Diagnosis Discussion- Torticollis

Torticollis is one of the most common diagnoses I see working in outpatient pediatrics among patients under 6 months old.

Torticollis can sound like a big scary word, so here’s some info on this diagnosis:

Torticollis can mean a few different things.  But basically it is a twisting of the neck, where one’s head is tilted one way and rotated the other way, usually because of a tight neck muscle (sternocleidomastoid).

I gathered most of the following info from babycenter.com

• The patients that I see usually have congenital torticollis, which means they were born with the neck condition, usually because of position they were stuck in a little too long in utero.
• Congenital torticollis can also be caused by “abnormalities in the bones of the neck (the cervical vertebrae). The bones may be abnormally formed, stuck together (fused), or a combination of both. This condition is known as Klippel-Feil syndrome.“
• Infants can also have acquired torticollis which is torticollis that develops after birth.
• Babies with torticollis may also develop positional plagiocephaly (asymmetrical head shape) because they’ll often sleep with their head turned to the side.

If torticollis isn’t addressed early on (as early as 2 months old), patients tend to get (plagiocephaly) a flat spot on the side of their head that they’re always turning to.  If the flatness continues to progress, it can affect a child’s facial symmetry.

• larger forehead on 1 side
• 1 ear pushed forward
• Eye and cheek on flat side tends to look larger

If the head shape does not begin to resolve by the time the child is about 5 months old, a physician may recommend a helmet to help improve the child’s head shape.  In my experience, insurance companies have been more willing to approve the helmet if the child has facial asymmetries but not if they only have a flat spot on the back of their head.

Some sample helmets I found on google images:

       

So now if you see a baby with one of these cute helmets, you’ll know why they probably have one 🙂

Remember, the helmet’s purpose is purely cosmetic to just help to correct head shape.  Having a helmet but not addressing the cause of the changing head shape will not fix the problem! 

The reason I bring up torticollis as one of my first diagnosis discussion posts is because almost all my parents tell me that they wish they knew about this condition when their kids were born so they could have noticed it and taken care of it sooner.

Some common questions:

How do I know if my child may have torticollis?

• if your child is always looking to one side (ie sleeping with their head only to one side, even when you turn them the other way, or always looking in 1 direction when they’re awake).
• if your child’s head is always tilted in 1 direction
• your child may start to have a flatter spot on back/side of their head

What to do if you suspect it?

• go talk to your pediatrician to see what the next best step should be (it’ll likely be to go get a physical therapy evaluation)
• start arranging your child’s environment to encourage them to look in the opposite direction.  You can move their crib around, you can put all the interesting toys on the other side, and add a mirror to the side you want them to start turning to.

Where do I go to get a helmet?

• Your insurance company will likely have a company in their network.  Sometimes they have no idea who makes a torticollis helmet.  In that case, tell them you need someone who is an orthotist or a company that makes prosthetics and orthotics.

What can I do to prevent head flattening (plagiocephaly)?

• Tummy time!!!  Refer to my past post about tummy time.
• Any time off the back of their head is important to improving or maintaining appropriate head shape.

What are the negative affects of an uncorrected torticollis?  Here are a few…

• A helmet will only help the head shape, but if the head positioning isn’t corrected, you can also have the following effects:
• Vision can be affected because your child may not be fully able to track objects with their head only turned to one side.  As a result they can have delayed tracking, which can delay their interaction with objects in their environment.
• Fine motor skills and hand use can be affected as babies tend to use the hand they see more when their head is turned.  This can delay fine motor skills as they will not be using both hands equally.
• Gross motor skills can be delayed. These include progressing tummy time, as 1 side of the neck will be weak as a result of a baby always looking in 1 direction.  This can lead to a delay in the milestones following tummy time such as rolling and crawling.
• Balance can be affected since our balance centers depend on holding our head in the middle, and if a child is always tilted, the body will begin to think that the tilted position is the correct position.  A delay in developing age-appropriate balance can also lead to a delay in gross motor milestones.

What will a physical therapist do if I take my child for an evaluation and treatment?

• A PT will evaluate your child to determine the cause of the head position preference (why they prefer to look in one direction or why they have their head tilted most of the time).
• They will work on stretching your baby’s neck if there is muscle tightness present
• They will work on strengthening your baby’s neck muscles, since 1 side tends to be weaker
• They will work on overall head and trunk control to improve your child’s head and trunk alignment
• They will work on progressing milestones if the position preference is causing a delay

Any parents out there have experiences with torticollis you’d like to share?  Any therapists want to add any other info they think parents should know?

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Categories: Child Development, Diagnosis Discussion

Tags: health, pediatrics, physical therapist, physical therapy, rehabilitation, torticollis

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