My baby’s head is tilting or turning predominantly to one side. Torticollis is a common musculo-skeletal condition in infants affecting up to 16% of otherwise healthy infants. It is the third most common pediatric diagnosis in infancy. The main signs are that a baby prefers to turn/ rotate his head towards one side much more than the other side and that he tilts his head sideways. A typical scenario is “my baby only turns her head to the right and cannot hold her head in the middle.” “Her left ear is closer to her left shoulder.” Of course, this can also occur in the opposite direction.
Babies are frequently referred to physical therapy by their doctor at their 2, 4 or 6 month appointment. If you notice that your child is having difficulty with neck rotation to one side or consistently tilting their head to one side communicate this concern to your physician. Early diagnosis and physical therapy often have quicker results.
Why does this happen?
We have many neck muscles to help us turn and tilt our heads and look up and down. The main muscles affecting torticollis are the sternocleidomastoids. This is a big name for the muscle that attaches from behind the ear and connects down to the collar bone and breastbone (sternum). We have one on each side. If for instance the left one is tight, we tilt our head to the left and turn to the right.
What causes the tight muscle?
It is very hard to tell what factor caused torticollis, it is more important to resolve it. Many factors may play a role, such as in utero positioning, (higher incidence in multiple births,) head shape at birth, or being placed to sleep with baby’s head always turned to the same side.
What do I do for my child?
First be aware if your baby prefers turning mostly to one direction and/or if your baby consistently tilts to the same side, communicate this to your doctor.
Your doctor may decide that physical therapy is necessary. You will need a prescription from your doctor for physical therapy. Your physical therapist will teach you how to improve your baby’s muscle range of motion and then how to strengthen the muscles for improved movement.
Is treatment necessary?
A physical therapist will perform an evaluation. She will identify your baby’s needs and will often teach the parents a home exercise program (exercises & helpful hints). Treatment frequency will be based on your individual child’s needs. Because children acquire so many gross motor skills so quickly, symmetry is important to overall development.
The therapist or doctor might recommend a therapeutic molding helmet evaluation if one side is significantly flat. A child will sleep on the flat spot reinforcing the flatness. A molding helmet allows for head growth where the flat area is and an improved head shape.
What else can I do?
Homework! Many of the exercises can be incorporated as you interact with your baby, play with our baby, and carry your baby. There are some critical stretches that need to be performed frequently, but the majority of exercises can be addressed during play time.
Tummy time is very important! If your baby is not a fan of tummy time, work on increasing seconds to minutes. When you lie down on your back semi-upright have your baby lie on your chest. Supported sitting, sitting, and holding your baby are all ways to introduce more positions.
What is the best piece of equipment for my baby?
Your arms! We have many more gadgets available now for babies than ever before. In our busy lives we often securely place our children in these gadgets for prolonged periods of time. The baby is remaining in one position. This hinders the baby’s ability to move and explore. Torticollis and head flatness may resolve more slowly or worsen if the child is left in the same position.
Torticollis is a common condition. When identified and addressed, 90% of children achieve a good to excellent outcome in the resolution of their torticollis and continue to achieve their milestones.
—Amanda Froling, MPT and Carol Buell, MPT
The information in this article was compiled from the following recommended resources:
Cheng, J.C., Tang S.P., Chen, T.M., Wong, M.W., Wong, E.M. 2000
Karmel-Ross, K. 2006.
Stellwagen, L, Hubbard, E, Chambers, C, Lyons, K. 2008
Rabino,S, Peretz, S, Kastel-Deutch, T, Tirosh, E. 2013