the babies head.

Jim Wynne,CPO


In cronic dermatilogical cases, we have not found any liner to work well. We

have opted for a stockingnette type sock interface to be worn and washed

daily. The helmet is drilled with 3mm air holes. As many without losing

structural integrity.

John Hattingh CP


Hi! In response to problem with dermatitis reaction in your little patient.

Living in a hot country certainly poses some unique problems! I live in

South Africa, so can sympathize with you. About the only thing I can

suggest, is to put as many holes in the helmet as possible while still

maintaining its strength. You can also try making up a

soft inner cap from a toweling type material that the parents can remove &

wash on a regular basis. If the child has a lot of hair, then the dermatitis

is not usually so much of a problem. I used to manufacture special helmets

for CP. kids, but they were generally older & I was living in a cooler part

of the country at the time, so didn’t have as much trouble. If you can base

your design on a bicycle helmet you should also improve your air-flow to the

head a bit more.

Sean Thorncroft


I was wondering if it was simply a reaction due to heat and sweat, then have

you tried making a “head sock” out of cotton or something? As how with

afos, etc, we recommend that if this is a problem like this, that they wear

an absorbant sock and change them when necessary. I would imagine that it

would be easier to make them so that they fit over the inside of the helmet

rather than directly onto the childs head (a bit like an upside-down shower

cap) maybe with openings for the chin straps. Make a few so that they could

be changed when necessary, and washed.

Alison Stewart


I use Therafoam from American Plastics -800.772.7401 (i.e. UCOPlast #4, from

UCO International- 800.451.4030). This material is well documented as

hypoallergenic (but I still have had to change to Plastazote on two of my


Patrick K. McNally, CPO

Chief, Orthotics & Prosthetics

Arkansas Children’s Hospital


I have never experienced that type of problem after doing 200 babies. Tell

parents to wash inside of helmet everytime they bathe the baby and if they

go out in the sun to put a hat on him and if you did not put ventilation

holes in the helmet.

Bill Barringer, USA


>From what did you make the helmet? I have experienced this problem on a

rare occasion or two. Before resigning to the fact that it is the heat,

which is possible, a thorough examination of the material choices, adhesives

used, pressures applied, and perhaps any thinners or soaps used to clean the

helmet is necessary.

We have had to utilize or eliminate liners in the past and had to change the

plastics used.

Rob Kistenberg, CP, LP, FAAOP


UT Southwestern

Prosthetic Orthotics Program


The key is bathing every day sometimes twice a day and the most critical

area to clean is the inside of the helmet. Once must also rinse thoroughly.

As for a liner a simple cotton sock will do nicely. But again it must be

change at least once a day and all the clean is still required. A 1 or 2

ply Transfemoral soft sock will also work nicely. Just cut out the areas

you don’t want covered.

Bob Brown, Sr., CPO, FAAOP


Regarding the dermatitis that your patient developed: I guess I should ask

you if you do use a liner or not and what type?

I have been doing the plagiocephaly head orthosis since 6-7 years and I met

few babies that had a skin reaction either with perspiration or allergies.

I did change the liner with medium pelite pad and it did help a lot. I think

you should also have a very close follow up on your cases. I do see the kids

every 2 weeks to make sure that the helmet still fit properly or any

difficulties. It also gives you the chance to see any progress or adjustment

for growing.

Nathalie Anglehart

Canadian Certified Orthotist

The Rehabilitation Centre, Ottawa, Ontario, Canada


I had one such experience. It turned out that the dermatitis was a reaction

to a change in medications being given to the child at the same time the

helmet was fit.

Tom Lunsford (Houston, Texas)



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