Purchased for a child with flat head syndrome. It has been used, but I think it's relatively clean. I use Sarasa detergent. Includes: Two (2) main units (memory foam) Four (4) covers This is a used item, so please purchase only if you are okay with that. Packaging will be simple, so please understand. Returns are not accepted. #MitsukoBabyPillow #MitsukoFlatHead #MitsukoPositionalPlagiocephaly #MitsukoDonutPillow #MitsukoHeadTurnPreference