Pediatric Skull Clamp: Head Fixation in Infants and Children, Pins and Alternatives

Why paediatric head fixation is different

In infants and young children the skull is thin, sutures and fontanelles may still be open, and bone thickness varies from place to place. Excessive or uneven pin force can penetrate the inner table, cause a fracture or an epidural haematoma. The consequences of slippage are also different, because a small head can move quickly in a large clamp.

For these reasons paediatric head fixation requires pins and force settings designed for children, a clamp that opens to a suitable size and a team that follows age-specific guidance. Adult settings must never be assumed to be safe for a child.

Pin pressure limits and paediatric pins

The permitted pin force for a child is lower than for an adult and depends on age and bone quality. Always read the manufacturer's instructions for use of your clamp for the force range, the pin positions and any age limits, and use the force-adjustment tool supplied. Do not rely on feel alone.

The DORO Multi-Purpose Skull Clamp is designed for all ages, from newborns to seniors. Its universal set includes adult and paediatric pin holders, gel head and ear rings and an adjustable trio gel pad, and an optional 90 N torque screw gives finer control of lower pin forces. Mayfield pediatric pins from other manufacturers exist and can be assessed with the same questions about force control and compatibility.

It is also worth setting a written protocol for pin-force verification in children, with a second team member confirming the setting, so that the check does not rely on one person.

When not to use pins: head fixation in infants

In very young infants many surgeons avoid pins entirely and use a non-invasive set-up. Head fixation in infants is then achieved with gel pads and a horseshoe or combination fixation that supports the head without penetrating the skull. The DORO Multi-Purpose clamp allows a non-invasive set-up on gel pads, rigid pin fixation or a combination.

The age at which pins become acceptable is a clinical decision and varies by surgeon and institution. Having both options in the theatre means the team is never forced to choose the wrong tool.

Pediatric horseshoe headrest

A pediatric horseshoe headrest cradles the head on a gel pad and is the usual non-invasive option. The DORO Horseshoes put adult and paediatric gel pads on the same base, with adjustable base width, vertical and lateral adjustment, and easy-to-remove, cleanable pads. Radiolucent, carbon-tabletop and ENT versions exist.

The risk shifts from skull injury to skin and eye pressure, especially in the prone position, so check the face and pressure points often. For more detail see the horseshoe headrest guide.

• Infants: non-invasive gel pad set-up is commonly preferred
• Children: paediatric pin holders with torque-controlled force, as per IFU
• Teenagers: adult-size set-up may be acceptable, depending on bone and the surgeon's decision
• All ages: document the set-up, force and pin sites

Equipment checklist for a paediatric neurosurgery service

Stock paediatric pin holders and pads, the torque tool, spare pins, and a horseshoe with paediatric pads. Train the whole team in the specific steps, and keep the instructions for use in the theatre. Review incidents and near misses. For the broader safety review see skull clamp safety and complications.

Plan the stock around your case mix: a unit that treats few infants still needs the non-invasive set ready on the shelf, since these cases are often urgent.

Beckfinity supplies DORO head fixation, including paediatric options. Contact us to plan equipment for your paediatric theatres.