What is torticollis and deformational plagiocephaly?

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Mary Free Bed Rehabilitation Hospital

What is torticollis?

Torticollis is a shortening or tightening of the muscle that goes from behind the ear to the front of the neck (called the sternocleidomastoid muscle). This muscle helps your baby turn his or her head and bring his or her ear down to his or her shoulder.

Torticollis can be caused by a number of things, including:
  • Sleep position
  • Restrictive intrauterine positioning (common with large or multiple babies)
  • Congenital muscular torticollis
  • Maternal anatomical conditions
  • Birth trauma
  • Orthopedic conditions
  • Muscle weakness
What is deformational plagiocephaly?

Deformational plagiocephaly is an abnormal shape of an infant’s skull caused by external forces. This can appear at the time of your child’s birth or in the first few months. Parents and grandparents often are the first to notice this difference in head shape. Talk to your pediatrician if you have questions or concerns about your child.

Common signs of deformational plagiocephaly include:
  • asymmetrical skull shape
  • unilateral occipital flattening
  • ear offset (or anterior shift of the ear on the flattened side)
  • facial asymmetry in the eyes, nose and jaw
  • an unusually prominent forehead, opposite the side with flattening
  • torticollis also may be present
Other forms of deformational plagiocephaly we treat in our program include:
  • Deformational brachycephaly:
    • flat across the back of the head
    • head is also excessively wide compared to the length
    • a high slope, posterior towering or cone shape
  • Deformational asymmetrical brachycephaly (a combination of plagioephaly and brachycephaly)
  • Deformational scaphocephaly (a long narrow head shape; typically much longer than wide)
  • Torticollis and deformational plagiocephaly often occur together, but not always. The Mary Free Bed program addresses either, or both, diagnoses.
If Your Baby Has Torticollis and/or Plagiocephaly

Start by ensuring your baby receives a clinical evaluation to determine what, if any, complication exists. If deformational plagiocephaly or congenital torticollis is confirmed, you can start by repositioning your baby in the opposite direction he or she prefers to look during play and sleep.

Also, have your baby spend time on his or her stomach during waking hours and do therapy-directed stretching to loosen tight muscles. Repositioning your baby’s head during sleep also helps redistribute the pressure on his or her skull. An evaluation can help educate you on proper repositioning and tummy-time techniques.

What Happens if Torticollis Isn’t Treated?

Left untreated, the long-term effects of torticollis can include gross motor difficulties, vision problems, facial and ear asymmetry and asymmetric jaw development in moderate or severe cases.

Outpatient Pediatric Programs Services include:
Physical Therapy Assessment

A physical therapist talks with you about your child’s medical history and current torticollis and plagiocephaly symptoms and evaluates:

  • Range of motion throughout your child’s body
  • Control of shoulder girdle
  • Structure and appearance of your child’s face and neck
  • Gross motor skills
Occupational Therapy Assessment

An occupational therapist assesses your child’s range-of-motion, control of shoulder muscles and bones and the structure of his or her face and neck. They also evaluate your child’s fine motor skills and visual perceptual development.

Coordination with Orthotics

We’ll coordinate with other experts at Mary Free Bed to provide your child with the best possible care. This includes working with our on-site orthotics program for evaluation and cranial remolding treatment when necessary for cranial reshaping and/or neck collars when needed for retraining.

Torticollis and Plagiocephaly Therapy

We monitor your child to ensure they’re on track to hit developmental milestones and continued healthy patterns for movement.

Physical and occupational therapists work with your child
  • Stretching exercises
  • Increasing gross motor function with emphasis on symmetry of movement between the right and left sides of the body
  • Neck and trunk righting
  • Increasing control of the shoulder muscles and bones
  • Increasing range of motion in the neck
  • Increasing awareness of neglected side
  • Manual techniques to relax tight muscles
Family and Caregiver Education

Family involvement is a key component of our program. Our rehab experts educate you on positioning, stretching and play activities that support your baby’s therapy goals. You’ll receive training and support to ensure your child’s treatment continues at home and in other settings.

The Mary Free Bed Torticollis and Deformational Plagiocephaly Programs treat children affected by torticollis and/or deformational plagiocephaly. The programs at Mary Free Bed work closely together to allow for the best possible outcomes.
The torticollis program focuses on improving your child’s neck motion, symmetrical use of the arms and legs, hand-eye coordination and strengthening core muscles to make it easier for your child to develop age-appropriate motor skills. The plagiocephaly program can evaluate the asymmetries of the head shape. Our experienced clinicians will give a recommendation for continued repositioning or to move forward with a cranial remolding orthosis.
Torticollis and deformational plagiocephaly often, but don’t always, occur together. Our program is designed to address either or both diagnoses, depending on your child’s needs.

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