If you’re a caregiver to a new baby, you may have heard of torticollis.
This is a relatively common physical condition in babies, and it essentially means that your baby has a preference to turn his or her head in one direction. Torticollis can be congenital, meaning your baby was born with this preference, or torticollis can be acquired, meaning your baby developed this preference after birth.
The sternocleidomastoid (SCM, for short) is the key player in torticollis, and this muscle acts to turn the head in one direction and tip or tilt the head in the other direction. This muscle can be tight or overused in a baby that has torticollis. Thus, when a baby has the diagnosis, you may also see a tilt or tip associated with the opposite rotation preference.
Most commonly, torticollis will present with a right rotation preference (looking to the right side) with a left tilt preference (tilting the left ear toward the left shoulder). As physical therapists, we know this is super confusing, and it’s often difficult to spot. Your pediatrician will typically screen for torticollis at your regular appointments, and there are some ways that caregivers can be on the lookout for torticollis as well.
Torticollis may present as:
- A preference to only look in one direction
- A difficult time rotating his or her head in the opposite direction
- A preference to tip or tilt the head in one direction
- Difficulty maintaining the head in an upright, middle position
- Very commonly, parents say that they notice these preferences in pictures when they start to see the same turn or tilt preference pop up in photos
So, can torticollis be prevented?
In some cases, torticollis is completely unpreventable. Some babies maintain their heads in the same position throughout pregnancy, and as a result, these babies are born with a strong preference to keep their heads in that same position.
Some babies are also born with a tight or shortened SCM muscle, and those babies are also very prone to maintain their heads in the same position. In some cases, acid reflux, vision, and other diagnoses may also contribute, but these are less common causes.
However, in cases where babies are not born with torticollis, there are some ways to prevent it.
Tips to prevent torticollis:
- Be sure your baby is looking in both directions. Show your baby toys to both the right and left to ensure that your baby learns to look all the way to both directions.
- Hold your baby in a variety of ways. Try to hold your baby in both arms, over both shoulders, and facing out to see the world. This will encourage your baby to look at both directions. Full disclosure: it may feel super strange to hold your baby in the opposite arm if you’re used to always holding your baby in the same arm. You may also notice that one arm is much stronger than the other.
- Be consistent with tummy time. Tummy time will help your baby develop the muscles needed to hold his or her head up straight. It will also help elongate the SCM on the front of the neck to ensure that it doesn’t get tight or shortened.
- Avoid infant positioning equipment. Pieces of equipment, like exersaucers, swings, jumpers, and positioning seats, can place your baby in poor postures that can encourage the turn and tilt preference. Trade out time in the equipment for time on the floor in tummy time.
How do we treat torticollis?
If torticollis is noticed at an appointment, your pediatrician may recommend repositioning or other exercises, and very often will also recommend physical therapy. In physical therapy, you will work on a lot of the same recommendations from above.
- Encourage the opposite neck rotation. If your baby likes to look to the right, hold toys to the left or approach your baby from the left side.
- Set up the environment so it encourages the opposite neck rotation. If your baby likes to look to the right, set up the crib so your baby looks out to the room to the left side and set up toys on the left side of the play area.
- Do more tummy time. Your physical therapist will work with you on finding ways to make tummy time easy and enjoyable. Again, set up toys or mirrors on the opposite side here.
- Your physical therapist will work on creating an individualized exercise plan for your baby and family.
Why is this condition important to treat?
Very commonly, your baby will not outgrow torticollis without some intervention. If your baby continues to develop with the turn and tilt preferences, it can lead to asymmetries in gross motor skills. Your baby may sit with a weight shift preference or crawl with a bit of a hitch pattern. Additionally, torticollis can contribute to head shape asymmetries, such as brachycephaly or plagiocephaly (commonly known as “flat head syndrome”).
Luckily, the physical therapy treatment for these head shape asymmetries is exactly the same as torticollis, and both can improve with physical therapy. Ultimately, the early treatment of torticollis can ensure that your child develops with the ability to explore the environment in all directions and develop symmetric gross motor skills throughout the lifespan.
When should I talk to my doctor?
If you start to see a turn preference or tilt, definitely touch base with your doctor. He or she can monitor the symptoms and recommend physical therapy when he or she feels it is appropriate. The earlier the intervention, the easier and more successful it will be!