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Congenital Muscular Torticollis

Congenital Muscular Torticollis

There are a lot of muscles in the neck that help to move your head back and forth, and from side to side. Sometimes, one of the muscles in the neck, called the sternocleidomastoid, can be tighter and shorter on one side compared to the other, causing a condition known as congenital muscular torticollis, or better known simply as torticollis. Torticollis is relatively common among newborns.

What causes torticollis?

The sternocleidomastoid muscle runs on both sides of the neck, from behind the ears down the neck to the collarbone. Torticollis may be a result of your baby being packed tightly inside your uterus or abnormal positioning during pregnancy, causing the muscle in the neck to shorten. This may also be associated with hip dysplasia, along with the torticollis. Another reason may be from a stretched neck muscle during childbirth, which develops scar tissue while healing. Torticollis can sometimes be acquired after birth. This occurs when your baby tends to keep their head turned more often to one side compared to the other, causing the muscle on the opposite side to tighten.

What does torticollis look like?

Torticollis results when the tight sternocleidomastoid muscle causes the head to tilt toward the side with the shorter muscle, bending the neck towards the shoulder, with their chin turned to the opposite side. One of the first signs you may notice is that your baby may prefer looking towards one side compared to the other, the side that is opposite of the tight neck muscle. Or your baby may prefer to breast feed on one side instead of the other, since the other side is more difficult for them. You may notice that your baby may not be able to move their neck as well as other babies. Your baby may also have some scar tissue in their neck, which looks like a bump or lump. Some babies with torticollis may develop a flat spot on one side of their head from continually lying on that side. This is called positional plagiocephaly. Do not be alarmed about either the bump or the flat spot, as they usually resolve as the torticollis resolves.

How is torticollis diagnosed?

Torticollis is usually first noticed by a baby’s caregiver. When you see your doctor or nurse practitioner they will perform a physical exam. In the exam they will assess how far your baby is able to move their head from side to side, this is testing your baby’s range of motion. To ensure that the head tilt is unrelated to other medical conditions, they may also send you for an x-ray of your baby’s upper spine, called the cervical spine. Since torticollis and hip dysplasia often occur together, your doctor of nurse practitioner may check your baby’s hips. If your baby did not have a hip x-ray at birth to check for hip dysplasia, they may order one as well.

How is torticollis managed and treated?

The best way to resolve torticollis is to encourage your baby to look to the opposite side of the tightened muscle. This helps to stretch the tight sternocleidomastoid muscle. Your doctor or nurse practitioner may suggest seeing a physiotherapist to learn how to properly and safely perform exercises to help loosen the tight neck muscle.

Some things you can try at home with your baby include:

• Position your baby in their crib so that they face a wall or away from the rest of the room, forcing them to look around the room and away from the wall.
• When playing with your baby, get their attention with toys and your voice from the opposite side, making them turn their head in both directions and not just the preferred side.
• When feeding you baby, switch to the unfavoured side.

– Dr. Christina Cesareo and Dr. G Paul Dempsey

[Featured image: Wiki Commons {{PD-1923}}]

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