Torticollis is a Latin term that means “twisted neck.” An infant with torticollis typically holds his head tilted to the side and rotated away from the direction of the tilt. This would be “classic torticollis.” There can be associated tightness of other neck muscles which may produce variations in this posture. The infant will usually have a preference for turning his head to a particular side and difficulty turning the opposite way. There may also be a flattening on one side of the head.
What causes torticollis? There are many possible causes of torticollis. Congenital muscular torticollis is the main type of torticollis and is usually caused by positioning in the womb or birth injury. Tightness develops in one of the major neck muscles. Hearing deficits, visual deficits, inner ear disorders, and reflux may also produce a torticollis. In these cases, muscle tightness may develop secondarily due to a positional preference.
What are the risk factors? Risk factors for torticollis include complications with pregnancy or delivery requiring forceps or vacuum extraction, multiple birth, breech positioning, and high birth weight.
What if torticollis is not treated? If not addressed, torticollis can interfere with development of gross motor skills like rolling, sitting, and crawling. Torticollis can contribute to head malformation or craniofacial asymmetry. If severe, a child may be at risk for scoliosis, temporomandibular joint problems and visual problems.
How is torticollis treated? Physical therapy is typically very effective, and considered as the first course of action in treating torticollis, especially when treatment is started in the first few months of life. Treatment incorporates developmentally appropriate activities that include range of motion exercises, massage, positioning strategies, and muscle strengthening. The parents and caregivers are vital participants in the treatment program, as daily stretching and positioning exercises are a key part of the home program. In addition, it is important that the baby receive frequent tummy time to encourage active use of the neck and to strengthen the back and shoulder muscles. Exercises and activities are advanced as the baby grows and develops. Other interventions may include, wearing a specialized collar, a head shaping band, botox injections or surgery.
How long will it take to treat torticollis? The length of treatment is dependant on age, the amount of neck motion restriction, head malformation, and the family’s ability to consistently perform the home program. Ideally there should be positive changes occurring every week. Illnesses, growth spurts, teething or disruptions in schedule may slow progress temporarily. Meriter Hospital’s Pediatric Physical Therapy Department specializes in treating infants with torticollis. The average course of treatment includes approximately 9 physical therapy treatment sessions over a 3-4 month period.
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