My new internet momma-friend, Jamie, asked me this, just the other day:
“My 3 month-old baby is always looking to the left, even when we hold her, and her head always falls to the right shoulder when she’s sleeping in the car seat or swing. When I try to turn her head or tilt it the other way, she gets mad and cries and then just goes back to the way she was turning before. Is there something wrong with her muscles?”
I said, “That sounds like torticollis, my friend. Give me your baby and I will fix it in a flash!” (Well, only the first part was said out loud. Tehehe.) And then I bombarded her with everything she didn’t know she needed to know about torticollis and flat head syndrome.
Lucky for you, dear readers, you get the condensed (ha!) version here. You’re welcome!
What is Torticollis? Ask the Baby Expert #93
When I was in PT school, 15 years ago (yikes!), we learned about “congenital muscular torticollis.” It was relatively straightforward. Basically, a baby is born with a crooked neck, tighter on one side.
The tight muscle is the sternocleidomastoid (SCM,) which is a large neck muscle that connects from the middle of the collarbone (at the sternum) to the side of the head, right behind the ear. When the SCM is tight, it causes the head to tilt toward the tight side (ear is closer to shoulder on the tight side.) But since it pulls in a diagonal, it causes the nose/face to rotate the opposite direction.
Typically, torticollis is more common with the tight muscles on the right side than the left. (Why? Read on my friends!) And babies diagnosed with torticollis almost always have plagiocephaly as well by the time they get to me (the pediatric physical therapist for treatment.) Oh no!
Congenital torticollis was cured with tummy time–back then. When a baby used to sleep and play on her tummy around the clock, just the act of lifting her head and turning her face side to side would stretch out her neck muscles and the problem often resolved on its own.
But that was then….and this is now.
Currently, in my practice, I am seeing lots of babies with torticollis who didn’t have any issues at birth. They came out of the belly with a nice rounded (or oval) head and full range of motion in their neck. But within a couple of weeks to months, their environment causes the development of acquired torticollis and/or positional plagiocephaly (flat head syndrome acquired after birth.)
Read more about flat head syndrome here, here, and here:
“So, if babies aren’t born with torticollis or plagiocephaly, how does it develop?”
In one word….GRAVITY.
(But you know I can’t just stop at one word, silly!)
Why is it different “now” versus “then?”
For one, babies are not on their tummies near as much as they were before the Back to Sleep campaign in the early 1990s. While the rate of SIDS deaths decreased by over 50% in just a few years, parents were scared to put their babies on their tummies when they were awake, too.
The other reason I think it’s so common now is because of detachable infant car seat carriers. In our busy, modern lives, it’s much easier to transport your baby in the car seat wherever you go so you don’t have to buckle and unbuckle every time you get out of the car. (Super convenient for sleeping babies!) But many well-intending parents let the laid back, happy baby stay in the car seat way too much!
The problem with too much time in the car seat is related to the flat surface and poor head control. Infants have very poor head control, and if they are somewhat upright on a flat surface, their head will bob to one side or the other.
So most of the babies I see in the clinic have developed torticollis after birth as a result of weak neck muscles and too much time upright with their heads unsupported. And the lack of tummy time means babies with torticollis aren’t “fixing it” on their own or “growing out of it with time.”
Then torticollis causes flat head syndrome on one side of the head (positional plagiocephaly).
If a baby always turns or tilts his head to the same side it will get flatter, and he will spend even more time on the flat part, especially if he has poor head control.
It’s like a cereal bowl…is it easier for a bowl to sit on the table on the round side or the flat bottom? Yes, the flat bottom! It’s so stable and easily stays put. Do you think the bowl would by likely to roll off the flat bottom and roll around on the rounded sides? That would be a lot of work (and magic), and gravity doesn’t make it any easier!
The longer torticollis goes untreated, the greater chance it can lead to other, bigger issues like asymmetries in vision and motor skills (only looking to one side or using one side of the body more), delays in development (starting with rolling), and possibly long-term musculoskeletal problems like scoliosis.
There are several other environmental factors that contribute to the increase in acquired torticollis and positional plagiocephaly:
Back to Sleep (Not preventable)
Babies now spend all their sleeping time on their backs. Unfortunately, this leads to a higher incidence of torticollis and plagiocephaly, but it’s better than the alternative.
Read my post about preventing SIDS here:
**Please, ALWAYS put your baby to sleep on her back. ALWAYS!**
Not Enough Tummy Time (Preventable!)
