Earlier this week, Chrissy Teigen tweeted that her baby Miles was being "fitted for a little helmet".
"Don't feel bad for him," she told her fans, adding that the helmet will fix the six-month-old's "adorable slightly misshapen head," a condition known as plagiocephaly or "flat head syndrome." It can occur as a result of abnormal forces on the skull during pregnancy or after birth. Postnatally, it is usually the result of gravity - if a baby lies in one position for a long time.
baby miles getting fitted for a little helmet today for his adorable slightly misshapen head. so if you see pictures, don't feel bad for him because he's just fixing his flat and honestly he's probably gonna be even cuter with it somehow— christine teigen (@chrissyteigen) December 3, 2018
Teigen later shared an image of her little "baby bug", assuring her followers that he was "happy" after the fitting.
In response, she was inundated with photos of other babies in their customised helmets.
Had to share what a little craft paint and stickers can do! (and the helmets work wonders!) pic.twitter.com/GvBtCUlyO2— Amy Nichols (@amynichols) December 3, 2018
Henry loves his helmet pic.twitter.com/XRUwdFvp6I— Jennifer Allwine (@JenniferAllwine) December 3, 2018
My son had his for three months. It took some time to get used to but it made the world of difference for him. Took him out often and it was always a conversation starter. The artist did an amazing job to turn it from a “medical device” to a aviator helmet! pic.twitter.com/yXfJ8b45Up— Chris (@SmprShenanigans) December 4, 2018
But while many of Teigen's fans tweeted their support, the mother-of-two also received a backlash about using a helmet, which she later addressed. "Miles has been seeing a physiotherapist," she said. "We didn't just go straight to helmet ... Also your flat-headed kid turned out fine - yes yes yes, I agree."
Good morning trolls! Just a friendly reminder that you do not indeed know absolutely everything. Miles has been seeing a physiotherapist - we didn’t just go straight to helmet. We tried muscle work and will continue. Also your flat headed kid turned out fine yes yes yes I agree— christine teigen (@chrissyteigen) December 4, 2018
Just didn’t want you guys to see pictures and wonder. Not promoting anything. Just sharing our story! Thank you back to your bridge now.— christine teigen (@chrissyteigen) December 4, 2018
That Teigen's tweet received a mixed response on social media isn't at surprising, according to paediatric neurosurgeon Dr Adam Fowler. Dr Fowler explains that some degree of "positional moulding" is very common in bubs (particularly following recommendations for babies to sleep on their backs to reduce SIDS).
As a result, however, he says this also raises the question of what is and isn't pathological. It's further complicated by the fact that even among craniofacial experts, using helmets as a treatment for plagiocephaly remains controversial - and emotionally charged.
"Everyone wants a perfect baby," Dr Fowler says, noting that as true positional moulding has no neurodevelopmental implications, treatment is largely based on cosmetic issues. And, he continues, "there are large parental variations in what is considered 'good' as far as their bub's head shape is concerned."
According to Dr Fowler, Helmets are also expensive and require excellent parental and medical surveillance. "They're not a benign treatment," he says. "Each one is individually made and requires an experienced orthotist to mould." And because babies grow so rapidly, they usually need more than one helmet over the course of their treatment.
Research into helmet therapy has also garnered mixed results. A review of the evidence, published in Pediatrics in 2016 concludes: "When judging the totality of the evidence, it appears that currently accepted management of positional plagiocephaly in infants—using conservative therapy (repositioning and physical therapy) for the treatment of mild/moderate deformity in younger infants and reserving helmet therapy for more severe deformity, especially in those older infants who have failed to see improvement with conservative measures—can be justified by the data."
In english, please? According to Dr Fowler, more tummy time, making environmental changes like moving a baby's cot and physiotherapy often helps in the first instance, once other conditions are ruled out.
But there are some caveats.
"Evidence in favour of helmet use must be tempered by the lack of data regarding the extent of natural improvement of positional plagiocephaly, the long-term effects of helmet therapy (and of "untreated" plagiocephaly), and the costs associated with helmet therapy."
As such, Dr Fowler acknowledges that Teigen shouldn't have received the backlash she did. "It's one of those ongoing controversies in which difference of opinion thrives." And, he notes, if you're concerned about the shape of your baby's head, consult your GP, who will arrange for a specialist referral if required.