Infant Torticollis and Plagiocephaly

Article at a Glance

• Infants with torticollis have a tilted head and difficulty turning their necks.
• Plagiocephaly is when the back or one side of a baby’s head is flattened.
• Plagiocephaly and torticollis are both very treatable with early and consistent physical therapy.

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Many new parents don’t know what torticollis and plagiocephaly are, but they are fairly common in infants and are very treatable when caught early.

What is Torticollis?

Torticollis, meaning “twisted neck” in Latin, is caused when the sternocleidomastoid muscle has either been damaged or shortened. The sternocleidomastoid is a pair of muscles in the neck that work to turn the head from side to side and to extend the neck. Infants with torticollis typically have their head tilted to one side while the chin is turned to the other.

Things to look for in babies include:

• A preference to always look in the same direction.
• Not having a full range of movement with their neck.
• Head tilting to the side.
• A strong preference to breastfeed on one side and difficulty breastfeeding on the other.
• Sometimes you can feel small pea-sized lump or tumor on the sternocleidomastoid.
• Always sleeping with their head in the same position.

Types of Torticollis
Congenital torticollis is when a baby is born with the condition. It is fairly common—about 1 in 250 babies are born with it. Usually it is caused by how a baby is positioned in the uterus, by lack of space in the uterus, multiple births, low amniotic fluid, or a traumatic birth. For some babies the muscle is just tight and for others there may be an actual tumor on the muscle.

Acquired torticollis in infants develops after birth and is usually due to spending too much time in car seats, swings, bouncers, and strollers. It can result when babies don’t get enough tummy time so the muscles in their back and neck aren’t being stretched out.

Getting a Diagnosis
If your baby has torticollis, your pediatrician will usually catch it within the first couple months. If you notice any of the symptoms at home, definitely bring them up with your pediatrician. Treatment works best when it is started as early as possible. Your pediatrician may also check to make sure that there are no other structural defects with the neck.

What is Plagiocephaly?

Plagiocephaly is when the back or one side of a baby’s head is flattened. In severe cases the face and ears might also be asymmetrical. Babies’ head are very soft and the skull has not yet fused together. This helps during birth and also allows for rapid brain growth during that first year. But it also means that the head can be molded into a flat shape if too much pressure is constantly being put on one side.

After birth, babies’ heads are usually a little misshaped, but if the problem persists after six weeks you will want to have your baby examined by a doctor.

Causes

• It is not uncommon for babies with torticollis to develop plagiocephaly. This is because they usually sleep or position their head to the same side—putting more pressure on one side of the head than the other.Babies with plagiocephaly may also develop torticollis. It takes a lot more energy to turn your head when lying down if your head has a flat spot. You can’t just roll your head, but you have to pick it up a little too. So most babies with plagiocephaly choose to just look in the same direction. After time, their neck muscles become stiff from not using them.
• Sometimes plagiocephaly also occurs if pressure was placed on the head in the womb—maybe by the mother’s pelvis or by a twin.
• Babies can also develop plagiocephaly if they spend too much time lying on their backs in a crib, stroller, or swing.

Treatment for Plagiocephaly and Torticollis

Plagiocephaly and torticollis are usually treated using many of the same techniques.

Physical therapy is usually the first line of treatment. Stretching exercises and proper positioning can help stretch the neck muscles and prevent flattening of the head. Over time with consistent and daily practice most babies are able to move their necks completely and build up equal strength on both sides of the body.

Most of the exercises focus on encouraging babies to turn their heads to the non-preferred side. Babies can’t hurt themselves if they are turning their heads by themselves.

Some things your physical therapist might ask you to do include:

• Place the car seat so that your baby has to turn the other way to see a sibling or out the window.
• Place a baby safe mirror in the crib on the non-preferred side.
• Lots and lots of tummy time—this is especially important. If your baby hates tummy time, ask your therapist for tips on how to make it easier and more enjoyable for your baby.
• Turn the crib with the side against the wall so that your baby has to look the other way to see out.
• Practice some gentle massage techniques.
• Feed and play with your baby in a way that encourages your baby to look towards the non-preferred side. This can include switching the side you breastfeed on and offering the spoon from the other side when you are feeding your baby solids.

Even if you are worried about a flat spot, always put babies to sleep on their backs. Other techniques can help correct the problem without the risk of sudden infant death syndrome.

With torticollis, parents usually see results from physical therapy in just a few weeks. But in about 15 percent of the cases babies may need surgery to lengthen the muscles.

For babies with severe plagiocephaly, a doctor might prescribe a custom-molded helmet if no progress is being made with physical therapy. The helmet puts gentle pressure on the baby’s head to encourage proper growth. But helmets are typically not needed and should only be used if prescribed by a doctor.

Should I Be Worried?

The prognosis for both infant plagiocephaly and torticollis is excellent. Most of the problems will resolve themselves with proper treatment and as babies spend less time on their backs and their skulls grow. Even though the head might never be totally symmetrical, it will become less noticeable as your child’s body grows. The important part is to start physical therapy early and to be consistent.