Congenital Muscular Torticollis is a condition where your baby has limited neck range of motion. Most commonly this causes them to only hold their head tilted to one side with their head rotated in the opposite direction. The sternocleidomastoid muscle (SCM) is the most attributed to the head position and typically the most constricted muscle when treatment is performed— sometimes a fibrotic mass can also be felt within the muscle. Torticollis is the third most common musculoskeletal condition in infants and affects 0.3% to 1.9% of newborns. Most recently, there has been an increase in incidence associated with the beginning of the Back to Sleep Campaign, which has saved countless infants from Sudden Infant Death Syndrome (SIDS). However, the campaign led parents to decrease the amount of time spent on an infant's stomach as well as an increase in time spent in carrier devices with weight on the back of their head.
The Sternocleidomastoid Muscle is most commonly affected in Torticollis.
Did I do THIS to my Baby?? (I promise you did not!)
The exact causes of Torticollis are unknown but there are several theories on why an infant develops the condition (none of which you could have done anything about so don't beat yourself up!). Pre-birth factors include decreased space in the uterus (from maternal frame size, increased fetal size, or uterine abnormalities), decreased fetal movement, multiple birth (twins), and a breeched birth position. During birth factors are specifically trauma to the SCM muscle (lack of oxygen or bleeding) causing the infant to favor that side allowing tightness to develop. Post-birth causes include positional plagiocephaly (flattening of the head) or too much time spent in carrier devices. This type of Torticollis traditionally develops secondary to a normal lack of head control in the first months of life and a dependency on the shape of the head for their head positioning. (But more on plagiocephaly later!)
An infant demonstrating a left Torticollis typical presentation.
How do we know your baby HAS Torticollis you ask?
Torticollis is a traditionally a clinical diagnosis following observation, strength, and range of motion testing by your infant's doctor and pediatric physical therapist. X-ray's or MRI's are typically not performed unless the infant's case is severe or is not responded to traditional therapy. Sometimes an ultrasound is performed to visualize the SCM if a mass is present or to rule out hip dysplasia (unstable hip joint) which is associated with torticollis. 20% of infants with Torticollis develop hip dysplasia and your infant's doctor and PT will perform a clinical test to rule it out or recommend an US if the test is positive.
Won't they just grow out of it? The answer is a resounding NO!
Torticollis doesn't just affect your infant's head and neck but has a global effect on their development. Treatment of torticollis is important in prevention of gross motor delay and gross motor asymmetries early in development. Without treatment, as your child ages, they could develop difficulty in vestibular development (inner ear/balance), headaches, neck pain, and potentially development of scoliosis (abnormal curve of the spine) if torticollis is left untreated.
A traditional torticollis exercise your physical therapist wound teach you.
What can I do to HELP my baby?
First and foremost, if you notice a change in your baby's head shape OR a preference for looking or keeping their head tilted to one direction, bring it up with your Pediatrician. Voice your concerns. Doctors are getting better about early referrals, but torticollis is much easier and faster to treat if physical therapy is started prior to 2 months of age. Then once your referral is in hand, go to physical therapy and listen to your therapist! Torticollis is managed in the home. At Milestone, Dr. Megan serves as your guide to learn how YOU can help your baby. She teaches you stretching exercises, strengthening exercises, and gross motor activities throughout the treatment of your child. She will make sure you are as independent as possible in performing them in the home setting. Research is also showing that with torticollis MORE IS BETTER. The more stretching you can perform per day on your child the faster they will gain range and resolve their torticollis. One study even showed 100 stretches a day to be significantly more effective than 50 stretches a day.
How long will my baby have Torticollis?
Luckily if physical therapy is started within the first 6 months of life, an infant with torticollis typically resolves by 6 months of intervention at the longest, unless there are complications to care. Infants who start after 6 months may take 8-12 months of intervention depending on severity of the Torticollis and the asymmetries present in gross motor development. Timelines may differ if your infant has other co-morbidities/conditions to their health.
This photo depicts two types of head shape deformities potentially seen in infants.
You mentioned that Plagio-thingy earlier... what's that?!
Plagiocephaly is the flattening of one side of an infant’s head seen commonly in children with torticollis. Plagiocephaly is caused by either intra-uterine positioning or post-birth positioning. This head shape will contribute to and exacerbate the symptoms of torticollis is left untreated. Plagiocephaly is easily treatable with conservative re-positioning if your infant is under 3 months of age or with a cranial orthosis (helmet) if greater than 3 months of age. Plagiocephaly does not typically improve without intervention if the child has reached the “head growth spurt” that occurs around 4-6 months of age. Their head will tend to grow larger but sustain the same shape.
If moderate to severe plagiocephaly is left untreated there can be medical repercussions that may develop including, but not limited to, jaw malocclusion, facial asymmetries, or challenges with fitting safely in a helmet for sports or bicycling riding later in life. If your baby has significant plagiocephaly, your therapist will refer you to an orthotist who specializes in producing cranial orthosis for infant to perform a full examination and make their official recommendation on whether or not your infant needs a helmet.
Don’t worry if your baby needs a helmet, these babies are the cutest things around!
Torticollis isn’t so scary after all…
So hopefully if your child has torticollis or you are concerned about it, you are feeling a little more at ease. Torticollis is easily treated. With a little hard work, dedication, and physical therapy intervention, your infant will be better in no time and you’ll just have a pile of cute tilted head photos to show from it… and who knows? Maybe your baby will be the next best internet Meme because of it!