Many of our NAPA friends have torticollis in addition to their primary diagnosis, or they are at increased risk for developing it. We know now that torticollis is not merely an infant diagnosis, as it can affect children throughout their lives if not treated completely. As it affects the whole child, torticollis may contribute to the development of other impairments, such as vision or feeding delays, difficulty with symmetry or weight-bearing, or further concerns like scoliosis, low back pain, and sometimes even neglect of one side of the body.
First, what is torticollis? Torticollis is defined as an abnormal and asymmetrical position of the head or neck. The Latin definition of torticollis is “twisted neck” – “tort” meaning twisted and “coll” meaning neck. In children with this condition, the neck tends to twist to one side, causing a characteristic head tilt to one side, a result of spasm or tightening of one sternocleidomastoid (SCM), a muscle that runs on both sides of the neck from behind the ears to the collarbone, or clavicle.
4-16% of babies have a diagnosis of torticollis, in which the SCM muscle is shortened. It is extremely important to have torticollis treated to prevent permanent shortening of the SCM muscle. This requires quality and timely intervention to lengthen the muscle, restore ideal alignment, and address any strength deficits. Appropriate intervention can help avoid surgery and decrease head and neck pain.
These torticollis therapy exercises and simple position changes can be done at home to help build baby neck muscles and establish preventive habits.
• When baby is born preferring to rotate head one direction, intentionally hold baby on your chest, turning baby’s head to rest looking the opposite direction for a gentle, easy stretch.
• See a licensed infant physiotherapist for instruction on other stretches to perform that are specific to your child’s level of torticollis impairment and tolerance for neck stretches.
• Tummy time on therapy ball, rocking side to side and front to back. Toys, mirrors, pets, siblings, etc. can be used to encourage child to look away from restricted side.
• Seated on therapy ball to work on trunk strength and stability, lean side to side/front to back and have child work on returning to sitting position.
• Place child on soft incline wedge/ramp or pillow (Boppy works great) for tummy time to encourage head movement and arm weight-bearing. Increase challenge by decreasing size of support (pillow → rolled up swaddle blanket → small towel roll)
• Sitting activities: child will typically lean their trunk or fall away from the short side and toward the long side; place a toy on the shorter side to encourage weight-shifting to tight side and turning on muscles on weak side.
• Vary sleep and play surfaces; limit time in swings, bouncers, and plush surfaces to 15-20 min, as these restrict head and body motion and promote poor posture overtime if overused.
• Side-lying position is excellent to get child off their back and brings their hands to the middle of their body for midline play. Use a towel roll or pillow to help them keep this position.
• Football hold (side-lying carry): hold child with one arm between their legs and under their belly, with your hand at the shoulder on the shortened side of the neck. In this position, they are working to keep their head up and strengthening the long and weak side while stretching the short side.
• Hold your baby out in front of you and facing away – takes weight off the head and encourages neck strengthening.
• In infant carriers, have child face in until they show good head control and are able to right themselves
• Weight-shifting on ball: lying on back or belly, or sitting up on ball.
• When picking baby up from floor, crib, or changing table, first roll child to one side, then lift up; switch sides regularly.
• When putting baby down to sleep, turn their head so that they are not always looking one way.
→ TIP: Another way to encourage this is putting baby down with the head at a different end of the crib every day.
• Alternate sides whenever you feed baby a bottle (happens automatically with breastfeeding!) and change the hip that you hold your child on.
• Avoid leaving child in a car seat, infant seat, swing, carrier, etc., where head is likely to rest on the same spot.
• Tummy time: position toys away from shortened side to encourage child to rotate head to other side.
For specific torticollis physiotherapy exercises and neck stretches, we encourage you to consult with a specially trained physiotherapist. At NAPA Center, we offer both intensive and weekly infant physiotherapy for neck strengthening, aligning, and lengthening – customized to your child’s needs.
Cait Parr is a pediatric physiotherapist at NAPA Center. Her favorite animal is snails, because they remind her to slow down and enjoy the beautiful details about life. She loves desserts almost as much as she loves long walks with her husband on the beach at sunset.