Torticollis is a condition most commonly diagnosed in infancy in which the baby’s head is consistently tilted or turned to one direction. It is often present beginning at birth, but is typically noticed at 1-2 months of age as the baby’s head control improves. The most common cause is tightness in the neck muscles due to a variety of potential factors.
Torticollis risk factors:
Positioning in utero
Delivery in breech position or use of forceps for delivery
Multiples birth (twins, triplets, etc.)
Reflux (GERD)
Vision concerns
Genetic factors and syndromes
Signs of torticollis:
Baby or child consistently tilts head towards one side in most positions
Baby or child consistently turns head (rotates) or looks in one direction
Baby has difficulty bottle feeding or breastfeeding on one side noted
Baby has a flat spot on the head
Baby has asymmetries in the head and facial region
Torticollis can be treated by a pediatric physical therapist (PT). Your PT will work with you and your baby to create an individualized plan of care including stretching and strengthening activities for your baby’s neck and trunk. Improvements in strength and head position are typically noted within the first few months of physical therapy with a good prognosis to completely resolve the torticollis, especially if treated early. If left untreated, torticollis can impact the following areas of development: rolling, sitting, pulling to stand, crawling, standing, walking, balance, vision, bottle feeding and breastfeeding, and eating.
It is never too early to intervene and to treat torticollis. Schedule a free screening with a physical therapist at BDI Playhouse if you have any questions about your baby’s head position or head shape. So worry not, our BDI Playhouse therapists are experts in this area and we are waiting to answer any questions you may have!
Sit up straight! Posture is much more complicated than just sitting up straight. In order to function our best, we need the best possible posture to support that function. Posture is how the body is aligned in everything we do. Good posture is essential for sitting, standing, moving, and even sleeping. Poor posture causes poor movement patterns which leads to short and long term functional deficits.
What are posture red flags?
Assess posture in static and dynamic positions. Take note of your child’s posture when they are sitting/standing and playing. Look for these red flags.
Slouching
Leaning
Asymmetry
Flat or excessive curvature of back
Protruding abdomen
Forward head
Rounded shoulders
Head tilt
Shoulder elevation or more forward on one side
Inability to stand or sit still
Who is at risk for postural deficits?
Everyone but especially children! Posture is a life long journey, always needing improvement and is essential for good health. Certainly more screen time is not helping our postural alignment and it’s often unavoidable. Unfortunately poor posture during screen time is especially detrimental to children who have not fully developed. Children have weaker muscles and tissue connections as well as soft bones that are more prone to the effects of gravity. A diagnosis of Good postural alignment will help decrease the risk of future pain and injury.
How does posture affect children with special needs?
Children with special needs are at most risk for postural deficits due to possible weakness, tightness and movement challenges. Poor posture can cause breathing, visual and digestion deficits. Joint mobility issues are often compounded by postural misalignment. Posture is not easy to correct on the strongest of kids, a lot of energy goes into maintaining good posture. Helping to support the child in good alignment will allow them more energy to reach their full potential. Proper postural alignment is essential to ensure the best possible outcome for kids with special needs.
Who can help?
Our physical therapists are trained to evaluate posture in all positions for the best possible functional outcome. They will assess your child’s spinal position in static and dynamic activities to help correct positional dysfunctions to improve their motor patterns. Modifications may be needed to improve alignment and PT’s have the expertise to suggest might what work best for your child. Physical Therapists give personalized exercises, stretches and tips to improve postural endurance and alignment.
If you have any questions or concerns about your child’s posture, schedule a free screening with one of our physical therapists to help determine a cause and help correct postural misalignments.
What is Plagiocephaly (pronounced play-jee-oh-sef-uh-lee)?
Sometimes infants are born with or develop plagiocephaly or brachycephaly, a flat spot on the back or backside of their heads that is noticeable and may raise questions or be a cause of concern.
Understandably, you may ask:
Will my baby’s head shape stay like this?
