Infant Torticollis - What You Should Know

We all know a bad night's sleep can mean waking up with a stiff neck, which makes it hard or painful to turn your head. This is called torticollis (Latin for "twisted neck").

In newborns, torticollis (tor-tuh-KOL-is) can happen due to the baby's position in the womb or after a difficult childbirth. This is called infant torticollis or congenital muscular torticollis.

Typical torticollis presents with the head tilted to one side, with rotation to the opposite side. There are two main components of the body being inhibited in babies with torticollis; muscle and joint restrictions. You'll see a head tilt or head preference, where an infant is unable to or has a difficulty time properly moving their neck through full ranges of motion.

How can Torticollis be caused in infants?

Generally, torticollis appears during the birthing process, when unequal forces are applied to the baby’s cranial bones and neck while passing through the birthing canal. This results in an increase in tension on one side of the neck, and can even result in plagiocephaly, or flattening on one side of the baby’s head. Ruptured membranes, improper positioning of infant, prolonged or shortened labor are all possible factors that can contribute to torticollis.

Torticollis can also appear in babies that are not born vaginally, usually due to interuterine constriction, or shortened umbilical cords, not allowing baby to eventually move to the proper head down and occiput anterior position. Vacuum extractions and the use of forceps may also apply uneven force on the infant's head, thus increasing the chances of torticollis.

What does this mean and what should I look out for?

You may have noticed your baby has a head tilt or is favoring one direction, but what does this mean as far as developmental concerns? Infant’s with head tilts and rotational preferences often have difficulties with breastfeeding, due to the tighter muscles fatiguing quickly, and joints unable to move actively through their proper ranges of motion. Bottle feeding may also be difficult, due to the sternocleidomastoid (SCM) muscle fatiguing early on in the feeding because of tension. Tension in the muscles can also cause misalignments in the cervical vertebrae and anterior neck structures, which can further the effects of torticollis on an infant.

Failing to address the muscles and joints may inhibit response to care for infants with torticollis. In some cases of torticollis, flattening of the cranial bones, otherwise known as plagiocephaly can occur. This happens because the baby is favoring laying on one side for long periods of time, and cranial bones are not fully fused yet, therefore they will adjust to the forces being constantly applied on them and begin to shift. Not only can torticollis have an impact on cranial bones and the vertebrae within the neck, but the jaw and TMJ region can also be affected. This is because many muscles of the neck, jaw and even shoulders connect with one another. If there is tension in part of the muscle, the entire chain will be affected.

Symptoms of Infant Torticollis to look out for:

• Your child’s head tilts to one side with their chin pointed to the opposite shoulder.

• Their head doesn’t turn side to side or up and down easily.

• You feel a soft lump in your baby’s neck muscle.

• Your baby prefers to look over the shoulder at you. Their eyes don’t follow you because that would require turning their head.

• They have trouble breastfeeding on one side or prefers to feed on one side only.

• Your baby works hard to turn toward you, struggles to turn their head all the way, and becomes upset because the movement is hard.

• They might start getting a flat head on one side -- or both sides -- from lying in one position all the time. This is called “positional plagiocephaly.”

How are infants diagnosed?

Your healthcare provider will do an exam to see how far your baby can turn their head.

How is Infant Torticollis treated?

If your baby does have torticollis, the provider might teach you neck stretching exercises to practice at home. These help loosen the tight SCM and strengthen the weaker one on the opposite side. This will help to straighten out your baby's neck.

What can you do at home?

Try to get your baby to stretch those neck muscles. It’s the best treatment for torticollis, and it’s safe. The doctor may teach you some specific exercises to do with your little one. These moves will help lengthen the tighter, short muscle and also strengthen the muscle on the opposite side.

Here are some other things you can do at home:

• Use your baby’s appetite as an incentive: Offer the bottle or your breast in a way that gets them to turn away from the favored side.

• Place toys so that your baby is forced to look both ways: Those with sounds and lights are really good at drawing their attention.

• Get them to play with their hands and feet: Babies like to bring their hands together and their feet up to their hands. When your baby does this, it builds up muscles they will need to crawl.

• Give them plenty of time on your tummy: Holding your baby this way will strengthen back and neck muscles and keep the back of their head from flattening. Ideally, they should have 15 minutes of tummy time 4 times a day. You can support them on your chest, across your lap, or on a pillow if that makes it easier.

How can Pediatric Chiropractic care help infants with this condition?

As pediatric chiropractors, we work to assess the muscle and joints to ensure proper alignment and function of each of these. In torticollis patients, there can also be nerve involvement and inhibition, this then begins to affect the nervous system ,thus possibly delaying development at such a crucial time in a child’s life. Chiropractor works to assess this as well, and ensure proper growth and development. As much as we work towards proper alignment and activation of these muscles, joints and nerves, we are also able to perform and recommend home care strengthening and exercises for parents to perform at home in order to further this development. Pediatric chiropractors use very gentle, safe and specific techniques to perform these adjustments in order to correct misalignments and get your little one feeling their best!

ANH Wellness can address these specific problems in the body!

Our skilled providers can aid in eliminating infant torticollis at the source through manual treatment followed by specific strengthening and stretching exercises to help prevent injury while restoring strength and mobility in your little one!

By: Dr. Brooke Morphet

Chiropractor at ANH Wellness

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