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

Baby Boot Camp: The Importance of Tummy Time

Tummy time promotes development, strength, and a new visual perspective for your baby. Growing babies require many hours of sleep, which means your baby spends a large amount of time on his or her back to maintain a safe position while sleeping. Tummy time is pivotal during waking hours to strengthen the head, neck, and shoulder muscles and promote head control. Tummy time also gives your baby a fresh new perspective on the world as they can interact with toys and reach for objects in the environment. Tummy time is fundamental to your baby’s development and builds skills that promote later milestones of rolling over, crawling, and playing.

Getting started with Tummy Time

Tummy time can be started at any age, it is even recommended for newborns! Tummy time should always be a supervised activity. Gradually introduce your baby to tummy time by placing them on your stomach or chest in a reclined position such as laying on the couch. This allows your baby to continue bonding and interacting with you and may help them tolerate this new position. Start with short intervals on a safe and firm surface, such as the floor, for two to three minutes per day. You can progress up to 20 to 30 minutes of tummy time per day depending on your baby’s tolerance. Aim for tummy time at a time of day when he or she is alert, such as after nap time. Remember to always pay attention to your baby’s needs and look for signs of tiredness, such as crying or laying their head down on the floor.

How can I promote a successful tummy time experience?

  • Provide extra support with a bolster
    • Try rolling up a thin towel or blanket to make a bolster
    • Place the bolster under your baby’s chest with his or her arms positioned over the roll and hands in front
    • Always keep your baby’s chin in front of the roll to ensure their airway remains open
  • Promote weight bearing
    • Make sure your baby distributes his or her weight to both sides of the body in order to equally strengthen
  • Promote reaching for play
    • Get down on the floor with your baby to promote engagement and motivation
    • Hold a toy in front of your baby to encourage head control and reaching
    • Place toys in a circle around your baby to promote reaching in all directions
  • Try out other positions
    • Side-lying: Lay your baby on his or her side and support their back with your hand or a rolled towel. Place your baby’s arms out in front to promote reaching and play in this position.
    • Airplane: Lay down and hold your baby in your arms while he or she is on their belly. This a fun and motivating new perspective for babies with head control.
  • Make tummy time a routine
    • Incorporate tummy time during everyday tasks such as diaper changes, songs, toweling off, or reading a book.
    • Try burping your baby with him or her laying across your lap on their tummy
  • Make it a multi-sensory experience
    • Use a visually stimulating blanket or towel
    • Try placing your baby on a variety of textured blankets or mats
    • Use a mirror to motivate your baby to lift his or her head to see their reflection and encourage self-recognition
    • Alternate between various safe surfaces in your home such as carpet, tile, or wood

What are red flags to look out for? 

  • Pay attention if your baby shows a head preference. For optimal development, your baby should look to both sides equally. Does he or she have a strong preference towards one side?
  • Does your baby have difficulty weight bearing on one side of the body? For development, it is important that your baby strengthen both sides of the body and weight bear equally through both hands and arms.
  • Does your baby have a flat patch on the side or back of the head? Is your baby’s head asymmetrical? Flat patches may develop due to a strong head preference or increased time spent on their back.

If your child is demonstrating some of the observations above, consider contacting one of our occupational therapists or the Illinois Early Intervention system for more information.

Questions or concerns?

If you have questions or concerns about your child, please contact us at info@playworkschicago.com or 773-332-9439.

Robyn Geist, MS, OTR/L
Occupational Therapist

Reference: Pumerantz, Christa & Zachry, Anne (2018). Tips for living life to its fullest: Establishing tummy time routines to enhance your baby’s development. American Occupational Therapy Association.

Photo Credit: Moswyn via iStock.com