The first helmet fitting takes place about 1-2 weeks after surgery, once the incisions have healed enough to allow for safe wear. This timeline is important because early intervention ensures that skull growth is guided from the start, preventing deformities from developing.

During the initial fitting:

• A cranial orthotist (a specialist trained in cranial helmets) will take precise 3D measurements of your baby’s head.
• A custom-fitted cranial molding helmet will be designed to guide growth in the correct areas.
• You will be instructed on how to properly place, remove, and clean the helmet, as well as what to expect in terms of adjustments and follow-ups.

The first few days are a transitional period during which babies gradually increase their helmet-wearing time. Most infants adjust quickly and tolerate the helmet well, especially since it is lightweight, comfortable, and custom-fitted.

To achieve the best outcome, babies should wear the helmet 23 hours per day, removing it only for:

• Bathing
• Cleaning the helmet
• Skin checks (to ensure there is no irritation or redness)

The helmet does not squeeze or reshape the skull with pressure. Instead, it provides a guiding structure, allowing the skull to grow into the areas where space has been created.

Because babies grow rapidly, regular helmet adjustments are necessary.
Follow-up appointments with the cranial orthotist are typically scheduled:

• Every 2-4 weeks in the first few months
• Less frequently as skull growth slows

At these visits, the orthotist:

• Checks head growth progress
• Modifies the helmet to ensure proper guidance
• Addresses any fit concerns

You will also have periodic follow-ups with the craniofacial surgeon to monitor the overall surgical outcome and ensure the skull is growing as expected.

The duration of helmet therapy depends on the age of your baby at the time of surgery, the type of suture used, and the rate of skull reshaping; however, most babies wear the helmet for 6-12 months:

• Younger infants (2-3 months old at the time of surgery) may require longer helmet therapy because their skulls have more growing to do.
• Older infants(closer to 4-5 months old) often complete therapy in a shorter time because their skulls grow at a slightly slower rate.
• The helmet is discontinued once the desired head shape is achieved and skull growth slows naturally (usually around 12-18 months of age).

At first, helmet therapy may feel like an adjustment, but most babies adapt quickly and do not seem to mind it. Parents, however, often have concerns about comfort, fit, and whether their baby will be bothered by the helmet.

Here’s what to expect:

• Most babies adjust within a few days and do not show signs of discomfort.
• Helmets are lightweight, well ventilated, and designed to keep babies cool.
• There is no pain involved—helmets guide natural growth rather than applying pressure.
• Daily cleaning is essential to prevent irritation from sweat and oils.
• Skin redness may occur but should fade quickly after removing the helmet for cleaning.

Parental commitment to helmet therapy is one of the most important factors in achieving the best results.

Staying consistent with wear time and follow-up visits ensures that the skull grows symmetrically and evenly, avoiding the need for additional interventions.

If the helmet is not worn as prescribed, the skull may not reshape properly, leading to:

• Residual skull asymmetry (which may be permanent)
• Less effective correction of the craniosynostosis
• Potential need for additional procedures later in childhood
  

Since the goal of endoscopic suturectomy is to allow for natural skull reshaping, missing helmet therapy may result in incomplete treatment.

This is why parents play a critical role in ensuring their child gets the full benefits of surgery.

The primary goal of endoscopic suturectomy is to allow the skull to grow in a more natural shape while avoiding the more invasive nature of open surgery. Since helmet therapy guides this process, the final results are typically:

• Smooth, symmetrical head shape with improved proportions.
• Reduced forehead or back-of-head flattening, depending on the type of craniosynostosis.
• Better overall skull balance, with natural rounding over time.
• For most children, the head shape continues to improve gradually over the first two years of life, as growth slows and the skull takes on its final form.

It’s important to note that while helmet therapy helps achieve excellent results, perfection is not always the goal. Some children may still have slight asymmetries, but these are usually mild and not noticeable to others. In rare cases, if the reshaping is incomplete, additional treatment may be considered later in childhood.

One of the biggest concerns parents have is whether craniosynostosis or its treatment will impact brain development. Fortunately, studies show that when treated early, children who undergo endoscopic suturectomy develop normally, with no negative impact on intelligence, learning, or neurological function:

• The procedure removes the fused suture, allowing the skull to grow without restriction.
• There is no interference with the brain itself, as the surgery is performed only on the outer bone.
• Long-term research has demonstrated that children who undergo early treatment for craniosynostosis exhibit similar academic and cognitive development outcomes to their peers.

However, if craniosynostosis is left untreated, it can sometimes lead to increased intracranial pressure, which may contribute to headaches, vision problems, or developmental delays. This is why early diagnosis and treatment are so important—they help ensure healthy skull and brain development with no long-term concerns.

For most children, one surgery is enough, and no further treatment is required. However, in a small percentage of cases (about 5-15%), additional surgery may be considered if:

• Helmet therapy was not followed correctly, leading to incomplete skull reshaping.
• The skull fuses in an unexpected way, limiting growth.
• New areas of flattening develop, requiring minor adjustments.

When additional treatment is needed, it is usually less invasive than a full cranial vault reconstruction. In some cases, minor adjustments can be made using a second helmet, bone grafting, or a small corrective procedure later in childhood.

