Torticollis is the tilt/and or rotation of the head due to a shortening of one side of the Sternocleidomastoid muscle (SCM). Congenital Muscular Torticollis (CMT) is the most common form of Torticollis. Since the 1992 “Back to Sleep” Campaign, the incidence of Congenital Muscular Torticollis (CMT) has been as high as 1/60 live births.
Torticollis can be present at birth or can appear up to three months later. It is caused by positioning in utero, difficulty during delivery, or increased time in containers.
Untreated Torticollis may lead to:
- Difficulty with feeding
- Positional plagiocephaly: an atypical flattening of an infant's head that is caused by pressure on the bones of the skull before or after birth
- Decreased head control
- Delayed milestones such as sitting, crawling or walking
- Asymmetrical performance of milestones such as rolling
- Decreased tracking with eyes on the affected side
- Difficulty with balance
Some key indicators or redflags of Torticollis may include:
- Does your infant prefer to look to one side?
- If breastfeeding, does your infant seem to favor one side or one breast?
- Do you notice your child’s head frequently tilted to one side when you look at them or in photos of them?
- Do you notice a flat spot on your child’s head?
Early detection and early intervention is vital for effective torticollis treatment. A physical therapist will evaluate your child to assess their gross motor development, positioning, alignment, strength, and flexibility. The physical therapist will work with the family to develop and reach goals, implementing interventions that may include: muscle strengthening, correcting muscle imbalances and improving posture and alignment.
When dealing with CMN or positional acquired torticollis, resolution of symptoms is as high as 95% if physical therapy is initiated in the first 3 months of life, which is why early intervention is key. If untreated or treated after early infancy, CMT can lead to craniofacial deformities and painful limited cervical motion, requiring more invasive interventions such as botulinum neurotoxin injections and surgery.
If physical therapy is started before 1 month of age, 98% of infants with CMT achieve normal cervical range of motion within 1.5 months. Waiting until after 1 month of age prolongs the physical therapy episode of care up to 6 months, and waiting until after 6 months to begin physical therapy may require 9 to 10 months of physical therapy intervention, with progressively fewer infants achieving normal range.