Infant Torticollis

I’m happy to write a Doctor’s Note about infant torticollis, since I’m not only a pediatrician but also a mother of a baby who was born with it.

My third child showed signs of infant torticollis within the first month of life. He would always prefer to look to the right and have his head rotated more to the right than the left. Then I started noticing he prefered breastfeeding more on one breast, because he could keep his head rotated right while he was feeding from that side. Eventually he developed flattening on the back of his head on the right side, because he always had more pressure on the right side of the back of his head.

Despite increasing the stimulus to his non-prefered side, including putting a baby mirror in his crib facing the non-preferred side and increasing his tummy time, his torticollis did not improve as much as I wanted. In concert with his Kids Plus pediatrician, I contacted Early Intervention, and after an evaluation a pediatric physical therapist came to our home once a week and showed me stretching techniques to help improve his torticollis. The therapist was wonderful and showed new techniques as my son grew older.

My experience with my son inspired me to write this Note, to provide lots of good, clear information on this condition…

SO WHAT, EXACTLY, IS INFANT TORTICOLLIS?

Infant torticollis, otherwise known as congenital torticollis, is a “twisting” of the neck caused by a tight neck muscle. The sternocleidomastoid muscle is responsible for turning the neck and tilting the neck. There are right and left sternocleidomastoid muscles, one on each side of the neck running from behind the ears to the collarbone.

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WHAT CAUSES IT?

No one knows why some babies get torticollis and others don’t. Most doctors believe it could be related to the cramping of a baby inside the uterus, or abnormal positioning (such as being in the breech position, where the baby’s buttocks face the birth canal). The use of forceps or vacuum devices to deliver a baby during childbirth also makes a baby more likely to develop torticollis.

These factors all put pressure on a baby’s sternocleidomastoid muscle. Extra pressure on one side of the SCM can cause it to tighten, making it hard for a baby to turn her neck.

WHAT ARE THE SYMPTOMS?

Your baby will likely turn her head more towards one side than the other. Your baby may also tilt her head more to one side than the other.  Sometimes, if breastfed, the baby may have difficulty breastfeeding on one side or only prefer one breast.

Some babies with torticollis also will develop a flat back of their head on the side they always look towards.This is called positional plagiocephaly. Or they might develop a small neck lump or bump in the tight muscle in their neck, which is similar to a “knot” in a tense muscle. Both of these conditions tend to go away as the torticollis gets better.

WHAT SHOULD I DO IF I SEE MY INFANT ALWAYS HOLDING HIS HEAD TO ONE SIDE?

As the caregiver, you’re likely the first to notice that your baby always holds his head tilted to one side. Be sure to see your pediatrician for an exam, because other conditions may also cause this head position.

Your pediatrician will examine your baby and may ask you questions about your baby’s birth and your pregnancy. Your pediatrician may want an x-ray of the cervical spine to rule out bone problems, and he or she may also check your baby’s hips, because some babies who have congenital torticollis also have an abnormal development of the hip (hip dysplasia).

HOW IS IT TREATED?

After examining your baby and determining if she has torticollis, your pediatrician will encourage you to increase your baby’s tummy time.  Tummy time encourages your baby to work at using her neck muscles to work out the tightness in her neck. The key is the amount of tummy time you do: at least 20-30 minutes, 3-4 times per day.

Your pediatrican will also teach you some stretching exercises to relax the tight muscle in the baby’s neck. It’s important to do them several times a day. Your pediatrician may also refer you to a physical therapist to help teach you the stretching techniques as well. Through early intervention, the physical therapist comes right to your home; it’s a free service in Pensylvannia.

Other ways to encourage your baby to look the non-prefered way are to:

  • Place the baby in the crib so your child turns his  chin the correct way to see the room.
  • Place toys and other objects in such a way that your baby has to turn his her head to see and play with them.

If your baby does not improve after a few months of stretching, follow up with your pediatrician.  There may be another problem that we have to further evaluate.

Despite agressive physical therapy, my son already had a significant degree of flattening of the back of his head on the right side. He had developed positional plagiocephaly from always putting pressure on the right side of his head when lying on his back, which is how he laid most of the time. He was referred to the craniofascial clinic at Children’s Hospital of Pittsburgh, and it was recommended he get a helmet to correct his abnormally shaped head.

MY BEST ADVICE

The best advice I can give any parent of a child with torticollis is to do the stretching exercises and really increase tummy time to 20-30 minutes, 3-4 times a day. It will make the biggest difference. Also: any opportunity to have your baby not lying on his back, do it. This will get the pressure off the back of your child’s head to correct the torticollis and prevent positional plagiocephaly!

In my next Doctor’s Note, I’ll describe and explain some excellent stretching techniques and exercises for treating infant torticollis.

As always, you can give us a call in the office if you have any questions or concerns.

Dr. Ditte Karlovits joined Kids Plus in 2012.