“Tummy Time” is not a new phrase to parents, but torticollis and plagiocephaly might be. Gratefully, I learned about both conditions just shortly after my own baby was born. Both plagiocephaly and torticollis present themselves in the first few months of life and it is critical that they receive early medical intervention. My conversations with physical therapists at EIRMC’s Pediatric Therapy Services gave me the knowledge and know-how to help my child avoid these conditions.
What is Torticollis?
According to Briana Ulanowski Smyer, DPT, PT, torticollis is a rotation to one side, usually from an inflamed or tightened muscle. There are several reasons a child might develop torticollis. First, it can be developed due to genetics, usually in the form of a syndrome or tumor. Second, torticollis can be due to positioning in the womb or a traumatic birth. No matter the cause, the beginning signs of torticollis are usually visible during the first eight weeks of life.
Signs of Torticollis to Watch For
- Torticollis is often associated with reflux
- Very stiff or floppy when held
- Preference for the baby to be on one side for feeding, sleep, etc.
- Irritability when positioned on the opposite side of preference
- Tightening of neck muscles on one side
- Lump on one side of the neck
- Red neck creases on the preferred side more so than the non-preferred side
- Baby jerks away from preferred side
- Baby follows or tracks only with their eyes on the non-preferred side rather than moving head
- Baby is not lifting up and turning their head during tummy time
- Only rolling over to one side
What is Plagiocephaly?
According to Victoria Cain, PT, MS, DPT, CWS, NTMTC, plagiocephaly is the flattening of the skull, usually behind the ears on one side of the head. It occurs in the first 3-4 months of life due to positioning. When a baby experiences torticollis, they spend most of their time laying on that part of their head, or their preferred side. Because their skull is so malleable, this causes the skull to flatten. You might recognize plagiocephaly in small children because the condition is usually fixed using a helmet.
What You Can Do
If you notice signs of flattening or signs that your baby is preferring one side, it is very important to change their positioning. Most cases (95%) of plagiocephaly are due to positioning; as such, you can do the most good trying to change your baby’s position often.
- Do not try to manually move head or neck unless properly trained
- Move furniture, such as cribs or changing tables, to change points of visual interest
- Breastfeed or bottle-feed on opposite sides each feed
- Massage baby in the bath
- Change diapers from your baby’s feet rather than at their side
- Give baby items such as toys at the midline (middle) of their body
- Change which side of the car your car seat is on
- Alternate what side of your body you carry baby on
- Seek a referral with a physical therapist
It is very important if you see warning signs of plagiocephaly and torticollis to get a referral before four months old. By then, your child will have adapted not only their vision but their muscles for their preferred side. Contact your child’s pediatrician and request an evaluation with EIRMC’s physical therapy services when you start to see signs of torticollis.
A physical therapist will do a full-body exam to determine what your child needs. They will create a physical therapy plan and determine if your child will need to see an orthotist to create a cranial orthotic (helmet). The earlier you get a referral, the more likely a cranial orthotic will be paid for by prevention and wellness healthcare. Medicaid may not pay for them, meaning early intervention is critical. The physical therapists at EIRMC will also teach you exercises that you can do at home to help your child develop strength, coordination, and symmetry of movement.