Torticollis
Does your child have a head preference? Do they look in one direction more than the other?
Torticollis, or simply twisted neck, causes the head to turn in one direction and tilt in the opposite direction. The muscle that is most commonly associated with torticollis is the SCM (sternocleidomastoid), but often, other muscles in the neck, shoulder and trunk (see Tortisoma) are also involved. It can be mild, moderate, or severe, and is the most documented cause of plagiocephaly (flat head syndrome).
Tortisoma
Tortisoma is also known as Postural Asymmetry
Tortisoma is tightness through the body related to torticollis. For many years, we only addressed the neck when treating torticollis, but now we know how important it is to treat the entire body!
When lying on their back, your baby's body may relax into a "C" shape or a backwards C shape. You may find it easier to place their right hand on the left knee but harder to put their left hand on their right knee. You may see their chest slightly rotated to one side and their belly rotated to the other. When seated (in the carseat for example), you may notice that they tend to always lean to one side.
Torticollis and Tortisoma
What causes torticollis and tortisoma?
What can I do about my baby's asymmetry?
How do I know if my baby has asymmetry?
The most common cause of torticollis and tortisoma is intra-uterine crowding or limited room to move in the womb
- Multiples (twins, triplets, etc.)
- First time mom
- Large birth weight
- Low or high amniotic fluid
- Low positioning in mom's pelvis
- Decreased tummy time
Factors after birth include:
- Babies born premature
- Infants with delays in strength to be able to move around
- Prolonged immobilization for medical intervention
- Decreased tummy time
How do I know if my baby has asymmetry?
What can I do about my baby's asymmetry?
How do I know if my baby has asymmetry?
Because torticollis typically starts in utero, a trained eye can pick up on neck tightness soon after birth.
Similar to plagiocephaly, pediatricians often notice the neck tightness at the 1-2 month well visit. Our goal is to bring awareness to this common condition and empower parents to identify it as soon as possible. If you know what to look for, you can get help sooner rather than later.
The earliest indication is that baby only wants to look in one direction and in some cases, seem uncomfortable when trying to turn the head in the opposite direction.
Another indicator is one ear is closer to the shoulder than the other ear. This is what we call a “head tilt.” It’s cute, but if your baby is always in this position, there may be an issue that needs to be addressed!
What can I do about my baby's asymmetry?
What can I do about my baby's asymmetry?
What can I do about my baby's asymmetry?
- Identify turn preference early
- Increase supervised tummy time
- Encourage baby to look in the non preferred direction
- Change position in crib
- Switch feeding positions
- Limit container usage (bouncy seats, boppy loungers, swings, carseat, etc.)
- Pediatric physiotherapy assessment and home exercise program
Does watch and wait work?
Does watch and wait work?
What can I do about my baby's asymmetry?
A wait and see approach does not work in this situation. Skilled therapy for torticollis is critical to success. This DOES NOT include stretches you found off a quick google search!
If your baby continues to have a strong turn preference and/or a flat head, despite your attempts to change it, therapy is indicated sooner rather than later.
During infant growth and development, we strive for symmetry in all gross motor skills.
What will physio do?
Does watch and wait work?
What will physio do?
A trained pediatric physiotherapist will provide a comprehensive assessment to evaluate any asymmetries your child may have throughout the body.
A program of therapeutic positions and play activities will then be provided to the family as a home program.
These activities should not be uncomfortable for your baby.
One word of encouragement: torticollis is difficult to treat and takes a while to resolve. This is because growth spurts cause the neck to retighten and it seems like you’re starting from scratch. This is normal but can be very frustrating. Keep up with your neck stretches and hang in there!
Why treat?
Does watch and wait work?
What will physio do?
Torticollis and tortisoma can cause difficulty or delays in achieving motor milestones:
- Rolling - it may be harder for your baby to roll in one direction compared to the other
- Sitting - A child more tilted to one side may have difficulty balancing in sitting as their weight is unevenly distributed on their hips
- Army Crawling - may army crawl for an extended time (often pushing with one leg more than the other)
- Crawling - may keep one knee up and the other down
- Pulling to standing - may always pull up to standing with one leg rather than the other