Parent Tips Part 1: Torticollis

In one way or another, whether you’re a new parent or you’ve just welcomed your 5th, there are bound to be limitless questions running through your mind. As this little miracle enters your life, you are watching their every move, every smile, and every coo. You begin noticing their “normal,” and getting a front-row seat to your baby’s first impressions of this world.

If you’re anything like millions of other new parents, you probably find yourself comparing your child to others’ (or to your other children) and spending plenty of time on Google.. “is this normal…”, “what does it mean if…”, “how will I know when…”. Believe me, you’re not the only one!

Let’s take posture or your baby’s positioning for example. Have you ever found yourself becoming concerned with the way your child seems to position their head or neck when they are laying down? Maybe you’re at the park, maybe your friend pointed something out, or maybe you’re just noticing it while your baby is sleeping in the carrier. Whatever the reason, you’re once again left wondering, “is there something wrong, or is this normal?”. If you are noticing your baby tilting their neck to one side frequently, your baby may be exhibiting the early warning signs of a condition known as Torticollis.

What is Torticollis and how do I know if my baby has it?
Congenital Muscular Torticollis (CMT) is the tilting of an infant’s head to one side (Miles, 2021). Most often, a baby will also present with rotation to the opposite side. The tilt occurs due to a shortening of the muscles in the neck. This condition results in a strong, tight muscle on one side of the baby’s head, and an overstretched, weak muscle on the other side.

Torticollis affects the entire child including how they explore their world, engage with their world, and interact with others around them. Some areas that can be affected by Torticollis are a baby’s visual system, vestibular processing, proprioception, feeding, sensory awareness on the involved side, motor development, midline development, postural control, motor planning, transitions, balance, and weight-bearing (Miles, 2021). For a baby to be able to fully rotate their neck side to side, the muscles in the trunk and lower extremities assist, which can result in tightness across one side of the baby’s entire body (Neumann, 2002). This results in an imbalance in the baby’s musculoskeletal system, which can impact all areas of development including rolling, crawling, sitting, transitioning to standing, and walking. Due to this, you may notice your baby avoiding using their affected tight side and preferring to use their unaffected elongated side to interact with their world as they grow and develop. 

When can treatment begin and how long will it take?
Research suggests that Torticollis is most often caused while the baby is in utero (Wei, 2001; Tang 1998). However, it may not become obvious to the eye until the baby develops more head and neck control. Everything may present as fine at their one-month checkup, but suddenly you may notice an increase in their head tilt when you bring them for their two-month checkup and beyond. It is critical that this diagnosis be caught as early as possible. The later your baby is brought in for treatment, the longer it will take to resolve and treat this diagnosis. Therefore, early detection and intervention are essential in fostering success. The length of treatment is dependent upon the severity of the muscle tightness, how old your child is when they begin services, the degree of limitation in range of motion they have on their affected side compared to their unaffected side, and any other co-occurring diagnoses (i.e. plagiocephaly).

Both disciplines of pediatric occupational therapy and physical therapy are highly trained and qualified to treat your baby with torticollis. We help your child by stretching the tight muscle, strengthening the opposite weak side, promoting symmetrical active movement patterns, and helping you to change the environment around your baby to foster success at home.

What can I do at home to reduce the effects of CMT?
Your therapist will guide you through a series of advancing stretches and will provide strategies on how you can change the environment around your baby to reduce the effects of Torticollis. Below are some quick tips:

  • Remember that babies will always want to shorten their tight side and elongate their weak side, so you want to set them up in play positions that require them to move in the opposite pattern (i.e. if your baby prefers to roll to their unaffected elongated side, work to facilitate them rolling to their tight affected side). We want them to elongate their tight affected side to create symmetry!
  • During bath time, diaper changes, or when they are in their high chair position yourself or toys to the baby’s tight affected side so they are motivated to turn to you or the object.
  • During play time you can place toys, books, and yourself not in front of the baby, but off to the affected tight side to encourage active turning to that non-preferred side.
  • During car rides, move the toys hanging in the car seat from one side to the other or move the car seat itself from one side of the car to the other to encourage the child to look out of the window to their affected side.
  • Whenever possible, limit the amount of time your baby spends in their car seat to just travel.
  • Limit the amount of time your baby spends in any carrier including infant swings, infant carriers, car seats, strollers, infant/toddler rockers, etc. If the child needs to be in a carrier, ensure that their head is positioned at midline.
  • Alternate arms when feeding your child whenever possible to provide frequent changes in your baby’s position.

Even after successful discharge from either occupational therapy or physical therapy services, as your child grows and learns how to move in different ways such as walking, monitor them for the possible return of tilting and tightness. Your child may need to come in for a brief continuation of services.

If you or someone you know has concerns about their child, please contact KidSense Therapy Group and schedule an evaluation. Check back for a future blog addressing tips and strategies on Plagiocephaly!

References:

  1. Neumann, D. A., (2002). Kinesiology of the musculoskeletal system (1st Ed). Mosby
  2.  Tang S, Liu Z, Quan X, et al. Sternocleidomastoid pseudotumor of infants and congenital muscular torticollis: fine-structure research. J Pediatric Orthop. 1998;18:214-18
  3.  Wei JL, Schwartz KM, Weaver AL, Orvidas LJ. Pseudotumor of infancy and congenital muscular torticollis:170 cases. Laryngoscope. 2001;111(4):688-695.
  4.  Lephart, K. (2021, February, 7). Treating torticollis: Evidence-based assessments & interventions. Summit Professional Education.
  5.  Miles, C. (2021, April, 19,20,26,27). Torticollis: Assessment & treatment of infants & children – “Impact on the movement system of infants & beyond” [Live webinar]. Education Resources. 

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