How to identify torticollis
My baby only wants to look in one direction.
My baby can look both directions but prefers one more than the other.
Why does my baby keep leaning to one side?
My baby’s head is flat on one side.
If you have ever asked these questions or made these comments as a parent, it is possible your baby may have Torticollis.
Torticollis is a shortening of the Sternocleidomastoid muscle which is a large, superficial neck muscle that runs from just behind the ear diagonally to the most internal part of the collar bone. We have two of these muscles and when they are working symmetrically together, they help us to bend our head forward. When one is shortened or tighter than the other, our head will tilt ear to shoulder towards the side of the shortened muscle and rotate to the opposite direction. Tightening of this muscle as a newborn is mostly due to the position within the mother’s womb. Low amniotic fluid, breech positioning, traumatic delivery or having twins increase the liklihood of a baby being born with Torticollis. Other potential factors that can lead to Torticollis like symptoms and asymmetries are Gastroesophageal reflux, tongue tie, orthopedic/neuromuscular insult or visual impairment.
This shortening on one side creates a lengthening of the same muscle on the opposite side of the neck and this muscle imbalance makes it difficult for your kiddo to hold their head straight. This can also be the reason why your baby begins to develop a flatness on the back of their head known as Plagiocephaly.
Physical therapy can assist with developing symmetry in these muscles. This symmetry is important so that your child can establish midline head control, visual midline gaze and oculomotor control, sensory organization and symmetry through their future gross motor skill development.
Did you know that avoiding early intervention for Torticollis could potentially lead to possible complications such as scoliosis, visual motor deficits, crossing midline difficulties, primitive reflex retention, early hand preference, or even a crossbite?
It is highly recommended that if you notice Torticollis in your newborn to seek skilled Physical Therapy services as soon as possible. If referred early enough, a Physical Therapist can teach you repositioning techniques to avoid a flat head; however, if a helmet or band is needed for head shape abnormalities, the most ideal time to receive a helmet is between 4-6 months. This time is when the babies typically have strong enough head control to support a helmet and their heads are growing the fastest; which means LESS time in the helmets!
Treatment durations for Torticollis vary depending on the severity of the tightness and any other possible comorbidities or deficits that the child may have. The good thing is that Torticollis is VERY common and VERY treatable! We typically will see a child up through the first year of life to make sure they develop all of their gross motor skills with midline control and symmetry.
If you are questioning your child’s abnormal head shape, ability to keep their head or trunk in midline, or you see asymmetries in their movement from one side of their body to the other, perhaps question Torticollis AND seek Physical Therapy treatment as soon as possible! The earlier the treatment, the better the outcomes!
Example of a left tilt right rotation Torticollis. R ATNR (atonic neck reflex) also pictured.