Congenital Torticollis

Torticollis, formally Wry Neck, is a term used to describe a positional anomaly in babies that presents as asymmetry in the way they prefer to hold their head - are they tilted to one side, or do they always turn the same way when they sleep?

There are several presentations of torticollis, and various causes. Some premies who spent extended time in the NICU, lack the strength of a full term infant; if they are positioned such that their equipment, nursing staff, or other caregivers are all on one side of them, they are more likely to have their head turned in that direction and a flat spot on their head commonly develops. this flat spot, or plagiocephaly, further encourages the premie to keep their head turned in the same direction, resting on this stable flat surface. I'm sure you can imagine that this just increases the degree of flatness, and the cycle continues until the issue is identified and intervention is sought.

Other causes of torticollis include prenatal positioning, intrauterine growth restriction, visual anomalies, or structural issues in the neck muscle itself (usually presenting as a benign tumor of the sternocleidomastoid). Many believe that the incidence of torticollis increased over time as a result of the Back-to Sleep campaign to help combat the rising rate of SIDS.

Regardless of the cause or the specific presentation of congenital torticollis, it is crucial to identify the issue as young as possible, to seek intervention early, and to remain vigilant about monitoring the issues at least through the first year to year and a half of life as the severity of the asymmetry can ebb and flow as the baby develops. The good news is that intervention is extremely successful when started early (ideally by 3 months of age). One issue that families in my area often face is difficulty obtaining an appointment with a qualified pediatric physical therapist without having to schedule several weeks to months out.

I have encouraged families who reach out to me to seek assistance from their pediatrician, and to consider one or two visits with a private pediatric physical therapist to get educated and receive specific recommendations for what they can begin doing at home on a daily basis while they wait for their appointment with their in-network provider. This can be the difference between resolving torticollis for your infant with minimal visits to the therapist, and seeing torticollis become more stubborn and more difficult to curb as your infant develops increased strength and resistance to the home exercises that are recommended.