October is National Physical Therapy Month and we want to talk about Torticollis and Plagiocephaly in babies, two common conditions Pediatric Physical Therapists treat at Bothell Pediatric and Hand Therapy.

 Baby with a case of plagiocephaly which is being corrected by therapy and wearing a helmet.


Baby with a case of plagiocephaly which is being corrected by therapy and wearing a helmet.

Torticollis is a condition where a baby’s head and neck tilt to one side.  According to Robert E. Lyle, MD, associate professor in the Department of Pediatrics, University of Arkansas for Medical Sciences and co-director of the Neonatal Intensive Care Unit at Arkansas Children’s Hospital, “an involuntary one-sided contraction of the neck muscles can occur, resulting in an abnormal positioning of the head and limitation of the neck’s range of motion.”  Typically, there is a tightening of one of the neck muscles called the sternocleidomastoid (scm), which pulls the head sideways and toward the shoulder, turns the face toward the opposite shoulder, and brings the head forward towards the chest.

Torticollis is typically diagnosed at or shortly after birth. It can be caused by the baby’s position in utero, during the birth process, or by positioning or posture after the baby is born. The incidence of Torticollis in babies has risen since the American Academy of Pediatrics initiated the national Back to Sleep Program in 1994. The program was created to decrease the incidence of Sudden Infant Death Syndrome, which it accomplished by decreasing the incidence by 40%. Unfortunately, it also created a marked increase in the incidence of positional head deformities in newborns, such as Torticollis and Plagiocephaly, as babies started spending less time on their stomachs.

Plagiocephaly is a term meaning “misshapen head,” and is the flattening of one side of the back of the head. It can be mild to severe, and will sometimes correct itself. In severe cases, it may be corrected by wearing a helmet or by surgery.

When diagnosed at an early age, Torticollis can be decreased by positioning changes and stretching. If left untreated, it can limit a child’s ability to turn his or her head, see to both sides, and hear and interact with the environment. It can also lead to cognitive and motor delays, as well as delayed body awareness, muscle weakness, and poor balance.

Treatment for Torticollis by an Occupational Therapist (OT) or Physical Therapist (PT) usually consists of family education that focuses on positioning, muscle stretches, and exercises. Emphasis is placed on increasing “tummy time,” so that pressure on the back of the head is relieved and the baby can learn to move in a more symmetrical manner. Treatment for Torticollis can vary depending on the severity and the age of the baby, though it will usually be recommended weekly for 3-6 months. Babies who are treated from an earlier age tend to recover much more quickly than those who are diagnosed after they are 5-6 months old. Early intervention is key.

If your baby seems to look to one side more than the other most of the time, or has a flattened area on the back of his or her head, check with your doctor to see if there is a concern about Torticollis. Always encourage your baby to look to both sides by using your voice or a toy to draw his or her attention. Make sure your baby spends time every day on his or her tummy. If you have any concerns, be sure to ask your doctor to recommend an evaluation by a trained OT or PT. The effects of Torticollis can be long term, but Torticollis is very treatable. Please ask your physician for a referral. We are here to help.