New parents may be surprised to notice, or have someone else point out, that their infant holds his or her head at an odd angle. It may be even more alarming to hear the child’s pediatrician suggest that it may be torticollis and could require physical therapy. However, this is not cause for major concern, nor should a parent feel responsible or guilty. Congenital muscular torticollis is becoming increasingly common with doctors’ recommendation to put babies to sleep on their backs.
Positioning in the womb and the effects of a rough delivery can cause damage to muscles in an infant’s neck. This can lead to the shortening of the muscle. Visibly, the infant will be seen to hold his or her head in a tilted position with the chin pointed more toward one side. Holding the head in such a position can be encouraged by a baby’s sleeping on his or her back, as lying on the stomach helps to stretch the neck’s muscles. This is why the “back to sleep” movement seems to have increased the occurrence of torticollis in infants. Increased amounts of tummy time can help to counteract this effect.
Unfortunately, the parents may grow accustomed to seeing this, and it can fail to alarm them, making the diagnosis more difficult. However, pediatricians, who do not see the child all the time, are more likely to notice this. In addition to holding his or her head to the side, the infant may be delayed in rolling over, sitting, and crawling due to the discomfort that comes with motions which stretch the tightened muscle.
At first, the child’s pediatrician may recommend taking simple steps to help encourage the infant to stretch the muscle. These may include positioning the infant so he or she must turn the head against the tightness to see the people around him or her and placing toys on a specific side of the child so that he or she must stretch the muscles to play with them. If these suggestions fail to yield results, the doctor may send the infant to a physical therapist.
In physical therapy, the earlier mentioned steps will be continued. However, other steps will also be taken. Once the child begins the roll over, he or she will tend to roll to whichever side avoids stretching of the tight muscles. The therapist will work on encouraging the infant to roll to the other side. The parents will likely be asked to repeat certain stretches with the child at home, as well. In more severe cases, where therapy alone is not successful in treating the torticollis, surgery may be recommended or required.
Torticollis, and an infant’s subsequent hesitance to hold his or head in various positions, may lead to the formation of a flat spot on the child’s head. This is called positional plagiocephaly. If this does occur, the first step is to increase tummy time and try to encourage repositioning of the head while the infant is sleeping. If this does not bring about the desired results, the doctor may recommend seeing a specialist about the possibility of cranial remolding. This is accomplished with a helmet that is molded to fit the infant’s head. It helps to limit the growth on the rounded part of the head while encouraging outward growth of the flattened area. This is most effective before the child’s soft spot on his or her skull has disappeared.
Unfortunately, plagiocephaly can cause facial asymmetry. This can lead to possible jaw and other problems as the child gets older.
Early diagnosis and treatment of congenital muscular torticollis and any positional plagiocephaly it may cause is usually successful.