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Torticollis
Over the past few years the Centre has received an increasing number of referrals for infants with torticollis. With this condition, tight muscles on one side of the neck cause the head to be tilted to one side and turned to the opposite side. Muscles on the opposite side of the tilt are stretched and become weaker. If the head is tilted to the right a diagnosis of right torticollis is given and if it is tilted to the left then it is a left torticollis. This generally causes flattening of the skull referred to as plagiocephaly. Sometimes there may be some flattening due to positioning in utero. Depending on positioning after birth the amount of flattening may increase to the degree that the back of one side of the head is flat and the face on the opposite side is also flat (eye, ear and cheek may be smaller as well).
There are a number of ways that caregivers can position babies to help prevent skull flattening:
- Place baby on his tummy for short supervised periods when he is awake throughout the day. A rolled up towel under the chest is one way that weight can be taken off the baby's head and make it easier for him to tolerate this position. Initially tummy play is difficult as a baby's head is large and weighs a lot compared to the rest of his body. Brightly colored toys placed in front of him will keep his interest so he will stay for increasingly longer periods.
- Encourage baby to follow your face or colorful objects to both sides and become aware of both hands. Babies should not have a head preference to one side or a hand preference.
- Car seats should be used only when traveling. Having your child in an upright position before he develops adequate neck strength will often result in your child holding his head tilted markedly to one side. If necessary towels can be used to maintain the head in midline - both in car seats and other baby equipment such as infant swings. It is important that both eyes and ears are level.
- During the day, change baby's position frequently. He can also play on his sides with a firm blanket rolled up at his back. At sleep time a commercial crib roll can be used to roll baby slightly off his back, getting pressure off the flattened area but not allowing him to roll onto his tummy. Baby should be placed on his back for sleep to avoid Sudden Infant Death Syndrome (SIDS). Each night, change the baby's position so that the head is at the opposite end of the crib encouraging him to look to the door, window or inside of the room.
If you have concerns regarding your baby's head shape or neck position, which appears to remain the same or become worse, then a doctor's appointment with a referral to a physiotherapist is recommended.
The therapist will teach the family specific exercises for the baby to achieve neck flexibility and strength as well as proper positioning. If the baby is diagnosed and referred quickly a better outcome can be achieved in less time.
Submitted by: Diane Metcalfe, Physiotherapist and Hélène Mercier, Physiotherapist
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