Custom Cranial Orthosis


Cranial remolding orthosis are frequently prescribed and are an effective treatment modality for infants who have an abnormal head shape/ skull deformity.

Skull deformities can be described as asymmetry in the shape, cranial vault or height of the baby’s skull or a disproportional relationship of the width to the length of the skull with accompanying abnormal features. Most skull deformities resolve in about 6 weeks after birth.

A newborn’s skull is highly malleable and rapidly expanding./ Any restrictive or constructive forces applied to a baby’s head can result in dramatic distortions. These deformational head shapes vary in severity and are classified as being mild, moderate or severe according to internationally accepted scales and treatment guidelines. We make use of state-of-the-art 3-dimentional scanning technology to accurately measure the dimensions of the cranium, diagnose and classify the severity of the deformity.
The infant skull doubles in size by 6 months of age and doubles again by 2 years of age. The fastest brain growth occurs between birth and 8 months of age. The best time to treat any skull deformities is between 4 – 6 months of age. Treatment of the skull deformities can still be done after 8 months of age, treatment will just be a little longer.

Causes of skull deformities include prenatal constraints/ multiple births, delivery process or method, premature birth, sleeping positions, lack of tummy time and torticollis to name a few. These skull deformities are not only cosmetic as the type and severity of the deformity can lead to developmental delays. Depending on the type and severity of the cranial deformity the babies hearing, vision, teeth and jaw can also be affected.

Different types of head shapes


Plagiocephaly is asymmetrical distortion of the skull due to prolonged pressure on the same area of the head. Plagiocephaly is often accompanied by torticollis. Torticollis is the shortening/ tightening of the sternocleidomastoid muscle in the neck.Torticollis is the third most common musculoskeletal anomaly in infants.

Plagiocephaly is the most common skull deformity with a 68% occurrence in males. It is also called “flat-head syndrome” where the primary deformity is posterior flattening of the skull with collateral forehead flattening. The position of the ears and facial features can also be affected. The dotted line in the picture represents a normal skull shape.


Brachycephaly is a disruption in proportion between the normal relationship of cranial width to length resulting from external forces to the central occipital region. This is the second most common skull shape deformity.

With brachycephaly the skull is short and wide with unilateral or bilateral posterior flattening. There will be an increase in the skull height and a decrease in the skull length. The child’s face will be wide and round with minimal impact on the ears. The dotted line in the picture represents a normal skull shape.


Schaphocephaly is when the width of the skull is decreased and the length is increased. This is known as a disproportional head shape where the sides of the head is flattened. This is not a very common head shape but does still occur. The dotted line in the picture represents a normal skull shape.

Cranial remolding orthosis (CRO)

The STAR (Symmetry Through Active Remolding) cranial orthosis from Orthomerica includes a range of five different designs.   Each design serves a different function depending on what the patients’ needs are.   These designs include the STARband side-opening, STARband bi-valve, STARlight side-opening, STARlight bi-valve and STARlight Pro side-opening. Orthomerica’s STARband cranial remolding orthosis are the most prescribed FDA-cleared orthosis in the world. The STARband orthosis have been used to treat more than 400,000 infants since 2001.

Each CRO is custom made for the patient to provide a gentle hug over rounded areas and to provide room for growth over flattened areas. This full coverage means full correction. The CRO’s are made on a “one-and-done” design, meaning that one cranial orthosis will be sufficient to provide full correction of the skull.

Malcolm Freedman and Charne Schoeman have successfully completed the STARband training courses are accredited by Orthomerica. We work closely with the Orthomerica STARband team to ensure the best possible outcome for your baby.

What can you expect during the cranial treatment plan?

Malcolm or Charne will do a thorough evaluation of your child, gather all the necessary medical history, and take clinical photographs/ scans/ measurements needed to outline the full cranial care program. 3D scans of the child’s head will be done with a FDA approved SmartSoc data acquisition system – the most accurate hand-held scanner available for cranial applications.

Once decided that your baby needs a CRO, a STAR design will be chosen. As each baby is individual and unique, a STARband cranial design will be chosen to best fit the baby and the family’s needs.

With the initial CRO fitting we will make any necessary adjustments and modifications to achieve the best possible fit.   Follow-up visits will be scheduled depending on the patient needs. During follow-up visits we will assess the skin condition and fit of the CRO.   We will continuously make the needed adjustments to maintain optimal fit and comfort.   Additional appointments can also be made to address any concerns or questions from the parents/ family/ caregiver.

The length of the cranial care program will be dependent on a variety of factors.   The best age to start treating a cranial deformity is four to six months as it captures the greatest natural growth of the infant’s skull.   This in turn decreases the wearing time of the orthosis.   In most cases the wearing time is three to four months and correction are obtained in just one CRO.   In older infants’ correction can also be achieved but wearing time will be longer before full correction is achieved.