In this post, we are going to discuss the strange term “torticollis,” how it can be impacting your infant, and how parents and physical therapists can help treat this and aid in your infant’s physical development.
What is Torticollis?
Congenital muscular torticollis(CMT) is a tightening of a muscle in the neck, called the sternocleidomastoid (SCM) muscle. The SCM muscle helps us move our head into lateral flexion/side bending to one direction and rotation/head turning to the opposite direction. Our right SCM helps us complete right head tilting and left rotation. Our left SCM helps us complete left head tilting and right rotation. Tightening or shortening of the muscle on one side of the neck may result in weakness on the opposite side of the neck. This can cause infants to hold their head in certain positions for prolonged periods.
What are Plagiocephaly and Brachycephaly?
This is also known as flat head syndrome. Plagiocephaly causes an infant’s head to have a flattened appearance on one side. Brachycephaly is flattening on the back of the head, resulting in a wide head.
How to know if your baby has torticollis and/or plagiocephaly:
- They keep head rotated to one direction
- They have a consistent head tilt to one direction
- They have flattening on the side or back of the head
- They have difficulty with tracking toys with their eyes and head to to both directions
- They will prefer to look at you over one shoulder rather than turning to follow you with their eyes
- If breastfed, they may have trouble breastfeeding on one side or prefer one breast only
- They may have a small lump or “ropey” knot felt in the neck due to the tight muscle
What causes CMT?
The exact cause of CMT is unknown. CMT may be present at birth or can be acquired during the first few months of life. There are a number of theories regarding the cause or incidence of CMT which include:
- Breech presentation or the fetus’s position in the womb
- Use of forceps during delivery
- Slightly more common in males
- Exposure to opioids in the womb
- Long body length
- Lack of space in the uterus, with multiple fetuses (twins, triplets, etc.)
Acquired CMT can be caused by:
- Trauma or injury to the neck
- Excessive reflux or GERD
- Vision problems
- Remaining in one position for prolonged periods
What causes plagiocephaly or brachycephaly?
These are caused by repeated pressure on one part of the head. This can occur before birth due to the fetus’s position in the womb. It can also be developed after birth if the infant’s head is repeatedly in the same position. Plagiocephaly and brachycephaly are more common with multiple babies, with a mother’s first pregnancy, or with premature infants, who have more pliable skulls.
How can we prevent CMT and/or plagiocephaly? What can we do at home?
Unfortunately, we cannot always prevent it. Luckily, there are a number of things we can do to aid an infant’s development, including:
- Plenty of tummy time (at least 60 minutes broken up throughout the day)
- Limited use of containers, such as bouncy swings/seats, jumpers, exersaucers, car seats, etc. (up 10-15 minutes 1-2 times per day). Container use will likely keep your baby’s head in the same position for prolonged periods.
- Varying positions that your infant is in (tummy time, laying on their side, baby wearing, supporting them in sitting)
- Modify the environment (i.e. crib location, changing table, play mat) so that the infant has to turn their head to the non-preferred side in order to look around the room towards the excitement
- Turn their head to the non-preferred side when they sleep or look around the room
- Alternating which side your child is breastfed on, to encourage them to turn their heads in either direction during feedings
- Encouraging your baby to turn their head in both directions by having them follow toys with eyes and head, especially to the non-preferred side
How to treat torticollis:
If you have concerns that your infant has torticollis or plagiocephaly, reach out to your pediatrician. They may recommend physical therapy and/or an evaluation for a corrective helmet. Early treatment (especially before 6 months of age) will often result in better and faster outcomes. According to the American Physical Therapy Association, there are 5 main components as the first-choice treatment for infants with CMT.
- Stretches
- Active strengthening
- Development of symmetrical movement
- Environmental adaptations
- Caregiver education
If torticollis is left untreated, infants can develop range of motion limitations in their neck, physical asymmetries, asymmetrical movement patterns, motor delays, strength imbalances, balance impairments, and visual problems. Luckily, it is treatable and there are many ways we can encourage appropriate development!
Reach out to your pediatrician if you have concerns. PlayWorks Therapy, Inc. offers full physical therapy evaluations or free screenings if you have concerns or think your child may have torticollis.
Sarah D’Astice, PT, DPT
Licensed 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.
Kaplan, S. L. et al. (2018). Physical Therapy Management of Congential Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy.