Torticollis – What Every Parent Should Know
By Barbara Greenspan, OT
One of the first cases I saw when I first started treating children, was a 9 month old with a diagnosis of torticollis. I received the diagnosis verbally on the phone prior to seeing him. Upon observation, all I saw was an adorable baby boy who had a bit of difficulty turning his head. Since then, I have treated several cases of torticollis, including my niece who spent the better part of the last trimester breach. I have never treated a case that did not quickly resolve and I would like to bring this condition to your attention because it is so easily treatable when caught early.
The condition is called Congenital torticollis. Also known as "wry neck", Congenital torticollis is a shortened state of a large muscle in the neck called the sternocleidomastoid, (SCM). A SCM muscle is located on each side of the neck. Acting independently this muscle side bends the neck to the same side, while at the same time rotates the head to the opposite side.
In cases of torticollis, one SCM muscle is usually chronically contracted which results in bending of the neck to one side with the face rotated towards the opposite side. The infant will usually have a preferred head position when lying supine (on his back) or when being held. Please keep in mind that it is not unnatural to have a preferred head position and is not always indicative of torticollis. To rule out this condition, observe your child while tracking objects back and forth in front of the infant’s face. With torticollis,he will have difficulty turning his head toward the affected side. When the muscle is touched, one side will feel less resistant to touch and will appear more prominent.
In more severe cases there may also be a flattening of the head (plagiocephaly) from constant positioning on the affected side. Plagiocephaly is often the result of untreated torticollis.
Factors that can contribute to the risk of torticollis include malpositioning of the infant’s head in utero, and a difficult delivery. Some believe that the condition is exacerbated because of recommendations for parent to place their infants on their backs to sleep (this is recommended to prevent SIDS). The good news is that torticollis that is caused by the previously named risk factors can be treated conservatively.
First off, if you suspect your child has torticollis, contact your pediatrician immediately.
The following techniques will help to eliminate the torticollis as well as strengthen your infant’s neck and shoulder girdle.
Positioning: When sleeping on his back or when in a recumbent (reclined) position, try to position your child’s face away from the affected side. This can be achieved with a towel roll or better yet, by rolling a nice, soft blanket such as the Soft and Snuggly Blanket. If you feed your child with a bottle, be sure to switch sides when holding the baby; don’t just feed to one side. The Clip and Go Mobile can be placed on either side of a stroller or car seat to encourage head rotation to both sides.
Visual Tracking: Place your baby on his back and encourage him to track objects with his eyes and facilitate rotation of the neck by placing the object he is tracking on the floor beside his face. Try to pick objects which will pique his curiosity. We recommend the Night Light Soother which will attract his attention with the lights and sounds. You can even record your voice to issue instructions to your infant. The Rockin’ Aquarium Gym has so many interesting objects placed in an arc over his head which will also help to promote head rotation.
Tummy Time: Placing your child on his tummy and encouraging him to lift and rotate his head will help to strengthen the posterior (antagonist) muscles of the neck and will counter the shortening of the SCM. This also helps to strengthen the shoulder girdle and prepare your child for crawling. Ebeanstalk has several play mats to help you with this. My favorite is the Kick and Play Playground. Another option which is more portable is the Taggies Look At Me Mirror which will entice your child with images of his own face!
Massage: Consult with a therapist or pediatrician for instruction on how to massage and stretch the muscle. This can be performed several times a day.
As mentioned before, it is not uncommon for a child to have a preferred head position. If this is the case of your child, check his ability to turn his head from side to side and consult with your physician. More often than not, if caught early, the condition is easy to remedy.
If you liked this article, you may also want to read our other developmental articles: