EXPERT ADVICE: Torticollis & Plagiocephaly

Photo Credit:  www.cranialtech.com

 

 

Sometimes we think it’s a cute attribute that our baby is always turning their head to pose for the camera. Sometimes it’s your best friend who said their kid did that “head turning thing” but it went away in a few weeks. Sometimes it’s the pediatrician who asks you if baby always looks that way. Then there’s the time that you have prepared yourself and you know when to ask, does my baby have torticollis?

 

What is torticollis? 

Technically speaking, torticollis is the tightening/shortening of the sternocleidomastoid muscle or SCM. It is a long muscle in the neck which starts behind the ear and has two attachments at the middle and sternal ends of the collarbone. The muscle rotates the head opposite the side of the muscle and laterally flexes (bends) the ear toward the shoulder on the same side of the muscle. When restricted, your baby will bring the ear to the shoulder on the tight side and they will then look in the opposite direction. Torticollis can also cause facial asymmetry and skull asymmetry as the head tilts in one direction, squeezing one side and lengthening the other. 

 

Why does my baby have torticollis?

The answer can be many reasons. Torticollis can begin in utero. If a baby is either stuck or comfortably sitting in one position for days or weeks at a time the muscles can begin to shorten before birth. Then when born the baby already has a preference to look in one direction or bring one ear toward the shoulder. Another reason a baby may have torticollis is sleeping position. If baby is in the bassinet from day one and positioned to look at mom or baby chooses to look at the tag on the bassinet wall, they will develop a preference for this position. A third reason for developing torticollis can be from “bucket syndrome”. The more time baby spends in car seats, rock and plays, bouncers, and strollers, the more time the neck is in a flexed or crunched position. Lastly, your baby may have tethered oral tissues (ie: tongue tie). When the tongue is tied down to the bottom of the mouth (typically posterior tongue ties that can’t be obviously seen if not a professional) a one sided restriction/tightness can take place down the entire length of the body. This tightness can present itself as torticollis. In addition, a tethered tongue can block a baby’s airway. In this case, babies often bring their head and neck back into extension and to either side in order to open the airway again. 

 

What is Plagiocephaly?

One of the main contributing factors and/or effects of torticollis is plagiocephaly. Plagiocephaly/brachycephaly is when the bones in the skull begin to flatten in response to prolonged pressure. This may be from the baby sleeping on their back for multiple hours in a row at night. It may also be from being contained in a car seat/swing/bouncer too often with not enough freedom of neck movement. Plagiocephaly and torticollis go hand in hand like the chicken or the egg. Either plagiocephaly happens first in which the child only looks one way because they are lying on the flat spot and therefore it becomes difficult to turn the head in the other direction resulting in torticollis. The opposite would be that a child has torticollis which doesn’t allow them to turn their neck in the opposite direction leaving them stuck resting/sleeping in one position causing plagio/brachycephaly .

 

How is torticollis treated?

Torticollis is treated in many ways. The most addressed way to treat torticollis is to stretch the muscle. This means bringing the ear away from the shoulder on the affected side. I find that solely stretching isn’t the most effective tool as the baby is often irritated by the action. I prefer to “stretch” through positioning. For example holding the baby football style in order to separate the ear from the shoulder while walking around the house is a gentle and soothing way to stretch. In addition, I like to focus on fascial release from the elbow up to the ear. There are spider webs of connective tissue which can be twisted and pulled from any direction. Addressing the whole fascial chain will allow the body to relax much more than just treating the neck. This theory also holds true for a technique called CranioSacral Therapy. CST will address the body as a whole, allowing fascia to be freed throughout the body and cerebrospinal fluid to flow smoothly, thus allowing the neck to correct. Positioning is key when treating torticollis. The family must be consistently paying attention to the way baby is holding their head. If the head is in the affected position, baby must change positions. This includes sleeping, in strollers, and car seats. It is also important to strengthen the unaffected side. When the SCM muscle is tightened on one side of the body, the opposite SCM becomes over stretched. It is important to activate the unaffected SCM through exercises such as tummy time and head righting. 

 

The importance of tummy time.

Tummy time is amazing for many different reasons including growth, strength, and calming the nervous system. With regards to torticollis, tummy time will allow a child to actively move their head back and forth to look at and engage with their parents. Active rotation while engaging the nerves in the brain will naturally help to work out the tight muscles caused by torticollis. In addition, tummy time means that the child is not putting pressure on those tight skull bones so that flattening will not continue. 

 

How do I  prevent torticollis? 

As soon as baby is born make sure they are turning their head in both directions. This includes when sleeping, on the play mat, and changing table. Make sure you limit the amount of time baby spends in buckets/containers including bounces, strollers, car seats, rock and plays. Place baby in tummy time (on your chest/lap/floor) as much as possible. Seek treatment early. If baby shows a slight preference for one side seek out a therapist who is trained as soon as possible. Mild torticollis is easy to treat but severe torticollis can take months to correct.

 

 

Elizabeth Morel is the owner of Little Movers PT, Physical Therapy for mom and baby. She provides innovative hypopressive training for core and pelvic floor restoration. She also provides pediatric physical therapy and craniosacral therapy for babies with a specialty of breastfeeding support. You can find her at littlemoverspt.com , Facebook Little Movers PT and instagram @littlemoverspt

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