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Torticollis and Plagiocephaly

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Torticollis and Plagiocephaly

Diana Sullivan Compton, PT

Dominique Surprenant, PT

Belinda Dundon, RN, (EC), MN

Torticollis and plagiocephaly have become very common since the 'Back to Sleep' campaign began. It is still recommended to place your baby on their back to sleep. It is just as important to consider how your baby is positioned when awake. By knowing more about torticollis and plagiocephaly, you can help to prevent it. If you think your baby has one of these conditions, you can begin to treat it on your own while you wait for assessment.

What is torticollis?

Torticollis is caused when a muscle on one side of the neck (the sternocleidomastoid) is shorter or weaker than the one on the other side. Some babies are both tight and weak, but most babies are just weak on one side. It is important to figure out which is the case for your baby to make sure the treatment is appropriate.

A baby with torticollis will hold their head tilted to one side, and prefer to turn their head to the other side. Some babies are born with torticollis (congenital muscular torticollis) but others develop it after birth (positional torticollis).

What is plagiocephaly?

Plagiocephaly is flattening across the back and side of a baby's head. This is usually on the side where the baby prefers to look. It might also cause changes in the face on the same side, or one ear to shift forward. Because babies' bones are so soft, they flatten easily if they are in the same position for long periods of time.

How are torticollis and plagiocephaly linked?

It is sometimes difficult to tell which started first, the torticollis or the plagiocephaly. What we do know is that either one can cause the other, and that as one gets worse, so does the other. For example, if a baby has torticollis and prefers to look to his right, he spends more time with pressure on the right side of the head. This can cause plagiocephaly to develop. On the other hand, if the baby has plagiocephaly on the right side of the head, it makes it harder for him to turn left when lying on his back. This means the neck muscles can become weaker and tighter, causing torticollis. To successfully treat either of these conditions, they both need to be addressed.

What causes torticollis and plagiocephaly?

There are many possible causes, including:

  • Not enough 'tummy time' play
  • Positioning in the uterus before birth
  • Events during birth
  • Reflux

Why is 'tummy time' so important?

'Tummy time' is extremely important for all babies. It helps to keep your baby's head nice and round, or to re-shape it if it has started to flatten. It strengthens your baby's neck and shoulders, and it helps them develop skills like sitting, crawling and walking. It is recommended that all babies get at least an hour each day. This can be spread over several short sessions as your baby gets used to it. If your baby does not like 'tummy time,' a small roll placed under his chest can be helpful because it makes it easier for him to breathe. Soft surfaces are also helpful, and babies often love doing 'tummy time' when lying on mom or dad's chest. As long as you are reclined so that the baby has to push up on his arms, it counts! 'Tummy time' is not a choice, it must be done, so experiment with these different options to see what works best for your baby.

What should I do if I think my baby has torticollis or plagiocephaly?

  • Continue to place your baby on his back to sleep. Once he is able to roll onto his tummy by himself, it is safe for him to sleep that way.
  • Make sure your baby is getting enough 'tummy time' while awake - at least 1 hour each day.
  • Avoid the use of equipment that keeps your baby positioned on his back (eg. swing, bouncy seat, car seats except for travel).
  • If your baby prefers to look to one side, make sure that his crib, room, and toys are arranged on the other side to encourage him to look the other way. You may need to change the way he is positioned while you change his diaper so he has to turn the opposite way to look at you. Look around your house for 'traps' that are encouraging your baby to look to his preferred side, and rearrange his position to stimulate him to look the other way.
  • Talk to your doctor right away. The earlier treatment is started, the better.

Do you have more questions?