Torticollis: A Clinical Perspective 

 Attached are some links to help you identify what it is and if your baby has it and what to do about it.
  • First off, It would be wonderful to have OBs, midwives, and nurses identify which babies might be at risk for developing Torticollis. These tend to be babies with Breech or difficult birth including C-Section, preemies, babies with big heads, low resting tone also called Hypotonia or Floppy Baby, and twins. These are all infants with a higher prevalence of having or developing Torticollis by 4 months of age.
  • In a perfect world, they would tell you to have your baby lay on their stomach every day, and have your baby look left and right, try and carry your baby as much as possible and limit the use of car seats, prams, etc. Also many parents sleep with their babies in their room. Every day switch which side your baby faces you.
  • They all mention the importance of Tummy Time but what does that mean? It means having your baby lay on their tummy every day for as long as they can tolerate it. This can be a minute to ten minutes and ideally at least twice a day. It can be on top of you or on the floor while they are awake.
  • SIDS: Sudden Infant Death Syndrome has drastically reduced since the Back to Sleep program started putting babies on their backs to sleep. But it has also led to delayed motor control and development early on so that is why Tummy Time has become even more important.
  • First signs of Torticollis: often parents or doctors first notice something at around 2 months old.

    • Typically your baby only looks to one side
    • Often the head is always tilted to one side, (look at multiple pictures of your baby and you will see the same position in each one)
    • The head becomes flat on one side of the back of the head (Positional Plagiocephaly:  flattening of the head due to constant pressure on the head from surfaces)
    • The forehead protrudes out on one side
    • One eye or cheek is smaller on one side
    • The ear is smaller or bent down
    • A bump in the neck muscle (Sternocleidomastoid Muscle: SCM)
    • Feeding on one side can be difficult
  • What should you do next?

    • Meet with your doctor.
    • Your doctor will screen for any bony spine issue (Klippel-Feil Syndrome). It is very rare, but better to rule it out. Also screen for severe reflux (Sandifer’s Syndrome).
    • Do the above mentioned preventative measures in the meantime.
    • See a Physiotherapist who specializes in Torticollis for stretches and positioning.
  • What NOT to do!

    • Some doctors tell you to wait. Why? Babies don’t grow out of it!  They just get worse and the older they are the harder it is to fix!
    • There are many secondary issues that develop if you play the wait and see game. The head shape can get drastically worse in two weeks. Your baby loses the ability to sense the world on one side. Motor control gets delayed: head lifting, rolling, sitting, crawling and even walking can all be delayed.
    • Head (Cranium) growth is most rapid from 4-6 months of age and is 85% of final size by 1 year old. If your baby has Plagiocephaly it can best be treated before 4 months old.
    • Don’t try and do it by yourself. The stretches and positioning are only easy after a Physiotherapist has gone over and over them with you. They will show you hand positioning, easy tricks so your baby is comfortable and the signs to stop. Plus the stretches and positioning changes as your baby gets older and more active.
  • What to expect

    • You will meet with the Physiotherapist and go over all of the positioning and stretches.
    • You will see improvement weekly, but it will take up to 6 months or 12 months of age to be fully resolved. I prefer to see infants at 2-3 months of age. By 5-6 months the treatment is much more difficult.
    • With seeing a Physiotherapist, doing the positioning and stretches your baby will be fine. The success rate is 90-99% in the literature.
    • The literature discusses surgery, but that is very, very rare.
    • The first year of your baby’s life is when their muscle fiber numbers can continue to increase, but after 1 year muscles can only grow by hypertrophy of existing fibers. So the 1st year of life is so important for motor skills.
  • What a Physiotherapist will do for you

    • Evaluate your baby. They can measure their head for the level of Plagiocephaly (flat head) and monitor their progress. They can advise on the need for a helmet or not.
    • They will look at their motor control, how well they move, their motor skills and what needs to be worked on.
    • They will screen for any hip problems. (Hip Dysplasia)
    • They will go over all of the stretches and show you easy tricks to do them without your baby in distress. It is easier if  your baby is happily distracted and not crying.
    • They follow all of your progress until your baby is perfect!
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Kensington Physio & Sports Medicine was founded in 1992 to offer private physiotherapy services to the West London area. We have a well established team of leading, experienced therapists who thrive on patient progress in a supportive team environment.... Read More

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