Is there anything I can do to prevent or fix this?
Will this affect my baby’s brain growth or development?
In the early 90’s the American Academy of Pediatrics advised parents to put babies to sleep on their backs to reduce the risk of SIDS. This increased the time spent with increased pressure on the baby’s head from the surfaces they rested on. This also increased the incidence of plagiocephaly (a.k.a. “flat head syndrome”). In addition, there are dozens of baby positioning “containers” such as infant car seats, swings, and bouncy chairs that keep babies resting for longer periods on the back of their heads. Flat spots can make it challenging for babies to keep their heads in midline and they can develop a preference to turn or face toward a particular side. These babies may be resistant to or even refuse tummy time because lifting their little heads up against gravity can seem difficult and stressful. Although this will not typically cause problems with brain development, babies that have a flat spot may experience movement preferences to one side, may not latch on for nursing as well as expected, will experience reflux or digestive issues, and may be extra fussy, colicky or more difficult to calm.
How can I tell if my baby has a flat spot?
No two babies have the same head shape but asymmetries or flat spots are usually easy to detect if you know what to look for. Most areas will round or even out as a baby moves her head side to side, up and down, and begins to roll over in the first few months. Take a look at the baby’s head in several positions. If Baby has a lot of hair it is good to do this while the hair is wet, such as after a bath.
Look at your baby “face to face.” Are both eyes the same size or is one wider or narrower than the other? Is one cheek puffier than the other? Does the back of his head appear unusually wide or does the head slant sharply upward from his forehead to the back of the head? Do you notice that one ear is higher or in front of the ear on the other side?
Look at the baby’s head shape from behind while supporting him in sitting. This is often the first place a flat spot is detected. Are the ears level? Does the head tilt to one side? Is the top of the head very wide compared to the area just above the neck?
Now, look at the baby’s head from the top. Is one side of the forehead more forward than the other? Can you see one cheek puffing out more than the other? Is one ear significantly positioned in front of the other?
Finally, look at the baby’s head from the side. Is there a slope from the forehead that rises to a point in the back?
Notice if your baby’s head is moving freely with his body or is the head “planted” on the surface? Is he beginning to lift his shoulders and arms off of the surface and is the baby beginning to bring hands or toys to his mouth? Does the baby constantly only put one hand in his mouth or does he turn his head to mouth a toy instead of bringing the toy toward his middle. When Baby is on his belly, can he lift his head easily up in the middle or does he usually turn it fully to one side or the other to lift it up. These are all signs that there may indicate a muscle imbalance or be present as a result of the flat spot on a baby’s head. While none of these seem particularly alarming, they can keep your baby from developing movement and visual motor patterns that will advance him more naturally toward rolling, crawling, walking and gross motor play.
What Can I do if I notice a flat spot?
Provide lots of opportunities for Tummy time.
Limit time in baby carriers, car seats, bouncers, swings, and containers
Carry baby when you can but change positions often to keep hips healthy
Alternate the ends of the crib for sleeping so baby will face stimulating sights or light during waking times
Provide visual stimulation in front of the baby that moves side to side
Consult your pediatrician or a pediatric physical therapist if a flat spot persists for more than a few weeks. A baby’s head shape can change quickly from birth to 6 months.
What if the flat spot won’t go away?
If your baby’s head is held unusually still, he has a distinct head-side or position preference, he is having difficulty nursing, bottle feeding is stressful, or he is resisting positions like tummy time contact your pediatrician or a pediatric physical therapist who specializes in treating infants. It is best not to take a “wait and see” approach because most of a baby’s head growth happens between birth and 6-8 months and this is the best time to make big changes in head shape and mobility. Most consultations are free and professionals can offer advice and solutions that can help you and your baby.
BDI Playhouse Children’s Therapy offers free screenings and consultations through Telehealth or at one of our child-friendly therapy gyms in Orland Park and Aurora, IL
Written by Sheri Ireland-Berk, PT Physical Therapist
