Torticollis and Plagiocephaly

These posts should not be substituted for medical advice or considered medical advice. I am a pediatric physical therapist but would never consider advising someone without having seen them. Anyone with concerns based on what they read here should definitely schedule an appointment with their pediatrician.

In my last post I did not discuss the pseudotumor that is often associated with the congenital muscular torticollis. This is a knot in the muscle that is usually felt below the ear in the neck. It is called a pseudotumor because it feels like a tumor but is not a tumor. It resolves with treatment of torticollis. Sometimes fibrous tissue will remain after the tumor disappears.

Congenital Muscular Torticollis (where the muscles are involved vs the eyes or spine) can be treated by a pediatric physical therapist. Typically the treatment lasts about a year which sounds like a long time but the treatment sessions typically reduce to once a month after full range of motion is achieved. The reason the treatment continues is that while children are learning to sit, crawl, and walk they resort to positions that are easy for them to handle while they work on the new skill. Have you ever seen an adult learning to ski? They resort to the same position a toddler does as they are learning to walk. For a baby with torticollis the means the old rotated and laterally flexed position. Parents often report seeing it right before they notice their child attempting the new skill which makes them think their child is regressing though that is not the case.

Treatment involves stretching the tight muscles and strengthening the weak muscles. The therapist will teach the parents how to stretch the muscle but will also teach them how to help the baby stretch and strengthen the muscle through activities a baby normally does. The therapist will encourage the parents to hold the child in certain positions and perform the exercises diligently 5-6 times a day until full range of motion can be attained by the baby.

Gross motor development can be delayed slightly in children with torticollis. Because they are working so hard on holding their head up they have a hard time working on the normal motor milestones. Typically the children with torticollis catch up to their counter parts and some never have the delay to start with.

Sometimes children require an orthoses for the neck to assist with head positioning. The most common orthoses for cervical alignment is the TOT collar (Tubular Orthoses for Torticollis). I personally have found them rather effective if the stretching and strengthening are not working as well as desired. http://www.symmetric-designs.com/the-tot-collar-for-torticollis-treatment.html

At times the torticollis is severe enough to warrant surgery. Sometimes there is scar tissure that develops in and around the muscle which needs to be released. If you have been working with your child for an extended period of time (greater than a year) without resolve you may want to consider consulting a physician who has treated torticollis surgically. At some hospitals it is the craniofacial/plastic surgeon at others it is an orthopedic or neurosurgeon.

Assymmetry in the face: Sometimes parents notice some assymmetry in the facial structure of their child with torticollis. Usually the lower jaw (mandible), the bone around the eye (occiput) and cheekbone(zygomatic arch) are involved. Often these resolve without treatment because as any muscle develops and strengthens it pulls on the bone causing bone growth. Parents will sometimes report that they don't see the assymmetry anymore "except when I look at my child in the mirror."

What is plagiocephaly? Plagiocephaly is a malformation in the molding of the skull causing an oblique flattening in the skull. It is often associated with torticollis. Infants with torticollis have a shortened neck muscle (sternocleidomastoid) causing them to rotate and laterally flex their head. As a result they tend to lie in the same position causing the back of the head to flatten on one side. Plagiocephaly can be mild to severe. In recent years there has been an increased trend to treat the plagiocephaly with a cranial remolding orthoses. These devices look simply like partial helmets. Most of the parents I have spoken to really like the device as they feel they can really see a change in the head shape in a fairly short period of time ~3mos. One site which demonstrates the orthoses is http://www.orthomerica.com/products/cranial/cranialindex.htm

As a parent the best way to help your child with torticollis is to get him or her diagnosed and treated. Sometimes the torticollis will resolve but if you have noticed the torticollis there is a good chance it has not resolved yet and should be evaluated by a professional. Please read the post prior to this one for some basics on torticollis which were not discussed here.