By Susan Cotta
If you see that your baby is not holding her head in an upright position or may have limited neck motion, she may have ‘torticollis’ (meaning twisted neck) and or ‘plagiocephaly’ (flat or crooked head). There are various types of torticollis and I will be talking about the most common found in infants, it is called “Congenital Muscular Torticollis” (CMT).
Basically in CMT, you may not realize there is any problem until the baby starts to display the characteristic head ‘tilt’ to one side or you see that your baby is always sleeping with her head to the same side or your pediatrician tells you about it. Plagiocephaly is sometimes seen in conjunction with the CMT.
What is CMT?
CMT is a shortening of one of the sternocleidomastoid muscles in the front of the neck. This muscle controls head rotation and tilt. You may also see a change in the head shape so that one side of the head appears more forward than the other or other changes, which is referred to as ‘plagiocephaly’.
One of the reasons we are seeing an increase in plagiocephaly is that more babies are sleeping on their backs due to the ‘back sleep campaign” started in 1992 to decrease the cases of Sudden Infant Death Syndrome (SIDS). This campaign has produced a dramatic decrease in the cases of SIDS, but now there is a dramatic increase in deformation of the skull.
The most common causes of CMT are inutero positioning, lack of space (i.e. twins or a big baby and small mom), a traumatic birth and low amniotic fluid. If you suspect that your baby has torticollis or plagiocephaly, a visit to your pediatrician may be in order to rule out more serious conditions.
There are a variety of treatments from positioning, exercises, physical therapy (PT), neck devices (for CMT) and helmets (for plagiocephaly). I am going to deal with some of the positioning and physical therapy options in this article.
I believe the reason we see a dramatic increase in the plagiocephaly is due to lack of position changes for your baby – this may be a very EASY fix! I see parents who hear that their baby should sleep on their back to prevent SIDS and carry this over to baby’s waking time – so baby never gets any belly time.
When awake, you should give your baby a healthy dose of belly time. Belly time allows your baby to get up off her head and naturally stretch her neck muscles. She also sees the world in a different way and this helps her brain to develop and starts to get her ready to crawl. Can you imagine just seeing the world from your back (either lying down or sitting up supported at your back)? It would be pretty limiting! Think belly time – belly time – belly time!
Positioning your baby’s head straight is very important. Prop baby’s head whenever feasible (car seats, sitting in any seat, or swing). You want your baby to be seeing the world from a symmetrical view – not always to one side.
Position her when holding, feeding, changing diapers or in the crib so that she has to turn towards her affected side (she will usually want to turn away from the affected side). I suggest parents limit time in exersaucers, walkers and especially jumpers as these are very stressful to the neck muscles - especially a baby with weak neck muscles.
Sometimes a baby is positioned with a small positioning pillow during sleep time to prevent her from putting all the weight of her head on the back of her skull or on just one side of the skull.
Your pediatrician may also refer you to a pediatric physical therapist (PT) for a complete program of exercises.
A PT will show you exercises and positioning ideas for home as well as provide outpatient treatment.
One thing that is often NOT discussed with torticollis and plagiocephaly is the importance of addressing the fascia of the neck and into the cranium utilizing Cranio-Sacral Therapy (CST).
Often I see a fascial strain pattern from the cranium into the neck and if one were to only do neck stretches or a positioning device or the ever-popular ‘helmet’, we would be missing the boat for some of these babies. CST can be very effective in addressing either singularly or in combination torticollis and plagiocephaly.
Sue Cotta is a licensed physical therapist in Massachusetts and Rhode Island and a nationally certified athletic trainer. Her hands-on practice includes the spectrum of infants to adults with an emphasis in treating children, especially those on the autism spectrum.
She has been teaching CranioSacral Therapy for the Upledger Institute for over seven years. Her practice is located in Swansea, MA and you can contact her at 508-982-1100 or by email at firstname.lastname@example.org.
For more information visit her website at www.unlimitedpotentials.com
If you’re frustrated and looking for a less invasive option to getting pregnant, call me (508)982-1100. All treatments are done fully clothed in a private, caring and professional session.
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