Torticollis & Flat Head Syndrome: What You Should Know
April 26, 2023
By: Myla Wahlquist
Categories: Healthy Living, Maternity, Pediatrics
Does your baby always turn their head to one side for sleep and play? Do they tend to tilt to the same side in the car seat?
Does your baby struggle to breastfeed? Do they nurse better on one breast than the other?
Is your baby struggling with tummy time? Are there any flat spots developing on their head?
If you answered yes to any of these questions, your baby may have a condition called congenital muscular torticollis (CMT). According to the American Academy of Pediatrics, CMT is present in 3.9 to 16% of infants.
As a pediatric physical therapist at Tallahassee Memorial HealthCare (TMH), I treat children with torticollis regularly.
What is Torticollis?
CMT is a condition in which there is muscle tightness on one side of the neck and muscle weakness on the other. This condition most commonly presents when your baby demonstrates a preference to tilt their head to one side (with their ear closer to their shoulder) and a preference to rotate or turn their head to the opposite side.
What Causes Torticollis?
Most experts believe CMT is primarily related to how the baby is positioned in the uterus while developing and preparing for birth. Sometimes, due to the size of mom’s torso compared to the size of baby, a baby’s head position stays cramped to one side on the uterus and their muscles become tight.
CMT is common in babies who are breech – when the baby’s buttocks, feet or both are positioned to come out first during birth – because of the position of baby’s head against their mom’s ribcage. It's also common in babies born in multiples because they have limited intrauterine space.
Flat Head Syndrome
Craniofacial asymmetries – asymmetrical head and face shape – can occur in as many as 90% of babies with CMT. The most common form is a condition called plagiocephaly, also known as flat head syndrome.
Plagiocephaly occurs when the shape of the baby’s head and face are impacted by the position, they favor because of their neck muscle tightness. Because their skulls are so malleable and their cranial plates are not fused into place, newborns are especially susceptible to head shape changes.
When a baby prefers to turn their head to one side over the other, more pressure is placed on that side of the head, causing a flat spot to develop on the favored side. This can cause the skull to not only become flat in that spot, but the plates of the skull to start rotating, causing the ear to migrate forward and the forehead to become more prominent on that side. These changes can happen surprisingly quickly, causing asymmetry within just weeks, and can even advance to the point that a cranial orthotic, or helmet molding therapy, is needed.
How to Prevent Flat Head Syndrome
Follow these tips to avoid the development of flat spots on your baby’s head.
Positioning
- Always place your baby on their back for sleep, but on the tummy or side when they are awake or during playtime.
- Alter the way your baby’s head is turned during naps and nighttime. If your baby prefers turning toward one side over the other, try changing their position to prevent the development of flatness on that side of the head. Also, encourage your baby to look in both directions equally when they are awake during playtime.
- All newborns lean their head to one side or the other when in the car seat or upright position. If your baby always leans their head to one side and never the other, make a point to position them away from the “always” side so those muscles can be stretched out.
- Minimize time in semi-reclined positions such as the car seat, swing, and bouncy seat. These positions can block developmental progress and cause head and neck problems.
- When it comes to carrying, holding and feeding, don’t always hold your baby on the same arm – switch sides!
Tummy Time
- Give your baby short, but frequent periods of tummy time every day. Even if your baby gets fussy, continue to build endurance for a few minutes at a time throughout the day.
- Note the amount of time your baby is on their back and facing upward in places like their crib and infant carrier. Remember, spending too much time in any one position can change the shape of your baby’s head. Use awake time to get off the back and onto the tummy as much as possible.
- By 3 months old, your baby should be happy while playing on their tummy and lifting their head for 20-minute periods several times per day.
Screening for Torticollis
Talk to your child’s pediatrician if you are concerned about your baby’s head shape, neck movement and head control, or if your baby cries when you try to alter their head position.
Tallahassee Memorial Pediatric Rehabilitation offers a free torticollis screening clinic every Tuesday 12:30 - 1:30 pm at 1425 Village Square Blvd, Suite 3.
Parents can bring their infant in without a referral for a free torticollis and head-shape screening. Our team will share the findings of this screening with your pediatrician upon request, and they can refer your child for a full physical therapy evaluation and treatment, as needed.
We encourage parents to bring in their infants to be screened by age 2 - 4 weeks, but infants of all ages are welcome.
Early treatment allows for the best outcomes with torticollis and plagiocephaly. Often, if the condition is caught early, small changes in routine along with simple exercises can resolve symptoms very quickly.
Learn more about services available through TMH’s Pediatric Rehabilitation Program.
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