Torticollis

Torticollis, or wryneck, literally means "twisted neck" in Latin. You may have woken up with torticollis after an uncomfortable night of sleep. In newborns, torticollis can happen due to positioning in the womb or after a difficult childbirth. This is called infant torticollis or congenital muscular torticollis. It can be upsetting to see that your baby has a tilted head or difficulty turning his or her neck. But most babies don't feel any pain as a result of their torticollis. And, fortunately, the problem usually gets better with simple position changes or stretching exercises that can be done at home.

About Infant Torticollis

Torticollis is relatively common in newborns. Boys and girls are equally likely to develop the head tilt. It can be present at birth or take up to 3 months to develop. No one knows why some babies get torticollis and others don't. Most doctors believe it could be related to the cramping of a fetus inside the uterus or abnormal positioning (such as being in the breech position, where the baby's buttocks face the birth canal). The use of forceps or vacuum devices to deliver a baby during childbirth also makes a baby more likely to develop torticollis.

These factors put pressure on a baby's sternocleidomastoid muscle (SCM) — the large, rope-like muscle that runs on both sides of the neck from the back of the ears to the collarbone. Extra pressure on one side of this muscle can cause it to tighten, making it difficult for a baby to turn his or her neck.

Signs & Symptoms

Babies with torticollis will act like most other babies except when it comes to activities that involve turning. A baby with torticollis might tilt the head in one direction (this can be difficult to see in very young infants), prefer looking at you over one shoulder instead of turning to follow you with his or her eyes, if breastfed, have difficulty breastfeeding on one side (or prefers one breast only), and work hard to turn toward you and get frustrated when unable turn his or her head completely. Some babies with torticollis also will develop a flat head (positional plagiocephaly) on one or both sides , due to laying in one direction all the time. Or they might develop a small neck lump or bump, which is similar to a "knot" in a tense muscle. Both of these conditions tend to go away as the torticollis gets better.

Diagnosis

If you think your baby might have torticollis, ask your doctor to perform a physical examination on your baby, which involves seeing how far your baby can turn his or her head. If a diagnosis is made, the doctor might teach you neck stretching exercises to practice with your baby at home. These exercises help loosen the tight SCM and strengthen the weaker one on the opposite side (which has weakened due to underuse). This will help to straighten out your baby's neck. In certain cases, the doctor may suggest taking your baby to a physical therapist for more intensive treatment. After treatment has started, the doctor may examine your baby every 2 to 4 weeks to see how treatment is going.

Treatment at Home

The best way to treat torticollis is to encourage your baby to turn his or her head in both directions. This will help to loosen tense neck muscles and tighten the loose ones. Rest assured that babies cannot hurt themselves by turning their heads on their own. Below are some neck exercises to help improve its range of motion. They should be done at each diaper change.  The child can be placed flat on the couch, changing table or on your lap.



Chin to Shoulder

The head should be rotated so the chin is touching the shoulder.  Place one hand on the child’s face and the other shoulder.  Gently and firmly move the chin to the shoulder.  Turn the head to initial resistance and discomfort.  Hold for 10 seconds.  Repeat for three times.  Do this on both sides.

Ear to Shoulder

This stretch will be more difficult. The head should be tilted to the left and right side so that the ear is touching the shoulder. Place one hand over the child’s ear and head while the other hand is on top of the shoulder.  Gently and firmly tilt the head to the side and pull down on the shoulder.  Be sure that your baby is not trying to turn the head to the side as in the exercise above.  You should press to the initial resistance and discomfort and hold it for 10 seconds. You should do these exercises three times on each side.

Over time you will need to increase the length of the stretch. This will be based on the baby, but the average is about every 5 days. You will need to do these exercises until the baby has normal range of motion. If your baby has a flat spot on the back of the head, you should encourage lots of tummy time while the baby is awake.  When the baby is lying on his back you should reposition the baby’s head off the flat side.

Don't Forget "Tummy Time"

Laying your baby on the stomach for brief periods while awake (known as "tummy time") is an important exercise because it helps strengthen neck and shoulder muscles and prepares your baby for crawling. This exercise is especially useful for a baby with torticollis and a flat head — and can actually help treat both problems at once.

Here's how to do it: Lay your baby on your lap for tummy time. Position your baby so that his or her head is turned away from you. Then, talk or sing to your baby and encourage him or her to turn and face you. Practice this exercise for 10 to 15 minutes.

Outlook

Most babies with torticollis get better on their own through position changes and stretching exercises. The condition might take up to 6 months to go away completely, though in some cases it can take up to a year or longer. If you find that your baby's torticollis is not improving with stretching, talk to your doctor. Your baby may be a candidate for muscle-release surgery, a procedure that cures most cases of torticollis that don't improve with physical therapy alone.