Sara Hammons | June 8, 2023 | Occupational Therapy

Torticollis and Plagiocephaly

Parents can often feel overwhelmed sorting through medical and societal advice on how to best care for their baby. One of the most important recommendations is put your baby on his/her back to sleep. The American Academy of Pediatrics initiated the “Back to Sleep” campaign in 1994 in efforts to prevent sudden infant death syndrome (SIDS). The second part to this recommendation is to put baby on his/her tummy to play during supervised adult awake times. Research has shown supervised tummy time has a positive impact on preventing and improving torticollis. At Marshall Pediatric Therapy, our physical therapists help parents implement and carry through an individualized tummy time routine that best suits your child’s needs. 

Torticollis translates to a “tight” or “twisted” neck. This term originated back in ancient Greek times. Today it is commonly diagnosed a congenital muscular deformity. Torticollis often occurs when there is a problem with a major muscle in the neck called the sternocleidomastoid (SCM). However, torticollis can involve multiple body systems including vision, vestibular, orthopedic, respiratory, neurological, integumentary, and gastrointestinal systems. Your physical therapy team completes a thorough evaluation to screen for problems in these areas. 

Plagiocephaly, having a flat or abnormal head shape, and torticollis often happen together. Like torticollis, plagiocephaly can present at birth or develop over time. Babies heads are very vulnerable to changing shape within the first eight months of life. When a baby has a head turn or positional preference, sustained pressure on that area causes gradual flattening and abnormal facial/head shaping. Depending on the severity of flattening and facial asymmetry, your physical therapist may recommend an evaluation for a cranial helmet. Your physical therapist will discuss treatment plans, helmet wear, and provide positioning recommendations throughout your child’s plan of care. 

Risk Factors

There are a few factors that increase a baby’s chance for developing torticollis: birth trauma/difficult delivery; intrauterine growth restriction; fetal malpositioning; first born; prematurity; breech delivery. Babies who do not receive enough tummy time or sit in a positioning device for long amounts of time are at a greater risk of developing torticollis. Positioners, such as swings, sit me ups, or bouncy seats, limit free neck movement, and do not allow babies to look both directions. 

Signs To Watch For

  • Difficulty breastfeeding or bottle feeding on one side versus the other

  • Baby tilts head on one side or looks in one direction

  • Greater use of one arm versus the other

  • Difficulty cleaning infant’s neck

  • Reduced tolerance to play when placed on his/her stomach

  • Concerns for gross motor delay

Importance of Early Intervention

Research indicates physical therapy intervention is highly effective in resolving torticollis when initiated in early infancy. Waiting until after one month of age prolongs the length of physical therapy needed to approximately six months of age. Waiting after six months of age can require 9-10 months of physical therapy, with few infants achieving a near normal range of motion. Early intervention requires parents to keep an eye out for the signs. It is recommended to bring up concerns to your child’s pediatrician as soon as notice any of these signs. 

Screen For Other Conditions

If your baby is diagnosed with torticollis, it’s important to rule out other conditions that may affect how your child holds his/her head. Your physical therapist will screen for orthopedic, neurological, vision, respiratory, and gastrointestinal problems. We will also look for other diagnoses that could present with torticollis such as plagiocephaly, hip dysplasia, and early motor delays. Our physical therapists often consult with Occupational Therapists and Speech Therapists to rule out other concerns that sometimes are associated with torticollis. 

Prevention Methods

Here are a few ways to help prevent torticollis: 

  • Provide supervised tummy time while baby is awake. This will strengthen his/her neck, arms, shoulders, tummy, and back muscles. 

  • Change your baby’s position often when awake.

  • Alternate the sides of the crib your baby sleeps on helps to encourage head turning in both directions. 

  • Limit the amount of time your baby rests in positioning devices, like car seats, bouncy chairs, baby swings, and strollers. 

  • Look for signs and symptoms discussed above, such as asymmetry and postural preferences. Take pictures of your baby’s posture in different positions often. Pictures help provide an objective view and can be useful in documenting your child’s progress.  Don’t hesitate to contact your pediatrician if you notice something concerning!