Congenital Muscular Torticollis (Head Turned To One Side)

STEFFI & JESS ARE 2 PAEDIATRIC PHYSIOTHERAPISTS FROM FLOW PHYSIO CO SUTHERLAND AND TODAY THEY CHAT THROUGH Congenital Muscular Torticollis.

If your baby has a flat head or only turns their head to one side they may have congenital muscular torticollis (CMT).

CMT affects the sternocleidomastoid muscle, this muscle either becomes tight due to:

• positioning in the womb

• having a flat head

• a mass in the the muscle making it difficult to stretch the muscle out

CMT occurs between 0.3% and 2% in newborn infants. It causes head tilt to one side and rotation to the other. 

In some children with CMT they may have issues with their hips or position of their spine, so it is important to get these checked by a professional. 

What to look for? 

• Does your baby tend to hold their head tilted to one side or do they hold their head in the midline?

• Does your baby prefer to look in one direction?

• If you lie your baby on their back, do they look evenly to both sides?

• When on their back, can they turn their head all the way to the left and to the right?

What can you do?

• Book in to see a professional for your baby to be screened. Your child may only need a once off appointment or may benefit from some monitoring.

• It is important for a professional to show you the correct stretches to do, to keep your baby safe. When given the appropriate stretches research says the 98% of patients will gain appropriate neck movement even when they have severe muscle fibre changes.

• Try some of the strategies suggested for a flat head

References: 

Congenital muscular torticollis. Kumar Nilesh and Srijon Mukherji. Ann Maxillofac Surg. 2013 Jul-Dec; 3(2): 198–200.

Clinical features and outcome of physiotherapy in early presenting congenital muscular torticollis with severe fibrosis on ultrasonography: a prospective study. Journal of Pediatric Surgery. Volume 46, Issue 8, August 2011, Pages 1526-1531

Does my baby have Plagiocephaly (flat head)? Paediatric Physio Sutherland

Steffi & Jess are 2 Paediatric Physiotherapists from Flow Physio Co Sutherland and today they chat through Plagiocephaly.

What is Plagiocephaly (flat head)?

There are two types of “flat” head, plagiocephaly and brachycephaly.

Plagiocephaly - the back of the head is flat on one side

Brachycephaly - the back of the head is flat

The prevalence of babies getting a flat head has increased with the SIDS (sudden infant death syndrome) guidelines. Babies should be placed flat on their backs to sleep until 12months of age.

Following this guideline significantly reduces the risk of SIDS occurring. We would strongly recommend families to continue to follow this guideline as we have lots of other strategies to promote a round head shape.

What causes a flat head?

The flattening can be because of a few different reasons;

• Sleeping flat on their back

• Tight neck muscles/a mass in one their neck muscle (torticollis), or

• Environment

Example of Plagiocephaly. Photo: Gzzz. Used with permission under license CC BY-SA 4.0

Due to the flattening, you may notice your baby’s ears may not be symmetrical or their forehead may have some bulging. Depending on the significance of this we may suggest more or less intervention. 

When a baby is born there are “suture” lines along the skull and small openings called fontanelles, these allow for the baby’s skull to change shape and grow.

There are four sutures and two fontanelles. The fontanelle at the back of the skull closes at around 1-2 months and the fontanelle at the front of the skulls closes at around 9-18 months.

It is important that the fontanelles and sutures don’t close or fuse too early (craniosynostosis). This is something we would check for as it can significantly affect your baby’s head growth/shape/brain development.

What to check/look out for?

• Looking at the back of your baby’s head: Does it look symmetrical and round from left to right? Is there flattening on one side?

• Looking from the top at your baby’s head: Does it look symmetrical and round? Is there flattening on one side? Does the whole back of head look flat? Are their ears in line with each other? Is one of their ears pushed forward? 

• Looking at your baby’s face: Is their forehead symmetrical? Does one side of their forward bulge out?

If you notice any of the above, we would love to help give you strategies to improve your baby’s head shape and also assess to ensure early closing of sutures/fontanelles is not occuring. 

What can you do?

• Try to make all the environments your baby is in to be symmetrical, thinking about:

  • Cot and pram → do you always approach from the same direction? Try to switch it up, you can even turn your baby around in the cot (making sure to keep their feet at the end of the cot).

  • Are all the toys on one side? → Try to have them equally placed.

• Do you think your baby has torticollis?

  • Check to see if they can look in both directions by gently turning their head. You can use a toy to guide their movement.

  •  We can help show you which stretches are most important.

  • It is important that you are shown the correct stretches and do them gently.

• Play

  • When your baby is awake, place them on their tummy.

    • This is the best position for development early in life

    • Make sure you supervise them when doing tummy time

    • Provides little or no pressure on the head

Steffi & Jess are 2 SENIOR Paediatric Physiotherapists WHO RUn OUR PAEDIATRIC SERVICE from Flow Physio Co Sutherland.

To book an appointment with Steffi or Jess, click the button below.

 

Source: Conservative interventions for positional plagiocephaly: a systematic review. Andrea E Bialocerkowski (a1), Sharon L Vladusic (a2) and Stephanie M Howell (a2) Volume 47, Issue 8. August 2005 , pp. 563-570