Congenital Muscular Torticollis
By Ina Joshi
Do not go where the path may lead, go instead where there is no path and leave a trail. ~ Ralph Waldo Emerson
Torticollis is a tightening of muscles on one side of the neck, specifically the sternocleidomastoid (SCM) muscle. It causes a baby to tilt their head toward the tight muscles and rotate their face in the opposite direction.
Congenital muscular torticollis can be present at birth or develop early in infancy. The cause is unknown, however may be due to a muscular, boney, neurological or visual abnormality. Onset of visual or ocular torticollis may occur later than non-ocular torticollis. Torticollis is common among multiple birth pregnancies, where one of the babies is held in one position, causing tightness through one side of the neck. The incidence of torticollis is reported to be between 2% to 4% and some references report incidence up to 16%. Depending on the cause of the torticollis an X-ray or ultrasound may be performed.
A preference to hold the head in a tilt to one side or to look in one direction is often noticed by the caregivers or pediatrician in the first couple of months of life. Torticollis is often associated with brachycephaly or plagiocephaly, a flattening of the infant’s skull due to prolonged pressure on one area. Torticollis may also be associated with difficulty feeding and nursing, especially to one side. You may see the infant hiking up their shoulder to the affected side and bending their trunk in the opposite direction.
This asymmetric posture can lead to asymmetric gross and fine motor skills. The child may only roll to the right if their head is shifting their body weight in that direction. They may only use their left hand for reaching and grasping if they are always looking at this part of their environment. If these patterns persist, asymmetric development of gross and fine motor skills can occur. It is important to note “handedness” does not typically develop until 5 or 6 years of age. This asymmetry can lead to impaired balance reactions and delayed independent sitting.
Play at home:
Encourage visual tracking to both sides with head in midline, using your face or a toy.
Encourage the infant to turn their head both ways by following a toy side to side
Position the baby with their head in midline in car seats and carriages. If you are going on a long drive, take your baby out of the car seat during rest stops.
Carry your baby in your arms as much as possible, switching sides frequently. Do not favor one side more than another.
Encourage use of both arms during play in all positions.
Strengthen the neck, arm, and back muscles through tummy time. This is the best position for the baby to work these postural muscles against gravity. See our blog on tummy time!
Earlier intervention and physical therapy treatment help prevent motor delays as well as postural and facial asymmetries. Contact your pediatrician to learn more about physical therapy intervention for congenital muscular torticollis.