What Parents Should Know About Signs & Treatments
When you have a baby, it’s safe to say that your world completely turns upside down, for the better! There is so much new territory to navigate, and it’s understandable that you may feel more than a little overwhelmed by it all. Thankfully, understanding torticollis can be simple and is very helpful information to have as you care for and watch your beautiful little baby grow!
Below, I will answer some common questions and concerns from caregivers.
Does My Infant Have Torticollis?
Congenital muscular torticollis (CMT) is a condition that you can identify if you see your baby turning his or her head to look one way more frequently than the other or tilting their head to one side.
These signs of torticollis will likely become evident within the first couple months after birth and can have a variety of causes. If this describes your baby, don’t worry! Physical therapy treatment for this condition has a high success rate with early conservative intervention.
Wait, What Exactly Is Torticollis?
Torticollis is the shortening of one of the sternocleidomastoid (SCM) muscles. This muscle can become shortened for a variety of reasons, such as cramped positioning in the womb or environmental stimulation causing them to look to one side more than another (such as crib positioning against a wall or feeding on one side).
Each person has two of these SCM muscles, one on each side of the neck. When only one of these muscles contract, the head rotates to the opposite side, the neck flexes forward on that side, and the head tilts to the same side. When both muscles contract at the same time, the neck flexes forward. You can see and feel this muscle protruding when you turn your head to the side, creating a line from behind your ear to your collarbone. You may be able to feel little lumps in this muscle in infants with CMT, but these are not painful and should go away with time and physical therapy intervention.
There are other conditions such as hip dysplasia, brachial plexus injury, and developmental delay that may be present with CMT, which your physical therapist and primary care doctor can screen for.
What About My Infant’s Head Shape?
You may also notice that your infant has developed a flat spot on the back of their head on one side, called plagiocephaly. This flat spot can be associated with CMT if the infant maintains a position on their back or in a container with their head rotated to their preferred side. Your physical therapist can measure the severity of this and determine the best intervention to help promote symmetrical head shape development. Mild cases often will resolve with increasing time spent upright to relieve pressure from their head, and more severe cases may resolve better with a cranial orthosis (which are those cute helmets you see babies wearing).
How Physical Therapy Can Help?
A physical therapist can perform a comprehensive evaluation to help determine contributing factors and interventions to encourage symmetrical rotation of the head, decrease and eliminate head tilt, and facilitate appropriate gross motor development.
Torticollis left untreated can result in delayed motor milestones, asymmetrical development of facial features and head shape, and possible need for Botox injections in the future if muscle tightness does not resolve.
Your Physical Therapist will work with you to customize a home program to fit you and your little one, consisting of stretching and strengthening exercises, tummy time techniques, soft tissue mobilization methods, positioning and environmental set-up recommendations, and any additional referrals necessary.
When Should I Bring My Infant In To Physical Therapy?
Evidence supports early intervention! If intervention is initiated before 1 month of age, 98% of babies achieve nearly normal range of motion within 1.5 months. Intervention begun between 1-6 months typically requires about 6 months of treatment, and intervention begun after 6 months may require 9-10 months of treatment. But don’t worry if you’ve missed that 6 month window! There is still a lot of growing and development left for your little one, and we are here to help!
In Home Tips for Torticollis.
Think about your baby’s typical environment.
Is your baby often sitting in a swing with the TV turned on to one side? Switch up the swing’s position to make them look the other way! Is your baby entertained by an older sibling playing with them in the back seat of the car? Put the baby on the side of the car to encourage head turning to their non-preferred side to look at the sibling. Do you usually hold them on only one side when bottle feeding? Switch it up! There are plenty of simple things you can start doing that will go a long way with your little one.
Physical Therapy Appointment for your Child.
Give us a call at (828) 398-0043. We would be happy to schedule an appointment to evaluate your child and help equip you to promote healthy development of your infant!
References
Congenital Muscular Torticollis (Twisted Neck). (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/congenital-muscular-torticollis-twisted-neck
Gray, G. M., & Tasso, K. H. (2009). Differential Diagnosis of Torticollis: A Case Report. Pediatric Physical Therapy, 21(4), 369-374. doi:10.1097/pep.0b013e3181beca44
Heidenreich, E., Johnson, R., & Sargent, B. (2018). Informing the Update to the Physical Therapy Management of Congenital Muscular Torticollis Evidence-Based Clinical Practice Guideline. Pediatric Physical Therapy, 30(3), 164-175. doi:10.1097/pep.0000000000000517
Linnea Hardin, PT, DPT is a is a Licensed Physical Therapist with Carolina Pediatric Therapy. She is a part of an interprofessional collaborative team including behavioral health, occupational therapists, physical therapists, speech-language pathologists, and psychologists dedicated to supporting and promoting children’s development and well being.