However, with early intervention and proper helmet use, most children achieve excellent results with just one surgery.

Parents who choose endoscopic suturectomy often report high levels of satisfaction with their child’s results, especially because of the minimally invasive nature of the procedure. Some of the most commonly mentioned benefits include the following:

• Smaller scars that heal quickly and are barely noticeable over time.
• Shorter hospital stay and faster recovery compared to open surgery.
• Less swelling and discomfort after surgery.
• Excellent long-term head shape with helmet therapy.

The biggest challenge parents report is adapting to helmet therapy in the months following surgery. However, most families say that seeing the gradual improvements in their child’s head shape makes the commitment worthwhile. For parents who stay diligent with helmet use, the results are often just as good—or even better—than those achieved with open surgery.

After the helmet therapy phase is completed, most children only require routine follow-up visits with their craniofacial team to monitor skull growth over time:

• By 18-24 months of age, helmet therapy is typically discontinued, and the head shape is considered stable.
• By preschool age, most children show no visible signs of having had craniosynostosis, and their development is completely normal.
• In rare cases, minor refinements to the skull shape can be made later in childhood, but this is uncommon.

There are no long-term activity restrictions—children who have undergone endoscopic suturectomy can play sports, swim, and do everything other kids do. The skull bones fully heal and develop just as strong as any other child’s, meaning there is no increased risk of injury.

Endoscopic suturectomy is much less invasive than cranial vault remodeling, meaning blood loss is minimal and the need for a blood transfusion is rare. However, as with any surgery, there is still a small risk of bleeding, especially since the skull bones contain many tiny blood vessels.

To minimize this risk, surgeons use advanced techniques to control bleeding, including cauterization (sealing blood vessels during surgery) and bone wax (a specialized material that helps stop bleeding in bones). If bleeding occurs after surgery, it is usually minor and resolves on its own, but in extremely rare cases, a follow-up procedure may be necessary to address it.

Any time a surgical incision is made, there is a risk of infection, though this is very uncommon with endoscopic suturectomy.
The incisions are small and heal quickly, significantly reducing the chance of bacteria entering the surgical site.

To further lower this risk:

• The surgical team follows strict sterile protocols during the procedure.
• Babies receive a short course of antibiotics before and sometimes after surgery.
• Parents are given detailed wound care instructions to keep the incision sites clean at home.

Signs of infection include:

• Redness, warmth, or swelling around the incisions
• Fever (above 100.4°F or 38°C)
• Pus or unusual drainage from the surgical site
• Irritability or excessive sleepiness

If any of these symptoms occur, you should contact your doctor immediately, as early treatment with antibiotics can quickly resolve the issue.

The dura is the thin, protective membrane that covers the brain. During surgery, the surgeon takes great care to avoid injuring the dura, but in rare cases, a small tear can occur. If this happens, cerebrospinal fluid (CSF) surrounding the brain may leak.

This complication is uncommon, and in most cases, small tears are repaired during surgery using a special sealant. If a CSF leak is noticed after surgery (e.g., fluid leaking from the incision), the surgeon may recommend a short hospital stay for observation or, in rare cases, a minor procedure to seal the leak.

Endoscopic suturectomy relies on natural skull growth and helmet therapy to achieve the desired results.
If helmet therapy is not followed correctly, the skull may not reshape as expected, leading to:

• Residual head asymmetry
• Uneven skull expansion
• A need for additional procedures later in childhood

To prevent this, it’s essential to stay consistent with helmet use (23 hours per day) and attend all follow-up visits with the orthotist and surgeon. If the skull is not shaping properly, minor helmet adjustments can usually correct the issue before it becomes a long-term concern.

Observe your baby’s head shape and symmetry—does it seem unusually elongated, flattened, or misshapen?

• Bring up concerns with your pediatrician as soon as possible.
• Request a referral to a craniofacial specialist for further evaluation.
• If needed, ask about imaging tests (CT scan or ultrasound) to confirm the diagnosis.

• Discuss treatment options with a craniofacial surgeon and ask if your baby qualifies for endoscopic suturectomy.
• If your baby is under 3 months old, schedule surgery as soon as possible to keep endoscopic options open.
• If your baby is older than 6 months, consult with your doctor about cranial vault remodeling and its benefits.
• Ask detailed questions about surgical risks, recovery, and expected outcomes.

• Schedule a helmet therapy consultation before surgery so you’re prepared for the post-op phase.
• Plan for helmet fitting within one to two weeks after surgery to ensure proper skull growth guidance.
• Stay committed to helmet wear (23 hours per day) and attend regular adjustments with the cranial orthotist.
• Keep up with follow-up visits with the surgeon to track skull growth and progress.

• Prepare for a longer hospital stay (three to five days) and initial swelling, which is normal.
• Follow post-op care instructions to keep incisions clean and monitor them for signs of infection.
• Attend routine follow-ups with the surgeon to ensure proper skull healing.
• No helmet therapy is required—your child’s skull reshaping is complete after surgery.

• Celebrate the end of the journey—most children require no further intervention. 
• If your child has small scars, apply gentle scar creams or massage techniques as recommended by your doctor.
• Monitor head growth during routine pediatric visits to ensure everything continues developing normally.
• If any concerns arise later, reach out to your craniofacial specialist for guidance.