What is Torticollis - When Your Baby Favors Looking to One Side

Torticollis Definition

Torticollis (Wryneck)

Torticollis, also known as wryneck, is a twisting of the neck that causes the head to rotate and tilt at an odd angle.

What is Torticollis?

•  Congenital Muscular Torticollis (CMT): The most common type present at birth. It's caused by a shortened or overly tight sternocleidomastoid (SCM) muscle in the neck. 

Acquired Torticollis: This form develops after birth, often due to injury, illness, or unknown causes.

Causes

Here's a breakdown of some injury, illness, and unknown causes of acquired torticollis: 

Injury

• Birth trauma: During difficult deliveries, injury can occur to the neck muscles, leading to torticollis. 
• Minor neck trauma: Injuries sustained in sports, minor accidents, or even awkward sleeping positions can cause muscle strain or inflammation, leading to torticollis.

Illness

• Upper respiratory infections: Viral or bacterial infections of the throat, lymph nodes, or ears can cause inflammation and pain, leading to muscle spasms in the neck.
• Gastroesophageal Reflux Disease (GERD): The discomfort from GERD can cause a child to arch their body and twist their neck in an attempt to find relief.
• Sandifer Syndrome: A severe type of GERD where twisting of the neck and odd postures are prominent symptoms.
• Cervical spine abnormalities: Less common, but issues with the bones of the neck (vertebrae) can cause torticollis.
• Tumors or Laryngomaliacia: In rare instances, structures in the esophagus (laryngomalacia) or tumors in the neck or brain region might lead to torticollis.

Unknown Causes

• Benign paroxysmal torticollis of infancy: This temporary condition occurs in some infants. Episodes of head tilting and twisting happen for unknown reasons and usually resolve on their own. This can be an early sign of genetics due to the baby lying in the womb prior to delivery.
• Idiopathic: Many cases of acquired torticollis have no identifiable cause. Caesarean ‘C’ Sections, nuchal cord (occurring in 29% of birth deliveries), prolonged time in the vaginal canal can cause stresses to the neck. Please note, your OB/GYN needs to protect and save your life and your baby. Never prevent medical intervention due to concerns in development. 

 (Picture of Optin Bundle)

Additional Causes

• Dystonia: A neurological movement disorder causing involuntary muscle contractions. This can be a primary condition or occur as a side effect of certain medications.
• Vision Problems: Children may tilt their head to compensate for vision difficulties (ocular torticollis).

Torticollis and Developmental Milestones

Important Note: If you or your child develops sudden head tilting or persistent neck pain, it's crucial to see a doctor. Early diagnosis and appropriate intervention are important for treating torticollis and preventing complications.

Here's how torticollis might cause delays or deviations in typical development:

•  How does Torticollis affect Development?

Here's a hypothetical scenario explaining how torticollis could prevent a baby from grabbing their feet:

The Case of Clara

Clara, a 4-month-old baby, has a left-sided congenital muscular torticollis (CMT). This means her left sternocleidomastoid (SCM) muscle is tight, causing her head to tilt to the left and her face to turn to the right.

Limited Range of Motion

Due to the tight SCM muscle, limited, and asymmetrical rotational movements, Clara has limited neck mobility, especially turning her head to the right. This restricts her ability to see and reach across her body towards her midline and crossing midline.

Reaching for Feet Challenge

Grabbing her feet requires Clara to reach across her body and rotate (twist) at the waist. However, because of the torticollis:

• Difficulty Looking Right: She struggles to turn her head and see her right foot properly. This lack of visual guidance makes it harder to coordinate reaching.
• Limited Rotation: The tightness in her left SCM muscle restricts her ability to twist her torso far enough to the right to comfortably reach her foot. Since your baby will not make a movement that is difficult or hurts them, they will deviate or prevent the movement. 

Alternative Strategies

While reaching her right foot directly might be difficult, Clara might try alternative strategies:

• Bringing Foot to Hand: She might try kicking her right leg up towards her hand instead of reaching down.
• Reaching with Left Hand: She might favor reaching for her left foot with her left hand, which requires less twisting.

