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Torticollis (Tilted Neck) and Plagiocephaly (Mis-shapen head) in Babies

by on March 6, 2013

Torticollis and Plagiocephaly in Babies
By Rhona Feldman MA, OTR/L, MOSAIC Center for Therapy Services, Seattle, WA
Torticollis is a condition where a baby’s head and neck tilt to one side. According to Robert E. Lyle, MD, “An involuntary one-sided contraction of the neck muscles can occur, resulting in an abnormal positioning of the head and limitation of the neck’s range of motion”. Typically there is a tightening of one of the neck muscles called the sternocleidomastoid (scm), that pulls the head sideways and toward the shoulder, turns the face toward the opposite shoulder and brings the head forward on the chest.
Torticollis is often diagnosed at or shortly after birth. It can be caused by the baby’s position in utero, during the birth process or by positioning or posture after the baby is born.
The incidence of Torticollis in babies has risen since the American Academy of Pediatrics initiated the national Back to Sleep Program in 1994. The program was created to decrease the incidence of Sudden Infant Death Syndrome, which it accomplished by decreasing the incidence by 40%. Unfortunately, it also created a marked increase in the incidence of positional head deformities in newborns, such as Torticollis and Plagiocephaly as babies started spending less time on their stomachs.
Plagiocephaly is a term meaning “misshapen head” and is the flattening of one side of the back of the head. It can be mild of severe and will sometimes correct itself. In severe cases it may require the wearing of a helmet or surgery to correct.
When diagnosed at an early age, Torticollis can be decreased by positioning changes and stretching. If left untreated in can limit a child’s ability to turn his or her head, see to both sides, hear and interact with the environment. It can also lead to cognitive and motor delays as well as delayed body awareness, muscle weakness and poor balance.
Treatment for Torticollis by an Occupational or Physical Therapist usually consists of family education that focuses on positioning, muscle stretches and exercises. Emphasis is placed on increasing “tummy time” so that pressure on the back of the head is relieved and the baby can learn to move in a more symmetrical manner.
Treatment for Torticollis can vary depending on the severity and the age of the baby, and will usually be recommended weekly for 3-6 months. Babies who are treated from an earlier age tend to recover much more quickly that those who are diagnosed after they are 5-6 months old. Early intervention is key.
If your baby seems to look to one side more than the other most of the time or has a flattened area on the back of his or her head, check with your doctor to see if there is a concern about Torticollis.
Always encourage your baby to look to both sides by using your voice or a toy to draw his or her attention. Make sure your baby spends time every day on his or her tummy.
If you have any concerns, be sure to ask your doctor to recommend an evaluation by a trained OT or PT. The effects of Torticollis can be long term and are very treatable. Ask your physician for a referral. We’re here to help.

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