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What is Torticollis? And does pediatric Physical Therapy help?

Torticollis occurs when your baby’s neck muscles cause their head to tip and rotate to the opposite or same side. The top of their head may be tilted to one side and their chin may be tilted to the other side.

This means that the head can tilt to the left and turn to the left; tilt to the left and turn to the right, or tilt right and turn right; tilt right and turn left. 

For Torticollis, the main muscle that is tight is the sternocleidomastoid, which is one of the most superficial muscles in your neck. 

Torticollis is due to one of three causes, typically: 

1 – In-utero positioning: The mother’s uterus is too small, or the baby is too big and there was not enough room. 

2 – The least common cause is from a traumatic birth: Where the baby had to be delivered in an emergency situation and the neck is torqued. 

3 – The most common cause is positioning: How the baby is being held. They will feed into the Torticollis because it is easier. Ex: if they are tipped and rotated in a certain direction and parents or caregivers prefer a certain holding or positioning pattern the baby will most likely continue into the incorrect pattern.

Putting a child in a seated position may also cause this if they are not age-appropriate or do not have the strength to hold their body up. This can cause a tilt one way. 

Is Torticollis common? 

Most babies are born with a little bit of Torticollis. Now does that mean every baby needs pediatric physical therapy? No. But it is more common than you think. 

There are cases that range from very minimal to severe. Westside therapists encourage parents to try and discourage feeding into the child’s pattern. Working on trying to hold the baby in the opposite arm or keeping their head neutral will help decrease torticollis tendencies. 

What is the typical age range Torticollis is noticed and treated? 

With any therapy, the earlier you can get your baby treated, the better. Especially with something like Torticollis, which actually can have effects on the entire body. 

The earliest a Westside Therapist has seen a baby to treat torticollis was 7 days old. Though, that was an extreme situation. The other end of the extreme was waiting until 18 months.  

The typical age range is: 

  • 2-4 months old (this is the ideal time to get your baby in if you notice they may have Torticollis). It is also typically when your pediatrician would refer you to therapy. 
  • 6-8 months (this is still a good time to get a baby in for treatment, but therapists recommend getting in before). Between the ages of 4-8 months is where many major motor milestones develop and is easier to treat before that occurs. 

When a child comes in for physical therapy early, they can also get out early! The longer you wait to get your baby in, the more time they may have to spend in therapy. 

What is the average time spent in therapy? It is usually recommended until your baby is walking. That does not mean you’re coming every week. As mentioned, Torticollis can affect the entire body. We want to make sure your child’s gross motor movements (rolling, crawling and walking) look symmetrical and appropriate. 

If we see symmetry that we are working toward, we are quicker to decrease the frequency of your visits. 

I think my baby has Torticollis. How is it diagnosed?

Torticollis is usually diagnosed one of two ways: 

  • Your pediatrician will be able to notice it early. They will see that the neck seems tight and recommend Physical Therapy. 
  • You can pick up on important signs. 
    • Your child isn’t turning one way
    • You see a neck tilt 
    • You have a hard time feeding one way
    • Notice that your baby likes to go this way and not this way

As a first-time parent, it may be tough to pick up on certain signs like that. But you can still try to be aware and if you notice anything that seems off, talk to your pediatrician. 

When should you be concerned? 

You’ll likely go in to see your pediatrician for your initial 2-week visit, 1 month, and so on. Your doctor will also likely be able to notice any hints of Torticollis. If you have concerns around 2 months and don’t see improvements to 4 months, that would be an ideal time to get your child in for Physical Therapy or talk to your doctor some more.

Red flags and early signs to look out for

An early sign or red flag, as mentioned above, is going to be:

  • Your child is tipped one way and the ear is on their shoulder, and they are rotated. 
  • When looking at them, you can only clearly see one side of their face and see a large opening on one side of their neck. 
  • It might be hard to clean the side of the neck that is tight, as it is restricted and you can’t get in.
  • Feeding can be difficult if the baby won’t turn one way. 
  • Facial asymmetry

Plagiocephaly is commonly seen in conjunction with Torticollis, which is the flattening of the head on an angle and is also treatable. Because the neck is tipped and rotated one way, a lot of pressure goes on one part of the skull, causing that part of the head to become flat. 

Brachycephaly is also a very common diagnosis with Torticollis. This is the flatness of the back of the skull and this can be caused by a baby being on their back for too long. 

Get your baby on their tummy!

Tummy time is highly recommended by Westside Physical Therapists. Our therapists recommend that for every waking hour, a baby should spend 10 minutes on their stomach, at least. 

If you’re on your back for 12 hours, you should be on your stomach for 12 hours. You want equal symmetry between your flexors on your stomach and your extensors on your back. 

Always being on your back can lead to flatness of the head, delayed motor milestones and potentially toe walking as body symmetry is not reached. **Torticollis can affect the entire body**

Supervised tummy time is recommended from early on. Westside therapists say that getting a baby on their stomach early is good! It helps with neck strength. 

Between the ages of 0-2 months, is an opportune time for babies to gain thoracic spine strength that will impact the rest of their life. That’s not to say that it cannot be worked on, but this is a great time for babies to get that strength. This gives them strength to other muscles and gets them to crawl, as well. 

If you have to go to the bathroom, or make food, put your baby on their stomach and let them explore! You can be near them and keep an eye on them and they can move around on their tummy. 

Babies also self-soothe on their stomach and it is calming for them. When you are on your back, certain reflexes (i.e. Startle Reflex) can be elicited. 

What does Physical Therapy for Torticollis look like at Westside?

The first thing you will notice is that you are NOT alone in having a child with Torticollis. This is something common we treat. You will certainly have a strong community of therapists around you as well as other parents. 

Physical Therapy at Westside is more medically-based than play-based. Therapists have their hands on the child for the full 55-minute session. This consists of lots of stretching for the baby. As they get older and have more strength, we will work on postural alignment and strength.

Will there be tears? Yes. But it’s because they are working. Not because they are in pain. And we of course can take breaks for you and your baby. 

Throughout the session, your baby is playing with toys, our therapists are interacting with them, and explaining to you what we’re doing. 

If we can get your baby symmetrical and then crawling symmetrically, we can eventually lessen the number of times we see you! 

As long as there is no regression, we can reduce the amount of time spent in therapy. 

We will also help you along the way with home exercises. We’ll never overwhelm you with a list of exercises. We’ll give you one or two each week and grow from there as we can. 

Nervous about starting therapy? 

It’s OK to be! But you have everyone at Westside in your corner as well as other parents. 

Our therapists like to tell parents that this can be such a short period of your life and your baby’s life. Let’s get things fixed and have them ready for the rest of their life! 

If you’d like to learn more about starting Physical Therapy, call (815) 469-1500 to Get Started. Or fill out the form below.