Due to keen interest from our followers, Small Steps has shared a lot of information on plagiocephaly over the past few months. But many parents may not be aware of the common link between plagiocephaly and torticollis. We asked Sally Hews of the London Orthotic Consultancy to tell us more about this condition, what to look out for and what can be done to address it.
What is torticollis?
Congenital muscular torticollis or infant torticollis is a condition which occurs in young infancy. It involves shortening or tightening of the sternocleidomastoid muscle (SCM muscle) in the side of the neck – this is the muscle that is responsible for moving the head. In Latin “tortus” means twisted and “collum” means neck, so the term torticollis translates to ‘twisted neck’ and is sometimes referred to as ‘wry-neck’, ‘stiff-neck’ and ‘crooked-neck’. ‘Congenital’ means present from birth.
Congenital muscular torticollis is very common and occurs in roughly 1 in 300 births, but sometimes it can go unnoticed until your baby is about 6-8 weeks old – because this is the period when they develop the strength to control their head and neck.
What causes torticollis?
Experts are unsure as to what the exact cause of torticollis is in young babies. It is thought to be attributed to the position in the uterus, or direct trauma to the SCM muscle during delivery which causes the muscle to tear, in turn creating scar tissue that makes the muscle tight and hard.
Other possible causes include:
- Spine misalignment in the uterus
- Foetal muscles or blood supply injured in the uterus
- Abnormal birth presentation, such as the breech position
- Vacuum extraction
- Forceps related injury
In rare cases, congenital torticollis can be caused by bone abnormalities in the neck area of the spine or an underlying genetic condition. Environmental factors such as spending too much time in a bouncer, pram, buggy or car seat can also exacerbate a stiff neck.
How can I tell if my baby has torticollis?
Torticollis is usually diagnosed within the first 2 months of a baby’s life but it can be hard to spot. Torticollis symptoms are:
- head tilted in one direction
- limited neck movement
- preference for looking at you over one shoulder instead of turning to follow you with his or her eyes
- difficulty breastfeeding on one side or showing a preference for one breast only
- working hard to turn towards you and getting frustrated when unable turn his or her head completely
- chin pointing up
- asymmetrical face, indicating plagiocephaly
- in some cases, a small lump in the neck muscle
There may also be a lump present in the side of your baby’s neck when the SCM muscle is tight, this swelling is likely to gradually become smaller after the first month of life and, by the age of 4 to 6 months, will usually have disappeared. Babies can also have torticollis without a lump present.
What is the link between torticollis and plagiocephaly?
If not corrected, babies with torticollis often develop plagiocephaly or flat head syndrome. In fact, plagiocephaly is reported in 80 - 90% of infants with congenital torticollis. This is because they will lie in their cot in the same position every night to reduce the discomfort in their necks – which in turn increases pressure on certain parts of the skull. At The London Orthotic Consultancy, we have found that torticollis is the primary cause of plagiocephaly in the babies that we examine.
Can torticollis be treated?
The condition can improve with exercises like tummy time and repositioning which allow the neck muscles to grow and stretch. However, physiotherapy is the recommended treatment offered to infants under 3 months of age. The Journal of Manual Medicine states that passive stretching helps 97% of all infants with torticollis as long as the condition is diagnosed in a timely manner and treatment starts as soon as possible.
A GP or Paediatric Physiotherapist can advise on how to position your infant during play, eating and feeding to help stimulate their neck muscles. Encourage your baby to spend as much time as possible playing on their tummies during the day. You can also hang toys above the opposite side of the cot to their preferred side to encourage them to turn.
It’s important to seek treatment early if you think your baby might have torticollis – both because treatment is very effective in early infancy and because, if left untreated, a baby could develop significant plagiocephaly. Long term risk factors may also include delayed motor skills, impaired coordination, neurodevelopmental delay and scoliosis later in life.
Can I prevent my baby from developing torticollis?
Unfortunately, because it’s not yet fully understood why some babies develop torticollis in the uterus, it is impossible to prevent. After birth, babies spend most of their infant lives on their backs - so positional plagiocephaly is also tricky to avoid.
How can I seek help for my baby's torticollis or plagiocephaly?
If you suspect your child may have torticollis, go to your GP for a diagnosis. If the condition is confirmed, you should then be referred to a Paediatric Physiotherapist for a course of gentle stretching exercise. If you also suspect your baby might have plagiocephaly then a specialist Orthotist should be consulted. If you are concerned about your baby’s head or neck and would like a fast, free opinion from one of LOC’s experienced clinicians, you can use the LOC flat head diagnosis form and receive a response within 24 hours.