Torticollis

Torticollis is generally diagnosed as being present at birth (congenital) or acquired (developing later in infancy or childhood). Despite being present at birth, congenital infant torticollis is not usually seen until the baby is several weeks old and begins having more control over their head and neck movement. 

Congenital muscular torticollis results from the shortening and contraction of the Sternocleidomastoid muscle (SCM). This muscle runs along both sides of the neck and controls head movement from side to side and up and down. A few possible causes include:

• Your baby’s position in the womb before birth
• Abnormal development of the SCM 
• Damage to the muscle during birth

Acquired torticollis can be caused by many issues ranging from mild to very serious. This type of torticollis can be caused by:

• A mild, usually viral, infection
• Problems with vision known as ocular torticollis
• An adverse reaction to a medication also known as a dystonic reaction

Torticollis can often be diagnosed based on medical history and a physical examination. In some case, an MRI or x-rays may be required if your child’s doctor believes the underlying issue is a skeletal one. 

When discussing your baby’s medical history expect the doctor to ask these types of questions:

1. When did the torticollis develop? Was the onset sudden or gradual?
2. Was there any trauma or injury to the head or neck?
3. Has your child had a fever or infection?
4. Have you taken note of any other symptoms?
5. Has your baby been exposed to any medication or other potentially harmful substances?

During the physical exam your child’s doctor will perform the following:

1. Check the range of motion in your child’s head and neck
2. Feel the SCM muscle on both sides of the neck. Approximately one of every three cases of congenital torticollis involve a lump or “pseudo tumor” on this muscle
3. Look for the presence or absence of asymmetry of your child’s face and head that indicates a condition called plagiocephaly. While the term “torticollis” may sound complex or intimidating, the condition itself simply indicates that one side of the face and neck are more developed due to the pull of the neck muscles.
4. Examine your child’s hips and their range of motion. Babies with congenital torticollis have a slightly higher risk of developing hip dysplasia. 

As with the majority medical conditions, the earlier torticollis treatment is started the more positive the outcome will be. Physical therapy is the frontline treatment for congenital torticollis and is most effective when your baby is three to six months old. The pediatric physical therapists at Hogg Therapy are among the best in their field and will provide you with all the tools and knowledge to help you and your child be successful. It’s important to be consistent with your child’s physical therapy appointments as you may not see full improvement until your baby has been in treatment for six months.

Some helpful tips before you get started in physical therapy are: 

• Encourage your infant to turn their head in both directions by using favorite toys and novel sounds to get their attention. Keep in mind that your baby cannot injure their neck when turning it on their own. 
• During feeding times, offer the bottle or breast in a way that invites your baby to turn toward the non-preferred direction. 
• When putting your child to sleep, place them on their side facing the bedroom wall. Babies are naturally curious, and this placement will cause the baby to actively turn in order to look out into the room. This movement will stretch tense muscles and create tension in the loose muscles. 
• Limit the time your baby spends in spots where their head is likely to rest in a stationary position, such as swings and car seats. 
• Allow your baby to engage in lots of tummy time! If your infant becomes distressed while on the floor propping them up on your chest is also considered tummy time.