Torticollis (Wry Neck)
Sometimes an infant tends to tilt the head or keep the head turned in one direction regularly. This may be a sign of congenital torticollis. There are others reasons for an infant or child to develop torticollis but here we will discuss only the congenital torticollis seen in newborns and usually noticed by the time the baby is one month old.
What is Torticollis?
Torticollis is caused by a shortening of one of the main neck muscles we use to turn our heads with: the sternocleidomastoid (SCM). The SCM runs from the skull down to several points roughly along the clavical. When this muscle contracts, it helps us tilt our heads in that direction and point our chins in the opposite direction (So the right SCM helps us tilt to the right and look to the left). In the condition we call torticollis, one of the SCM muscles (we have one on each side) is shortened or bunched up and there may even be a knot in the muscle we call the ‘pseudotumor’ of torticollis.
An infant with torticollis will tend to tilt his head or favor turning the head to one side.
If left untreated, torticollis can lead to craniofacial abnormalities and, rarely it can be associated with other conditions so you should always raise the concern with your pediatrician if you notice the baby seems to favor one side.
How do you cure Torticollis?
First, your pediatrician may do some imaging but not always. If there appears to be a mass or a bony abnormality, the doctor may order an ultrasound of the mass or do an x-ray. Oftentimes, this isn’t necessary as the diagnosis can be made by examining the baby.
Treatment can usually be managed at home through a variety of positioning techniques and passive exercises.
We want to encourage the baby to stretch the shortened muscle by looking in the opposite direction of their natural preference. If a baby has a right sided torticollis, the baby will tend to tilt to the right and look to the left. We want to encourage the baby to look to the right. For a right sided torticollis, hold the baby in the left arm if bottle feeding so that baby must tilt the chin back to the right to receive the nipple.
When placing the baby in the crib, always place them in such a way as to encourage them to look out at the room: if the baby has a right sided torticollis and likes to look left, make sure his right side is facing out to the room where everything is happening and where you are. To see you, he will be forced to bring his chin around to the right side to see the room.
Use toys and other eye catching objects and place them in such a way that the infant must look away from their natural preference, toward the side of the torticollis.
The goal of passive stretching is the same: to stretch the shortened muscle. It must be done when the infant is sleeping or relaxed and not resisting the exercise. These gentle stretches are designed to correct the tilt and the chin alignment by holding the infant firmly and gently pushing the chin toward the affected side and holding for a moment and then gently tilting the head away from the affected side and holding for a moment. A physical therapist or pediatrician should demonstrate these movements for you before you try it. There can be complications to doing exercises the wrong way or in a child who has an underlying cause of torticollis.
If these techniques are not successful and an infant is starting to have signs of facial asymmetry after a few months, surgery to correct the muscle shortening may be necessary. Use of surgery is rare and not without complications of its own so it is important to keep up with exercises so a baby has the best chance of correcting the condition on her own.
Matthew Toohey, MD. November 18, 2011