Congenital Muscular Torticollis: What is it and how can I help my child?

Infant smiling while laying on back

You may have heard the strange medical term “torticollis” from your pediatrician, neighbor, or friend. Frankly, it can be overwhelming and quite confusing to understand. In this post, we will review what torticollis is, reasons why babies may develop a torticollis, what parents can look for if they have concerns, associated impairments if left untreated, and tips on ways to prevent torticollis. 

What is torticollis?

The term torticollis is Latin for “twisted neck”. Congenital muscular torticollis (CMT) describes the posture of the head and neck caused by shortening or tightness of the sternocleidomastoid (SCM) muscle. This rope-like SCM muscle starts at the collarbone and sternum and inserts into the skull behind the ear. When this muscle contracts or is tight, it will cause the head to tilt towards the side of the muscle and rotate away from the involved SCM muscle. With this tightness, weakness on the opposite side of the neck may result. A torticollis is named for the side of the involved SCM muscle, either right or left.

What causes torticollis?

There is little agreement on what causes CMT. The most widely accepted theories include a difficult delivery requiring use of a vacuum or forceps and unusual positioning inside the uterus. Other risk factors for CMT include large birth weight, male gender, breech position, multiple birth, a primiparous (pregnant for the first time) mother, difficult labor and delivery, nuchal cord, and maternal uterine abnormalities.

What will a torticollis look like?

A baby with torticollis may present with the following: 

  • Tilt their head in one direction
  • Prefer looking at you over one shoulder rather than turning to follow you with his or her eyes
  • If breastfed, he or she may have trouble breastfeeding on one side or prefer one breast only
  • Have difficulty turning his or her head in one direction 
  • Some babies with torticollis will develop a flat spot on their head (plagiocephaly) caused by lying with their head consistently turned to one side
  • A small lump or “ropey” knot may also be felt in the neck due to a tight and tensed muscle. 

What can happen if a torticollis is left untreated?

An infant with CMT will be unable to have symmetrical movement of their head due to range of motion (ROM) and strength imbalances. If left untreated, associated impairments include jaw asymmetries, ear displacement, facial asymmetries, plagiocephaly, scoliosis (a curved spine), pelvic deformities and movement patterns that may affect normal development. 

What can you do?

If you have concerns that your child has torticollis or plagiocephaly, schedule an appointment with your pediatrician. Your doctor may teach you stretches and strengthening exercises to practice at home. They may also suggest taking your baby to a physical therapist (PT) for treatment. The skull is most malleable and with rapid brain growth during the first 3 months of life. This brain growth slows around 5-6 months. The sooner you address torticollis and plagiocephaly (especially before 6 months), the better and faster the outcomes!

While it is best for your baby to sleep on their back, incorporating various positions during supervised and awake playtime is great for strengthening his or her neck muscles. This includes tummy time, side-lying, and supported sitting. If your baby has a flat spot on their head, these positions can also help by relieving pressure off this area. You can do tummy time on the floor, on your chest, or even across your lap! Encourage your child to use their neck muscles to follow you or a toy with their eyes and head, especially turning their head to the side they least prefer. Start by working on this for 10-15 minutes total each day, gradually increasing as your child tolerates more. 

Another good way to encourage your baby to turn their head to their least preferred side would be to modify their room environment. This may include positioning their crib next to a wall rather than in the middle of their room. This will encourage your baby to use their weaker neck muscles to turn their head away from that non-exciting wall in order to look at whatever is interesting in their room. 

Questions or concerns?

If you have questions or concerns about your child potentially having torticollis or plagiocephaly, please contact us at info@playworkschicago.com or 773-332-9493. 

 

Elle Faerber, PT, DPT

Physical Therapist 

 

References: Campbell, S. K., Palisano, R. J., & Orlin, M. (2012). Physical therapy for children. Saunders. 

“Infant Torticollis.” Home – Johns Hopkins All Children’s Hospital, www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Infant-Torticollis. 

Photo Credit: Photo by Pexels at pixabay.com

Employee Spotlight: Rachel Weiser, MS, DT

What do you love most about working for PlayWorks Therapy?

I love the community PlayWorks provides. Every day I have the opportunity to learn new skills and tricks from my fellow coworkers and the families I work with.

What is your favorite children’s book?

I’m a big fan of anything by Mo Willems! I love his humor and the messages his stories provide.

What do you enjoy most about living in Chicago?

I love that there is always something to do in Chicago! Exploring new restaurants, going to a museum, I love being a tourist in my own city!

Would you rather a mountain or beach vacation?

This is tough for me! Both? My most recent favorite vacation was Grand Lake, CO featuring both a beach and mountains.

Share a proud “therapy moment” with one of your clients?

I was seeing a child with a gross motor delay. He was still learning how to walk. Through a motivating play scheme, I was able to see him take his first steps! It was a great moment!

