The American Physical Therapy Association Academy of Pediatric Physical Therapy recently published an updated evidenced-based clinical practice guideline for the management of Congenital Muscular Torticollis. The evidence supports better outcomes along with shorter treatment duration with early identification and intervention. This has us thinking all about what we can do to help with this early identification process. The new guideline recommends that best practice should include education for expectant parents and parents of newborns on how to not only identify torticollis sooner but also prevent it.
Torticollis is a common musculoskeletal condition seen in young babies. It is described as a postural deformity of the neck present at birth or shortly after most often caused by muscle tightness. It frequently presents as a head tilt to one side combined with a rotational preference to the opposite side. We have seen the incidence of torticollis increase with babies spending more time on their backs for sleep. The recommendation for back sleeping should absolutely be followed. However, since babies sleep a lot in the first couple of months they are at high risk for developing a neck posture or skull shape asymmetry if parents aren’t aware of the signs. In fact, the recommendation for tummy time to counteract/balance the time spent sleeping on the back is 60 cumulative minutes (can be in small increments) – here are some ideas to help.
Here are 5 common signs:
Always looking in the same direction
You may notice your newborn or young infant always keeping their head turned to the same side when you lay them down on their back. They may fuss or cry if you attempt to turn it to the opposite side and ultimately resume looking to their preferred side.
Head tilting
You may notice your newborn or young infant always rests with their head tilted to one side, ear closer to the shoulder. This will be evident in most positions and you may also notice it in the car seat.
Feeding difficulties
If your baby is breastfed you may notice more difficulty with possible fussing and crying on one side. If your baby is bottle fed, you may notice more difficulty if you cradle them with one arm vs. the other.
Flattening of the head
The skull of a young infant is very soft and at risk for becoming flat if too much pressure is created in one area over time. If the mobility of the neck is restricted the baby will likely keep the head in the same position most of the time, which means the pressure from the surface below the baby is always on the same part of the skull.
Facial asymmetry
If not addressed, Torticollis can ultimately lead to facial asymmetry. Some examples are one eye appearing smaller in pictures or one cheek looking fuller than the other. You may also notice one ear resting lower than the other.
We hope this article will be helpful for you or someone you know who might be expecting a baby or have a newborn at home. Being aware of the condition and the signs of its presentation can be the first step towards prevention! If you see any of these signs, make sure you reach out to your pediatrician or your local pediatric PT.
