We tried the medium on a 3-year-old, and the sizing seemed about right with plenty of room for her hair. The adjustable ties make it easy to change the fit, and the safety loop does a good job of keeping the ties contained. We didn't notice any pressure marks from the band.The biggest challenge for us was simply keeping it on. She didn't want to wear it for very long, and the bonnet tended to gradually slip backward. Tightening the ties helped it stay in place longer, but the silk itself is naturally slippery, so eventually it still wanted to move. That's going to depend a lot on the child, since some kids will tolerate sleeping in a bonnet much better than others.The silk is smooth enough, but it isn't quite as soft as I expected from a 100% silk product. There's also a very slight rustling sound when it moves. Construction and stitching look good, although overall it doesn't have an especially substantial or premium feel.We hand washed it without an issue. We didn't try wearing it reversed, so I can't comment on that feature.Overall, the bonnet itself is well made, adjustable, and comfortable enough. The bigger question is whether your child is old enough to understand why they're wearing it but still willing to keep it on while sleeping. For our 3-year-old, that proved to be the harder part.