What is Torticollis?
If you are concerned that your baby may have torticollis or has been diagnosed by your pediatrician, it may sound more frightening than it actually is. The word “torticollis” is derived from Latin meaning “twisted neck” and is a shortening or tightening of a neck muscle called the sternocleidomastoid. This thick, cord-like muscle runs from the back of the neck to the collar bone.
When the sternocleidomastoid is shortened, it changes the posture of the head and neck. Other neck muscles may be involved as well which may be addressed by a pediatric physical therapist. This does not hurt the baby and is a very common diagnosis in newborns.
How could this have happened?
There are many theories as to how torticollis develops and there is no definite answer. There are risk factors that may predispose baby to torticollis such as large birth weight, breech position, difficult labor and delivery, or maternal uterine abnormalities. It is believed that torticollis can be due to fetal constraint in the uterus (baby is abnormally positioned) which can sometimes happen in twin/multiple births. Also, use of external devices during a difficult labor such as forceps or vacuum-assist may cause torticollis. Other, more rare cases are due to ischemia, rupture of the muscle, neurogenic injury (like brachial plexus injury) or hereditary factors (like Klippel-Feil syndrome).
Signs and Symptoms
Most babies with torticollis develop normally and may have the following signs and symptoms:
- The head is tilted toward and rotated away from the tightened neck muscle
- Have a noticeable preference toward looking in one direction
- May prefer to roll in one direction
- Present with a slightly flattened side of their skull (called plagiocephaly)
- Have a small “bump” on the tight neck muscle much like a “knot” in sore muscles in adults
- May have difficulty with rotating their head during breastfeeding or bottle feeding
Diagnosis
If you are concerned that your baby may have torticollis, your pediatrician may do a physical examination of the baby’s head and neck posture. Your pediatrician may also check the hips to make sure your baby’s hips are stable.
Your pediatrician may also refer you to a pediatric physical therapist for more treatment. The physical therapist will teach you exercises you can do at home and how to position your baby during sleeping, feeding, and carrying. They may also do some gentle stretching and show how you can do this for your baby as well. Your therapist will also teach you how to work on developmental exercises so that your baby will strengthen and stretch all muscles to target the right milestones.
If you are concerned about other medical issues, please speak to your pediatrician. Your pediatrician may also screen your baby for any vision, hearing or speech issues.
What You Can Do At Home
There are things you can start right away at home with baby that may help with loosening the tight neck muscles:
- “Tummy time” is very important for baby’s neck and upper body strength. You can have baby do this on your chest, on your lap, in your arms or on a play mat. Place baby on his/her stomach and sing or talk to baby. Depending on the baby’s age, tummy time can range from 10 seconds to a few minutes. Make sure you are always watching baby and if baby fusses, you can give baby a break.
- When baby is playing on his/her back, try distracting baby with a toy towards the difficult side or lay down next to baby and sing or speak to baby. Baby loves your voice and may be more motivated to do this.
- While carrying or feeding baby, you can encourage baby to turn toward the more challenging side.
- If there is something in baby’s room that is causing baby to look toward the preferred side such as a window, you may have to rearrange baby’s crib to the other side.
It is important to do the exercises daily and to follow your baby’s home exercise program if given by your pediatrician or physical therapist. It is best that a medical professional show you how to stretch your baby’s neck. Always look for signs of discomfort during any of these activities and stop as needed. As baby gets older, the exercises may change to include balance activities.
Prognosis
Many babies get better within 6 months to a year if a home exercise program is followed closely. If conservative treatment does not help, you can talk to your pediatrician about other medical management such as surgical intervention or botox injection. Your baby may also be referred to a specialist if plagiocephaly (flattening of head shape) has worsened due to torticollis. The specialist may talk to you about having baby wear a helmet. Babies are constantly growing and you may see regression with torticollis as baby develops. Always check in with your pediatrician and/or physical therapist if you have any questions.
Thaomy Beltran
Thaomy Beltran, PT, DPT, PCS is a Physical Therapy board certified Pediatric Clinical Specialist. She is a part-time lecturer in the PT program at UCSF/San Francisco State University. She has over ten years of clinical experience in inpatient and outpatient pediatrics and adult care, aquatic therapy, and actively involved in the physical therapy community. Dr. Beltran is a kid at heart and is passionate about helping others and loves to see the smile on her patients’ face when they have learned a new skill. In addition to clinical work, she likes to play with her three children and immerse herself in a good movie. She hasn’t had an ankle sprain but had ‘tennis elbow’ and had to wear an arm brace when she played sports in school. She made sure she did all her exercises (well, some of them).
