TORTICOLLIS
WHAT SHOULD I EXPECT DURING THIS TREATMENT FOR MY BABY?
In 1992, the American Academy of Pediatrics began their “Back to Sleep” campaign to reduce Sudden Infant Death Syndrome (SIDS). The campaign was successful in reducing SIDS by 40% in the United States, but has resulted also in contributing to the development of torticollis in about 1 out of every 250 infants. In addition to babies now sleeping on their backs, newer car seats are also serving as infant carriers, which fasten directly into strollers and swings without having to remove the baby from the seat. This is leading to a generation of babies spending prolonged periods of time in one position. In addition, the incidence in a higher number of multiples has led to increased torticollis, as the babies frequently “run out of room” in utero and are in a sustained position for a longer period of time in the third trimester. Other contributing factors potentially leading to earlier onset torticollis are: larger babies, “good sleepers” or young babies who sleep for prolonged periods of time without much positional change, an overstretching or pull during assisted vaginal delivery, premature babies who are not able to be repositioned off of their backs much in the first weeks of life, and other corresponding medical diagnoses that lead to immobility of an infant.
What is torticollis?
Torticollis is a condition when the muscle on the sides of the neck becomes tight, weakened, or thickened causing a head tilt. Torticollis can come in many different forms, sometimes infants can be affected within the first 2 months of life due to birth trauma, or sleeping /remaining in one position for prolonged periods of time. Other times, visual deficits, cervical spine abnormalities, infections, abnormalities to the sternocleidomastoid muscle and more can affect their posture and result in torticollis. Torticollis is important to address because it can lead to:
- Flattening of the skull (plagiocephaly) in infants
- Movement that favors one side of the body, affecting the arms, trunk, and hips. This can lead to strength imbalances, such as an elevated shoulder and side-bending of the trunk.
- Developmental hip dysplasia
- Scoliosis
- Limited ability to turn the head to see, hear, and interact with surroundings, which can lead to delayed cognitive development
- Visual scanning deficits
- Delayed body awareness or lack of self-awareness and interaction
- Difficulty with balance
How is torticollis diagnosed?
Torticollis is commonly diagnosed via physician at the 2 or 4 month well visit checkups but an experienced physical therapist may also be able to identify if an infant has torticollis. If torticollis is a result of a musculoskeletal issue, pediatric physical therapists are the most skilled interventionists to provide treatment. Commonly, early treatment will result in the best and quickest outcome.
What to expect with treatment for torticollis?
Limitations due to torticollis should start to improve after receiving initial intense treatment for 4-6 weeks. A referral to a specialist about alternative interventions may be recommended if after 6 months of treatment, moderate resolution is noted, an infant is older than 12 months on initial examination and there is a significant facial asymmetry present, the infant is older than 7 months on initial exam and a tight band or SCM mass is present, or if the side of the torticollis changes.
Physical therapy services are recommended until the infant has full passive range of motion, symmetrical active movement patterns throughout the passive range, age-appropriate motor development, no visible head tilt, and parents/caregivers understand what to monitor as the child grows. The goals of physical therapy for the treatment of torticollis typically focuses on strengthening muscles, improving postural control, gaining range of motion, improving symmetry of movement, and achieving balance at midline. These goals can be achieved through stretching, strengthening, massage, positioning, taping, visual activities and most importantly, home exercise programs that the family implements on a daily basis.
It is also recommended that after discharge, a physical therapist provides follow up screenings of infants 3 to 12 months post-discharge or when the child initiates walking, to assure no asymmetries or head tilt has progressed into this important phase of upright movement.