Torticollis and Plagiocephaly

What is Torticollis?

Torticollis and Plagiocephaly

Torticollis means “twisted neck” and is caused by shortening of the sterno-cleido-mastoid muscle (SCM). It can be caused by in-utero positioning, lack of space in the uterus, a traumatic birth, multiple births or low amniotic fluid. Some babies may have tightness while others may have asymmetric neck posture due to eye problems, congenital absence of cervical muscles, low muscle tone or general delayed development. Torticollis can also be environmental or positionally induced. It seems to be more common today since the Back to Sleep campaign began in the early 1990’s to combat Sudden Infant Death Syndrome. Babies are sleeping on their back so the muscles in the neck and upper back are not being stretched out while the baby is sleeping.

What is Plagiocephaly?

Plagiocephaly refers to any condition characterized by a persistent flattened spot on the back or side of the head. It is sometimes referred to as “Flat Head Syndrome.” It can be caused by a restricted uterine environment, lack of amniotic fluid and multiple births. As with torticollis, there has been a dramatic increase with the number of babies with positional plagiocephaly. This is due to babies sleeping on their back and not receiving tummy time during awake periods. Many babies spend too much time in car seats, swings, infant carriers, etc. Some babies may require treatment with a Dynamic Orthotic Cranioplasty (DOC). This means they wear a helmet that was fitted for their head. The DOC band will re-shape their head to a more normal position.

How can I prevent my baby from developing positional torticollis and/or plagiocephaly? Tummy Time!!

Supervised tummy time is very important during the baby’s awake period. Tummy time for newborns is short and builds up as they grow and can tolerate being in this position. During the first three weeks of life, reflexes are present which allows the infant to clear their heads and breathe and also breathe against the resistance of the floor. If your child does not like tummy time, get on the floor and play with them or interact with them to build up their tolerance.

Limit the amount of time the baby spends lying in any piece of equipment like car seats, swing, etc. It is good to alternate the end where you place the baby’s head in the crib for sleep or on the changing table. Place toys on different sides of the stroller, bouncer seat, etc. to encourage the baby to turn the head to both sides.

If you notice your baby keeps their head to one side, for example the right side, then place toys on the left to encourage the baby to look to the weaker side. Interact with the baby equally on both sides but if you notice a preference then interact with them more on the weaker side.

What if I suspect Torticollis/Plagiocephaly?

It is best to catch torticollis/plagiocephaly as early as possible. If the baby’s head is asymmetrical or the neck muscles seem tight beyond 6 weeks, then see your doctor. If it is left untreated a child might have the following associated problems:

Open mouth posture Tongue may pull to one side Suck/swallow may be affected Shortening of other neck or trunk muscles Facial asymmetry can occur Feeding issues Fisting of hands, decreased strength, unequal weight bearing for crawling/walking

Some things a therapist might show you based upon your child’s needs:

Simple stretching that includes active and passive stretching Demonstrate proper positioning that encourage stretching while in a car seat or high chair, etc. Also, proper positioning to encourage alignment of the child’s neck, trunk and hips Ways to incorporate tummy time and how to address sitting and transitioning in and out of different positions. While in different positions, encourage reach and grasp Massage techniques

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