Importance of Early Intervention

How do we prevent or significantly improve Clara's or your baby’s situation?

Typically a parent is taught to stretch their left SCM muscle and strengthen the right side will help increase her neck mobility and range of motion. This can be very painful and causes stress on your baby and causes parents and professionals to look for range of motion, a measure used for adults, rather than developmental movements that include weight transfer, transitional skills, and rotation. 

• Newborn Movement Assessment

  Developed to help parents and professionals look and identify infant movements for optimal development. This course is free CLICK HERE

• Grabbing the Feet Course by Movement Lesson™ 

  Parents can work with their child’s development at the milestone. Your baby should be grabbing their feet at 4.5 months of age. Get the course CLICK HERE 

• Baby Milestone Courses for Optimal Development 

  Grow with your baby and all their milestones. Get the support you need for your baby’s future today! This will give you 60 Days free access to the Grabbing the Feet Course + Others. CLICK HERE to Access

Remember: This is a hypothetical scenario. The specific ways torticollis affects a baby's development can vary depending on the severity of the condition.

Helping Clara, and your baby, with early movements in their milestones will allow them to turn their head more freely, see her surroundings better, and reach for objects, including her feet, with more ease.

Gross Motor Skills:

Newborn to 3 Months - Horizontal Development 

• Absolute Horizon (Sleeping and Lying Down): Difficulty setting up a neutral response to their first spacial orientation. It's difficult to lay your baby down without waking them or they have to sleep in a device or put to sleep by a car ride.
• Tummy Time: Unable to present head-lift due to strain from the head tilt.
• Rolling Over: Difficulty rolling over, especially towards the side opposite the head tilt.

3 Month to 6 Months - Transitioning into Vertical Development

• Grabbing Feet: Head tilt positioning creates too much strain for pelvis and shoulder girdle to move into development.
• Crossing Midline: Coming to midline and crossing midline shows with stress with maintain body positioning to support the torticollis over developmental movements.

• Sitting Independent: Delayed independent sitting due to poor balance and head control in combination with lack or little midline and crossing midline abilities.

6 Months to 9 Months - Vertical Development into Synchronized Locomotion

• Coming to Sitting: Head tilt positioning creates too much strain for pelvis and shoulder girdle to move off the floor.

• All-Fours: The lack of Coming to Sitting directs your child into rolling through their belly and pushing up. This puts strain into all their movements.
• Crawling: Asymmetrical crawling patterns, favoring one side of the body.

9 Months to 12 Months - Getting Off the Floor

• Crawling and Reaching: Unable to support reaching due to head tilt positioning. A Baby will get to an object and sit or fall to the floor to play. They cannot perform locomotion and multi-tasking.

• Crawling and Reaching: Head tilt prevents the ability to look up and cross midline. Your baby will have to sit or get into another position to look up.

• Coming into Standing: Your baby will try to pull into standing as they will not have the pelvis, chest, or eye movements to come to standing. 

 Fine Motor Skills:

• Reaching & Grasping: Difficulty reaching for objects on the side opposite the head tilt, affecting hand-eye coordination.
• Playing: Preference for playing with toys on one side, which can contribute to the muscle tightness.

Visual Development:

• Visual following: Difficulty following moving objects through a visual midline, horizontal, due to head tilt will limit their visual field and functional vision.
• Depth perception: Inabilities for binocular vision and convergence will affect their ability to have depth perception in horizontal and vertical positioning due to altered head positioning.

Physical Impacts:

• Plagiocephaly: Flattening of one side of the head due to consistent positioning. 
• Facial Asymmetry: Potential development of uneven facial features over time if untreated.

Why Early Intervention with Movement is Crucial for Babies with Torticollis (and how Evaluation Helps)

Early Intervention is Key

Early Identification and Movement Lesson™ is crucial for treating torticollis and minimizing its possible impact on current and future development. You need to work with your child’s pediatrician and possible medical team when there are concerns for tortocollis presentation. 

