What can I do?
If you notice that your baby holds his head preferentially to one side, then mention it to your paediatrician. Torticollis can be difficult for a paediatrician to see if your baby is feeding during the visit or if he spends most of the appointment in your arms.
Parents can do gentle stretching exercises with the baby to help increase mobility of the shorter muscle. Alternating the feeding position can also help to stretch the neck in one direction and then the other. Changing the position of the headrest pillow in the car seat can help as well.
You should rotate the head position of any sleeping baby, but especially a baby with torticollis. When the neck muscles are uneven, a baby will clearly prefer to sleep with his head turned to one particular side. Because the bones of the skull change shape dramatically over the first few months of life, if a baby sleeps in the same position day and night, then the skull can flatten in one spot.
This can create a vicious cycle: if the baby prefers to hold the head in a certain position and there is a flat spot on the skull that serves as a nice shelf on which to rest the head, then fixing both problems can be twice as difficult. This is called torticollis-plagiocephaly sequence. So placing your sleeping baby on his back with his head sometimes turned to the right side and other times to the left and still other times straight in the middle will help resolve the torticollis and minimize head flattening.
When does my doctor need to be involved?
Your doctor should be aware of torticollis, but it often resolves on its own. If the neck muscles continue to be uneven past the first 2 or 3 months of life, a doctor will often introduce stretching exercises or refer the baby to physical therapy.
What tests need to be done, and what do the results mean?
The tests to check for torticollis are simply manoeuvres done during a physical exam. A doctor will look at how the baby holds his head and then will rotate the head and neck gently from side to side, checking for limitations. Sometimes a small mass (that feels like an olive) can be felt along the shorter side of the neck.
What are the treatments?
Over the first several weeks of life, torticollis often resolves with gentle stretching exercises of the neck. If this does not solve the problem entirely, then your doctor may want you to consult a physical therapist. Physical therapists utilize coordinated exercises to stretch the SCM. The torticollis should resolve within three months of starting physical therapy.
In very rare cases, a baby may not respond to physical therapy. If the torticollis persists, then surgery may be necessary. The surgery involves cutting the tight SCM on the shorter side of the neck so that the muscles can stretch. Physical therapy is still required, even after surgery, in order to further stretch and strengthen the muscle.
What are the possible complications?
The main potential complication of torticollis is plagiocephaly, or flattened head. As described above, this can happen when a baby prefers to keep his head in one particular position. The bones of the skull change shape over the first several months of life, so repeatedly sleeping or sitting in the same position puts pressure on one specific part of the skull, often causing it to flatten.