There are a variety of factors that play a role in the development of torticollis (stiff or tilted neck) and plagiocephaly (flattened head areas) in infants. It can be related to factors in-utero (space, first baby, location) and birth related factors (assisted or complicated deliveries). One large contributing factor is also the reluctance of parents to place their babies on their fronts as well as keeping their babies in carrier (container baby). Our Oakville Physiotherapists have treated many infants and babies with torticollis with an interplay of these reasons.
The contributing factors within our control are is the resistance to tummy time and use of containers the can be switched to the car, the stroller and to swings.
We are far more educated due to SIDS campaigns about the risks of babies sleeping on their tummies. The unfortunate carry-over is the fear or resistance to placing baby on their tummy during waking hours.
Another factor may be that baby is fussy on their tummy and doesn’t tolerate much time. While this may be the case, this fussiness should be explored. How is their latch, do they have reflux? are they colicky? Perhaps with these symptoms they should also be assessed by a qualified paediatric dentist for tongue or lip tie.
When a baby is born the bones of the skull are not fused. They are flexible and the shape of the head is determined by the position the baby assumes. The first 6-8 weeks is very important in the development of the head and skull. A baby that stays on their back or in a carrier all the time is at risk of developing a flattened spot on the skull. If baby always has their head turned to one direction they could develop a flattened area on the side of the head. This can also carry over to facial asymmetries. This can be alarming for some parents cosmetically. With a flattened area, babies head is more likely to turn to that side which leads to a tightening of the neck muscles on that side. This is difficult for baby to correct as they have not developed their neck muscles against gravity.
Tips to Prevent the Development of Torticollis and Plagiocephaly:
- Make sure baby has a variety of position changes when they are awake. These changes in positions are also important for the baby to strengthen muscles used for the development of gross motor skills such as rolling, crawling, and sitting.
- Tummy time and sidelying time that is supervised is important. Newborns can be places in chest to chest or an inclined position during snuggle times. As baby gets older adjust where the toys are so baby looks both ways and a variety of angles.
- Avoid long periods of time in the car seat, swings, crib, floor. If you’re busy try baby wearing, this helps baby strengthening their neck as well as provides input in different ways to baby’s vestibular system.
- Alternate head positions when baby is on their back to sleep.
- Encourage baby looking in different directions by changing the direction they lay in the crib in relation to the door or hanging decorations.
- Alternate sides of feeding
- Alternate the positions and sides that baby is held on.
While the above activities help reduce the risk of plagiocephaly and torticollis, they also assist baby in the development of strong neck muscles and head control. This then has a carry over to a solid foundation to development of other gross motor skills.
How is Plagiocephaly/Torticollis Treated?
Your paediatrician will help monitor baby to ensure there are not other reasons contributing to the development of these things. They may want to rule out and monitor baby’s hearing and vision. Your paediatric dentist or lactation consultant may want to rule out tongue tie or lip tie as a contributing factor.
While the above is being monitored, a physiotherapist that treats paediatric patients can help treat and prevent these issues from worsening. The physiotherapist can assist with stretching, strengthening exercise as positioning while in clinic. They will also give parents activities for home.
If baby’s head shape is a concern or not resolving your paediatrician of paediatric physio may suggest a helmet from a specialized orthotist. A baby’s head will mould until 1 year of age. It is more helpful when baby is younger.
New parents can have a lot on their plate. These issues may seem overwhelming. Your paediatrician and physiotherapists will do their best to educate you and put your mind at ease. Small bits throughout the day is helpful.