• Provide guidance on positioning and handling techniques to promote symmetrical movement patterns

Early intervention with movement therapy is vital for babies with torticollis because it addresses the root cause of the issue – limited mobility – during a critical window for development. Here's a breakdown of why it's important:

The Problem: Missed Milestones

Torticollis, especially when left untreated, can lead to a cascade of problems impacting a baby's development. The tight neck muscles restrict movement, leading to:

• Uneven muscle development: The stronger, unaffected muscles overcompensate for the weaker ones, causing imbalances.
• Delayed motor skills: Rolling over, sitting, crawling, and reaching milestones might be delayed due to limitations in head and neck control.
• Visual tracking issues: Difficulty following moving objects due to limited head movement.
• Plagiocephaly: Flattening of the head on one side due to persistent positioning with the head tilted.

Early Intervention: A Window of Opportunity

The brain and nervous system are most receptive to change during the first few years of life. Early intervention capitalizes on this plasticity by:

Initiating Developmental Movements for Milestone Creation:

While a typical approach from a physical therapists use gentle stretches and exercises to lengthen the tight neck muscles and improve flexibility. This allows the baby's head and neck to move more freely. Movement Lesson™ approach is from the core of your babies movements needed for optimal development. Your baby cannot progress to their maximum ability without weight transfer, transitional skills, and rotational movements.

Neutral Ability for Core Movements:

Exercises target your babies need for neutral movement, the equal ability for right and left, as they go into midline and crossing midline underused muscles on the affected side, promoting symmetrical development and improved balance cognitively and physically.

Promoting Optimal Development:

Your baby is not meant to have deviations in development. Parents and caregivers need to understand and jump on time-dictated development with movement techniques and activities that encourage the baby to move their head and body in all directions. This helps development to be on-track with proper movement for all future skills.

Extensive Evaluation Protocols: Guiding the Journey

The Movement Lesson™ Early intervention programs involve comprehensive evaluations to personalize treatment plans for your baby. Here's how these protocols benefit a child with torticollis:

• Baseline Assessment: The Newborn Movement Assessment™ (NMA™), can be used anytime during your baby’s development. This allows parents and caregivers to understand what movements to focus on for their child’s torticollis and can assess the severity of the torticollis, the baby's current movement responses, and any muscle imbalances.
•  Developmental Screening: Your physician may be looking at genetic issues, birth trauma(s), visual, and any medical concerns to look into further causes and course of action. They may use standardized tests to identify any potential delays in other developmental areas that might be impacted by torticollis.
•  Goal Setting: Parents can work with therapists and doctors to set strategic and achievable goals for the baby's progress using the Optimal Development Framework™ M.O.V.E.M.E.N.T.™ (More Observation, Valuable Essentials, Movement Evaluations, Next Transition)
•  Monitoring Progress: Using the NMA for regular assessments track the baby's response to therapy, allowing adjustments to be made as needed.

By focusing on milestone movement and addressing the physical limitations caused by torticollis early on, intervention programs can significantly improve a baby's chances of achieving optimal development across various domains – physical, cognitive, and visual. The extensive evaluation protocols ensure the therapy is tailored to the baby's specific needs, maximizing the benefits and promoting a brighter future.

3 Easy Steps

1. Newborn Movement Assessment

   - Developed to help parents and professionals look and identify infant movements for optimal development. This course is free CLICK HERE

2. Grabbing the Feet Course by Movement Lesson™ 

   Parents can work with their child’s development at the milestone. Your baby should be grabbing their feet at 4.5 months of age. CLICK HERE.

3. Baby Milestone Courses for Optimal Development 

   Grow with your baby and all their milestones. Get the support you need for your baby’s future today! This will give you 60 Days free access to the Grabbing the Feet Course + Others. CLICK HERE to Access 

Important Note: If you notice your baby consistently tilting their head to one side or favoring a specific side during play, consult your pediatrician. Early diagnosis and intervention significantly improve outcomes for children with torticollis.

Disclaimer:

This blog does not replace the advice of your medical professional. Please seek the help of your medical professional as you have concerns about your baby. By taking any course by Movement Lesson, you accept full responsibility for your child, and Movement Lesson is not responsible for any injury that may be incurred by doing a course or following any advice followed on this blog.