What is Torticollis – A parent’s guide.

baby tummy time happy peeking from under a towel
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Posing for a picture, or muscle tightness impacting posture?

We all love to pose for a photo with a little head tilt, to get our good side, right? Well, sometimes this position is not a choice, it’s a posture that a newborn or infant can be stuck in, and it can continue if not addressed early. It is called muscular torticollis (or CMT) and it is typically noticeable shortly after birth.

What is infant torticollis?

Torticollis is a twisting of the neck that causes an infant’s head to rotate in one direction and tilt the other.

It is often defined by tightness of a muscle called the sternocleidomastoid, or SCM for short. The condition presents in a way that many describe as “twisted neck.” Additionally, limited movement in a baby’s head and neck is one of the common symptoms of torticollis.

This asymmetry is linked to many different causes and can influence the path of development for our young kiddos in an atypical way.

How is torticollis diagnosed?

Once a parent notices signs or symptoms of torticollis in their baby, their pediatrician or pediatric physical therapist can perform a full evaluation to assess their condition. 

There are three different types of infant torticollis:

  1. Mass Thickening – a bulge develops and can be felt in SCM tissue, potentially associated with trauma to the muscle group and linked to loss of neck range of motion and flexibility.

  2. Muscular Torticollis – muscle tightness that does not present with a bulge, often associated with shortening of the SCM muscle that leads to a loss of neck range of motion and flexibility.

     

  3. Postural Torticollis – occurs when there is an adapted preference of head position caused by posture (i.e., being held exclusively in one way or an environmental cause for rotation preference). May be associated with muscle imbalance but is not typically linked to loss of neck range of motion and flexibility.

When should I worry about torticollis?

Many people ask, “Will infant torticollis go away on its own?” While it is possible that mild cases may resolve without treatment, in most cases intervention is needed.

When you think about all the systems being developed in a child’s early life, you can see why their head position is important. If they are fixed in one posture, they have trouble developing a symmetrical visual system, body awareness of one side (the side they are looking away from), asymmetrical movement patterns such as rolling to both sides equally and potentially the start of cascading postural dysfunction later in life.

As a parent, getting your baby the help they need early on is the best course of action.

Research shows that the earlier treatment is sought, the less intervention is needed. Also, babies who get the care they need to correct torticollis early experience faster recovery in which midline posture and symmetrical movement and development is achieved.

baby smiles up at caregiver

We want to promote a path of mobility and freedom of movement for our children that allows typical development.

If infant torticollis is not treated and symptoms linger, we typically see a shortened and a lengthened side with all movements, which can impact the development of equal ability between the right and left sides of the body.

Do all babies with torticollis need a helmet?

Plagiocephaly (a type of skull deformity) is also a diagnosis commonly linked to torticollis. You can imagine if an infant rotates their head to one side and they are unable to roll, are in carrier systems (car seats, strollers, swings, etc.), and sleep on their back that adds up to a lot of time spent on one side of the head. This can result in the flattening of the skull, called plagiocephaly. This might be treated with the use of a helmet. Research has shown that 90% of children with torticollis present with plagiocephaly.

How do you treat torticollis in babies?

Physical therapists can provide treatment for torticollis. As movement and developmental experts, pediatric physical therapists have the education, expertise, and experience necessary to screen, evaluate and diagnose torticollis. Your child’s customized treatment plan will be based on their exam and will be created to address their unique condition, including the severity.

The severity of Torticollis is graded on 1-8 scale based on age and amount of restriction. The older and more pronounced a child’s range of motion restriction, the higher grade of severity, which typically demands longer treatment time. The sooner a child presenting symptoms of infant torticollis receives intervention, the quicker and more complete their recovery.

In addition to outpatient physical therapy, you may qualify for PT services in your home, which can help expedite treatment with a newborn or infant.

At Therapeutic Associates Physical Therapy, our specialized pediatric providers utilize hands-on techniques and purposeful play to engage infants in activities designed to address the symptoms of torticollis. We also are committed to educating parents/caregivers so they may successfully and regularly continue treatment at home between visits. We are also committed to partnering with your child’s entire healthcare team to ensure optimal health and wellness.

healthcare provider interacts with mother and baby in their home.

The Academy of Pediatric Physical Therapy outlines the most effective interventions to perform when treating infant torticollis as:

  1. Neck passive range of motion exercises (this involves stretching the neck)

  2. Neck and trunk active range of motion exercises (working, through play, on the ability to turn the head equally in both directions)

  3. Development of symmetric movement (i.e., rolling equally between right and left)

  4. Environmental changes to promote symmetry

  5. Parent/caregiver education

What causes baby torticollis?

There are a variety of factors that may influence an infant’s head posture. Infant torticollis in not a birth defect, but can be the result of intrauterine growth restriction, such as in the case of twins or a large baby in a small space. A traumatic birth or C-section is sometimes linked to torticollis, though this is considered rare. Ultimately it is unclear why some babies are born with or develop torticollis and others don’t. It is not uncommon, and when treated, 95 percent of babies overcome the condition within a few months.

If you even think your child or someone you know has torticollis you may access physical therapy services via direct access. In addition to pursuing developmental pediatric physical therapy, you may also follow up with your pediatrician for further assessment. Remember, the earlier you get services the quicker and more successfully symptoms resolve. Also, working with a pediatric PT you can learn about your child’s development, get screened for age-appropriate motor milestones and learn a trick or two about healthy movement and how to promote it throughout development when playing. Be your kid’s advocate – find your Therapeutic Associates clinic today!

Pediatric Physical Therapy

Along the course of early development, the musculoskeletal and neurologic systems may have dysfunction and need attention. Physical therapy addresses issues that impact a child’s movement, posture, and quality of life.

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