Torticollis

--What problems occur with torticollis?

Torticollis is most often the result of a tight muscle in the neck that causes the child to hold their neck in a tilted and turned position. This is also called ‘congenital muscular torticollis’ or, occasionally, ‘wry neck’.  Some children with torticollis will have a small firm mass in their muscle that usually disappears over the first year of life. 

Torticollis is relatively common in newborns and is thought to occur between 0.3 and 1.9 per cent of births. Babies that are the first born, have a difficult delivery or are stuck in a difficult position in utero may be more likely to have torticollis.

Babies with torticollis need to be assessed by their GP or paediatric physiotherapist to rule out other causes of head tilt and to perform a full assessment. Babies with torticollis may be at a higher risk of asymmetry of the infant skull (deformational plagiocephaly), developmental dysplasia of the hip or foot abnormalities. If a torticollis is left untreated, it can be associated with spine abnormalities or facial asymmetry. Luckily, physiotherapy has been shown to be effective at treating torticollis.

--How can I tell my child has torticollis?

You may notice the lump in your child’s neck, that they are tilting their head or that they have trouble turning their head to one side. You may notice your child has a strong preference to turn in only one direction. Usually, if a child tilts their head to one side, they will turn their head to look in the other direction. It is important to remember that while the ‘mass’ in the muscle is often referred to as a ‘tumour’, it is not cancerous and resolves over time.

--How do I know if my child’s condition requires physiotherapy or other medical attention?

Torticollis can be diagnosed by your GP, early childhood nurse, or paediatric physiotherapist by a thorough assessment. Some children may require an X-ray of their neck or an eye assessment to rule out other causes of head tilt. All children that have torticollis require paediatric physiotherapy to guide you through exercises for your baby’s neck. Studies have consistently shown excellent results with physiotherapy in treating torticollis.

--Should I be worried?

It is not uncommon to worry about your child when they have torticollis, however, this worry usually diminishes as your child’s movement and head tilt improve with the exercises your physiotherapist will give you.

Physiotherapy has been shown to be very effective in managing torticollis, however, occasionally some residual movement restriction may persist. In this case your physiotherapist and GP will speak to you about referring your child for a second opinion. Your child’s vision and skeletal structure will be screened to ensure there are no other causes for their head tilt. Occasionally, children may require a minor surgery to release the muscle (usually after 12 months of age).

--How can physiotherapy help torticollis?

Physiotherapy can help torticollis by stretching the tight muscle. The paediatric physiotherapist will work with the parents to develop a home program of gentle stretching exercises and ideas for play and positioning. In babies over six months, strengthening exercises may also be included to assist the baby to develop their ability to hold their neck upright. This home program is best incorporated into the baby’s daily routine of nappy changes, feeding, sleep and play time. The gentle stretching exercises should not be painful or upsetting for the baby. If you have concerns that your baby is not tolerating the stretching exercises, you should speak to your paediatric physiotherapist. The home program may include:

• stretches to lengthen the tight muscle
• exercises to strengthen your baby’s neck muscles
• ways to carry your baby to encourage them to look to their non-preferred side or to stretch their tight muscles
• positions to play with your baby to help all of the above, as well as their development.

--How effective is physiotherapy for torticollis?

There are a number of studies which demonstrate excellent results with the initiation of physiotherapy at an early age. These studies demonstrate the most important factors impacting on how quickly the torticollis improves and resolves include: the type of torticollis, the severity of restriction in movement and the age of referral for physiotherapy. In general, the earlier the baby is referred to physiotherapy, the better the outcome.

--What can I do at home?

Physiotherapy for torticollis in babies is all about encouraging movement to the non-preferred side and reducing the risk of the baby developing plagiocephaly.

Ensuring your child spends time sleeping with their head turned to the non-preferred side: Put your baby to sleep at the end of the cot that encourages them to turn to their non-preferred side (always with their feet at the bottom of the cot), or change the position of the cot in the room. This helps because babies tend to look towards the centre of the room or the door where there is activity or the light. Gently reposition your baby’s head to their non-preferred side when they are sleeping.

Increasing tummy time when your child is awake

 Aim for three times per day for 10­–15 minutes at a time. This encourages stretching of their tight muscle, reduces the chance of them developing plagiocephaly and also helps your child reach their developmental milestones

Increasing time lying on their side for play when awake

This is best tolerated by babies who are not rolling yet (eg. under four months of age). Position your baby on their side when they are awake and supervised. This helps to encourage them to keep their neck in the middle and to take the pressure off the back of their head.

Encourage your baby to turn to the non-preferred side when awake

Talk to your baby with them facing their non-preferred side. Position toys on the non-preferred side for play. Position items on their stroller or car seat (such as rattles) on the non-preferred side. Encourage family members and day carers to utilise the same strategies when interacting with your baby.