Torticollis
Torticollis, also known as wryneck, is the twisting of the neck that causes the head to rotate and tilt to one side due to tightness of the neck muscles. This condition can cause plagiocephaly (for more information see "what causes plagiocephaly".)
Etiology
There is not one specific known cause.
There are two types of infant torticollis including:
Congenital muscular torticollis occurs due to the baby's positioning in utero resulting in an injury to the neck muscles, specifically the sternocleidomastoid muscle (SCM). This can be more prevalent to firstborn children (sometimes accompanied by a potential congenital hip dislocation.)
Acquired torticollis occurs after birth and can be caused from irritation from the cervical ligaments from a viral infection, injury, or vigorous movement. Additional causes include:
Sleeping in awkward position
Neck muscle injury at birth
Burn injury
Oral tongue, lip, or buccal ties
An injury leaving heavy scarring and skin or muscle shrinkage
Neck muscle spasm
Slipped facets
Herniated disks
Viral or bacterial infection
Diagnosis
Torticollis is confirmed with a collection of medical history and physical exams. Physical exams may include checking range of motion in the head and neck, palpating the SCM muscle, observation of the head and neck anatomy, and/or observation of hip anatomy and rotation capabilities.
Ultrasound may be used to look for certain abnormalities in the spine for rare, but serious health conditions.
Best practice for stretching & repositing
If your baby has torticollis your pediatrician may teach you stretching exercises to do at home to help loosen the tight sternocleidomastoid muscle and strengthen the weaker muscles to help straighten your child’s neck. If the torticollis is severe, your pediatrician might recommend physical or occupational therapy early on.
Torticollis can get better with repositioning and stretching however it may take up to 6 months to go away completely, and in some cases may take a year or longer.
Stretching exercises to treat torticollis work best if started when a baby is 3–6 months old. If you find that your baby's torticollis is not improving with stretching, talk to your doctor and they can refer you for physical or occupational therapy. (Josephson, 2017)
If you have concerns with the progress your child is making, don't wait to voice them! Therapy can help you and your child and in no way puts them at a disadvantage for later in life. The "wait and see" approach is not for everybody especially if you know your baby is making little progress. You are your baby's voice and biggest advocate.
Repositioning
Repositioning is effective up to a certain point. The main idea is to lay the baby with their head on the less flat side. This usually then requires the baby to rotate their neck into the unfavored position. You can get creative with positioning to help them tolerate the less comfortable side. See our post on repositioning.
While repositioning is effective, placing baby on back to sleep is still best practice recommended to prevent sudden infant death syndrome by the AAP.
Don't Forget About Tummy Time
Laying your baby on their stomach for brief periods of time while they are awake is an important exercise to help strengthen neck, back, and shoulder muscles and prepares your baby for crawling. Exercise is especially helpful for a baby with torticollis. Here are some tips:
Lay your baby on your lap for tummy time. Position your baby so that his or her head is turned away from you. Then, talk or sing to your baby or place toys in front of them to encourage him or her to turn and face you. Practice this exercise for 10 to 15 minutes. (Josephson, 2017)
When your baby wants to eat, offer the bottle or your breast in a way that encourages your baby to turn away from the favored side.
When putting your baby down to sleep, rotate them so their preferred way of laying faces them towards the wall. Since babies prefer to look out onto the room, your baby will actively turn away from the wall and this will stretch the tightened muscles of the neck.
During play, draw your baby's attention with toys and sounds to make him or her turn in both directions. (Josephson, 2017)
For more tips on tummy time see our post on repositioning or download our Tummy Time Toolkit download from the link below:
References
Cohen, D. A. (2020, September 1). Can Chiropractic Help with Torticollis in Infants and Children? Corrective Chiropractic. https://www.correctivechiropractic.com/blog/can-chiropractic-help-torticollis-infants-children/.
Infant Torticollis. Osteo2go. (2020, April 24). https://osteo2go.com/blog/paediatric/infant-torticollis/.
Patricia Solo-Josephson MD. (2017, July). Infant Torticollis. Kids Health. Retrieved from https://kidshealth.org/en/parents/torticollis.html#:~:text=Most%20babies%20with%20torticollis%20get,is%203%E2%80%936%20months%20old.
Torticollis (Wryneck). Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/torticollis-wryneck.