What’s your hometown?

Deerfield, IL

What do you specialize in?

I specialize in social emotional development. I love helping families increase their child’s frustration tolerance and attention span to adult directed (structured) activities. I incorporate my knowledge from my previous teaching career to set my clients up for success for when they exit Early Intervention.

What do you do in your free time?

I love to do anything outdoors- especially when the weather is nice!

What is your favorite therapy toy?

I love Mr. Potato head! Mr. Potato encourage growth of symbolic play, concept knowledge, and turn taking!

What is your favorite Telehealth activity?

I love doing scavenger hunts! I will hold up colors or shapes and ask a child to find something in their home that is the specific color or shape I am holding up! It’s a great way to get the kids moving and work on following directions!

Share a fun fact about yourself:

I was an extra in the Muppets movie!

Rachel Weiser, MS, DT
Developmental Therapist

Employee Spotlight: Ana Burgoon

What do you love most about working for PlayWorks Therapy?

PlayWorks places such an emphasis on caring for the whole child, not just teaching a particular skill, which I have found to be critical in the field of speech and language therapy. Also, you can’t beat working with a team of competent, supportive, and compassionate individuals, such as the team here at PlayWorks.

What is your favorite children’s book?

Miss Spider’s Tea Party, by David Kirk.

What do you enjoy most about living in Chicago?
My favorite thing about Chicago is living close to Lake Michigan. I also love the big buildings, being able to walk so many places, and never running out of things to do.

What is your favorite childhood memory?

I have many favorite memories related to spending time with my grandma and grandpa. One that came to mind involved attempting ballet to the sounds of a wind-up music box in my grandma’s living room. I now have the music box on my dresser and think of those memories affectionately and often. My grandpa did a series of stretches every morning and when he came to visit, I would always do them by his side.

Would you rather a mountain or beach vacation?

I do sincerely enjoy hiking, but I have to go with beach overall. I recently enjoyed a trip to California, where I was lucky enough to do both!

A proud “therapy moment”:

On my third session with a child with autism, they spontaneously gave me the biggest hug! I believe it was because they felt supported and understood that I was going to help them communicate.

What is your hometown?

Grand Rapids, Michigan!

What do you like to do in your free time?
I love exploring Chicago with my husband, heading up to Michigan to spend time with my family, taking pictures, and anything related to being outside (when it is warm enough).

What is your favorite therapy toy?
I always enjoy doing crafts with the kids – glitter pens, stickers, markers. The possibilities are endless. You can scaffold the activities to target a variety of skill levels and treatment objectives.

A fun fact about me:

I am a certified small boat sailor!

 

Ana Thrall Burgoon, M.S., CCC – SLP 

Speech-Language Pathologist

Employee Spotlight: Kristen McManus

What do you love most about being an Occupational Therapist?

I love that occupational therapy is all about cultivating success in everyday activities. Occupations for us mean anything a person needs or wants to do in his or her daily life. For kids, their most important occupation is play! There is no better job than playing with children to help them learn and have fun!

What is your favorite children’s book?

My favorite would have to be The Giving Tree. I think it has such a beautiful lesson, and Shel Silverstein’s illustrations are so unique.

What do you enjoy most about living in Chicago?

As a Texan born and raised, Chicago was quite the change for me! I love the views of Chicago most, especially those of the skyline or river. It is such a beautiful city, whether covered in sunshine or snow.

What is your favorite childhood memory?

I fondly remember playing board games with my grandmother. She played harder games with me, such as Scattergories or Scrabble, and she always had so much patience. I certainly think this is why I love incorporating games into my sessions, and why I use that same patience with the kids I work with in therapy.

Would you rather a mountain or beach vacation?

I would pick a beach vacation without a doubt. I am a fan of warm weather, and I think the sights and sounds of the ocean are wonderful.

Share a proud “therapy moment” with one of your clients.

I am a strong proponent of learning the child’s own goals. One little girl with cerebral palsy wanted to learn how to brush her own hair. One little boy on the autism spectrum wanted to learn how to make himself a snack. Some of my clients on the autism spectrum want to have a best friend. Nothing makes me more proud than to help these children achieve what is important to them.

What is your hometown?

I was born and raised in Beaumont, Texas.

What do you like to do in your free time?

In my free time, I like exploring the city. My fiancé and I will often go to a new neighborhood and walk around for hours, trying new restaurants and shops. I also enjoy reading novels, taking boxing classes, scrapbooking and crafting, and playing board games.

What is your favorite therapy toy?

I love using pretend play food or picnic sets. They encourage great imaginative play skills, along with social skills and fine motor skills.

Share a fun fact about yourself.

I can play the alto saxophone.

Kristen McManus, MOT, OTR/L
Occupational Therapist