Parents are still uncertain about the safety of putting babies on their tummies when they are awake. IT IS ABSOLUTELY SAFE FOR A BABY TO START TUMMY TIME THE DAY SHE IS BORN. The sooner you start it, the more likely she will be to tolerate it and like it. Then she is able to develop her foundational gross motor skills as nature intended, despite having to sleep on her back.
Too Much Time in the Car Seat (Preventable!)
Tummy time is also sacrificed by the invention of detachable infant car seat carriers and their stroller buddies! I know we are busy mommas, as is the norm in modern parenthood, but transporting your baby in the car seat carrier everywhere you go is depriving him of time on his belly and/or bonding with you!
The two most important activities for a baby 0-6 months are PARENTAL BONDING and TUMMY TIME! Click To Tweet
Sitting Up Too Soon (Preventable!)
Death to the Bumbo Seat, the Jumperoo, and the Exersaucer!
Ok, I know that sounds extreme, but babies are not neurologically wired to sit until at least 5.5-6 months! Before that, they have very poor head control and postural muscle strength. A baby’s back is curved in a forward C-shape at birth, a.k.a the fetal position, and only develops into a mature, S-shaped spine after lots of time spent on the floor strengthening the extensors (tummy time, lifting against gravity, rolling) and the flexors (rolling, lifting arms and legs on back, belly crawling and crawling on all fours).
Sitting requires a good balance between the flexors (front) and extensors (back) to maintain the sitting position independently, without support.
Babies are not developmentally (neurologically) ready to sit until they can get into and out of the sitting position on their own. If you see a baby sitting with a rounded back and hunched posture, he’s not ready for sitting and needs to spend more time on the floor. (Drop and give me 20!)
Besides…what’s the hurry! They’ll have plenty of time to sit for the rest of their lives!
Reflux (Not preventable, but treatable!)
Reflux causes an unusual presentation of torticollis, with tightness on the right, but the head is tilted and rotated to the right. They will usually have a flat spot on the right side of the back of the head. Why? Read on….
Babies with reflux are very uncomfortable with food in their bellies. The stomach acid (and other contents) come back up through the esophagus because the “doorway” to the stomach (cardiac sphincter) is underdeveloped in the first several months of life. Acid in the esophagus causes burning and inflammation, and a really fussy, inconsolable baby!
In efforts to minimize the pain and reflux, babies will “posture” when they’re fussing, to get the stomach as far away from the mouth as possible. Since the stomach is more on the left side of the body, babies will arch their backs, throw their heads back and turn their faces to the right as far as possible. Usually, the arms are up and out with hands fisted, and they are squirming like crazy! Reflux babies with torticollis are extremely grumpy little things!!
Does this sound familiar to anyone?
Read more about reflux here and here:
“Do You Have a Fussy Baby? Is it Colic, Allergies, or Reflux?”
“Ways to Manage Reflux With or Without Medication” (Coming Soon. Join my email list so you don’t miss it!)
Prematurity (Not preventable)
Babies born premature are at a disadvantage in so many ways. Poor little itty bitty ones! Not only are they weaker because they are less developed, but they also have extremely soft, tiny skull bones that can be smushed and pushed very easily. Weakness + flat spot on head = torticollis. Boo hoo.
Read more about torticollis here: (Coming Soon. Click on the banner above to receive the new posts in your inbox!)
“6 Great Tips and Tricks to Prevent Torticollis”
“‘I Think My Baby Has Torticollis! What do I do?’ Ask the Baby Expert #94”
My take home message is this:
The sooner your baby gets physical therapy treatment for torticollis, the better the outcome.The sooner your baby gets physical therapy treatment for torticollis, the better the outcome.Click To Tweet
If you notice your baby looking to one side a lot more that the other, tell your pediatrician and get a referral to PT or work with me from home!
If you notice your baby likes to tilt his head to one side and his shoulder seems to be glued to his ear, tell your pediatrician and get a referral to PT or work with me from home!
Or… your baby has skin breakdown in the folds of his neck on one side more than the other and he fusses when you try to tip his head the other way so you can clean it, tell your pediatrician and get a referral to PTor work with me from home!
So that’s today’s lesson on Torticollis…Clear as mud?
“Uh sure, Wendy.” If you aren’t sure about your baby’s tight neck muscles and have questions or concerns, please leave a comment at the bottom of the post or call me using the link above!
Congratulations! You made it to the end!
What do you think? Did you like this article? Has a child of yours been diagnosed with torticollis? Can you think of some other causes of torticollis that I didn’t mention in this article?
Please share your comments below!