Torticollis is a term to describe the asymmetrical posturing of the head and neck.  It is the third most common musculoskeletal condition found in babies and children.  About 1 in 200 babies have Torticollis, and present with a shortening of a muscle (the sternocleidomastoid muscle, or SCM) in their neck causing their head to tilt to one side.  Most of the babies who present with Torticollis in the first year of their life have Congenital Muscular Torticollis (CMT).  Congenital just means it was present at birth.


What will I see?

• Usually if a child has Torticollis you notice that the baby’s head is usually turned to one side, and they find it difficult to turn to the other side.
• Baby’s head is also usually tilted so they seem to be looking up as well as to the side.  This is due to the shortened muscle on the other side of the neck pulling the head into position.
• Sometimes, as well as the muscle feeling tight, there can be a small lump in the middle of the muscle, like the size of a pea.

In this condition, the head is always turned to one side the face and head can be misshapen, so it’s best to start treatment to prevent further changes in shape. The misshapen head occurs to pressure always being on the same part of the movable bones in a babies head, rather than a more even distribution of pressure facilitated by free movement of the neck in all directions. This is called positional plagiocephaly.

In my experience it also appears to be occurring more as we now only sleep babies on their backs due to SIDs prevention knowledge. It is essential that parents follow the guidelines about safe sleeping , but also ensure that when baby is awake that they allow baby lots of tummy time (more than 3 times each day) plus supervised play time in side lying. This changes the mechanical pressure on the head causing positional plagiocephaly (misshapen head). Take a look on the SIDS website. http://www.sidsandkids.org/documents/HeadShape_2009_10.pdf


What Causes Torticollis?
This is poorly understood still, but research to date has presented the current theories of the usual cause being:

• the position the baby was in the womb before birth
• birth trauma

What do I do?
Your maternal health nurse can check for you and refer you to a local paediatric physiotherapist.  You are also free to contact a physiotherapist directly to make an appointment.  Physiotherapy has been shown to be the effective treatment of this condition.  You may like to reassure yourself by visiting your paediatrician and ruling out any other possible (but rare) conditions that can have associated Torticollis.  Surgery is occasionally needed.

The earlier you start physiotherapy the better the outcome for your baby.  If the muscle is not stretched it could become permanently tight. Physiotherapy will help you in stretching, positioning your baby to play and sleep, and find ways to carry your baby to improve the head position. Your paediatric physiotherapist will also teach you ways to encourage active movement of the head and neck. This is a muscular problem, not spinal, so “adjustments” of the spine will not resolve the problem. Massage alone also does not address the underlying problems.

References:

• Physiotherapy in Paediatrics (1995) R. B. Shepherd
• The differential diagnosis of torticollis in children.  Physical and Occupational Therapy in Pediatrics (1997j 17/2):1-11
• http://www.sidsandkids.org/documents/HeadShape_2009_10.pdf

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This article was kindly written for Bub Hub by Margaret Charlton from Blackburn North Physiotherapy Centre, members of the Australian Physiotherapy Association. 

ph:  (03) 9877 7304
address:  74 Surrey Road, Blackburn North  VIC   3130

Margaret Charlton, Physiotherapy (Paediatrics)