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Illnesses & Symptoms

Torticollis (Stiff neck)

What is torticollis and what causes it?

Torticollis is a condition in which a child's head is tilted to one side.  It is typically caused by either a tightening of the muscles of the neck, flattening of the back of the head or a combination of the two.  It is common after birth and generally resolves as the baby moves the head back and forth, sometimes with help from parents stretching the muscles. 

Secondary problems related to torticollis

Torticollis limits a child's ability to turn the head to see, hear and interact freely with the environment. Because of this, torticollis may lead to delayed development, weakness of one side of the body, and difficulties with balance.

Torticollis is also associated with a flattening of the back of the head called plagiocephaly. The constant pressure on the back of the side of the head the baby always turns toward leads to flattening of that side and a bulging on that side of the forehead. The brain continues to fill the space it is given, so it continues to grow, but if untreated, torticollis and plagiocephaly may contribute to perceptual problems and learning disabilities when children reach school-age.

Treatment

Treatment for torticollis involves:
 
  • Stretch the muscles regularly at home and possibly with a physical therapist.  Click here for directions on neck stretching.
  • Massage the neck and back muscles and use a warm wash cloth to loosen the muscles before stretching.
  • Encourage tummy time and hold upright when awake. 
  • Place the flat side of the head up when sleeping as much as possible initially, then allow more equal time on both sides as the head flattening decreases to avoid flattening on the other side.
  • Place interesting things for babies to look equally in both directions during play time and in the crib.
  • Minimize the use of baby equipment (car seats, bouncy seats, swings, etc.) to help increase the movement of the neck and decrease the time spent on one side of the head.

For children with torticollis, it is very important that they play in all the following positions: on their tummy, on their side, sitting and supported standing. These are appropriate and necessary at any age. Encourage them to look at and interact with toys that promote rotation of the head and body to the child's non-preferred side. Set up the child's environment (i.e. orientation of toys, crib and play mat) to promote exploration toward the baby's non-preferred side.

Tummy Time

It is important that all infants spend time awake on their stomachs. Tummy time allows babies to strengthen and stretch muscles that are important for developing basic valuable motor skills such as crawling, standing, sitting and walking. Tummy time also facilitates visual development as your baby learns to move his/her head to look at objects and track movement. Tummy time should always occur while the baby is awake and be supervised by an adult. To reduce the risk of Sudden Infant Death Syndrome (SIDS) all healthy infants should sleep on their backs until they are able to roll from their tummies to their backs easily.

Babies who do not spend enough time on their tummy and spend too much time on their back generally:
 
  • Roll and walk later than babies who have spent time on their tummy.
  • Have tight muscles in their necks.
  • Have flat spots on the back of their heads.
  • Have weaker back and stomach muscles which may lead to difficulty sitting, standing straight or balancing in upright positions.

Aim for your baby to spend half their waking time throughout the day on their tummy. Start tummy time the day of your baby's birth. The sooner a baby spends time on his/her tummy the more comfortable this position will be as he/she continues to develop. If a baby is not used to spending time on his/her tummy, they may not enjoy it at first. Try introducing small amounts of tummy time and build up to the half day slowly. Try the following positions to give your baby some quality tummy time:
 
  • Place a thin blanket and toys on a firm surface (such as the floor) and lay your baby on his/her tummy to play. This is a great position for babies to look at toys and practice lifting their head.
  • Get down on the floor facing your baby with or without toys placed between you. Approach the baby from the non-preferred side. Hold toys above and to the non-preferred side.
  • Put toys straight ahead or to the side the baby avoids turning towards.
  • Place your baby on his/her tummy on your stomach while you are lying on your back. This way your baby can easily make eye contact with you.
  • Put your baby on his/her tummy over your lap.
  • Carry your baby horizontally by scooping your hand under the baby's chest so its legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.

Play time

  • During stroller rides place grasp toys in front of or to the non-preferred side of the baby.
  • When playing, hold toys above and to the non-preferred side.
  • Carry your baby horizontally by scooping your hand under the baby's chest so its legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.

Lying on Their Side

  • Place toys in a way that encourages downward gazing.
  • This is an easy posture to start rolling to the stomach.
  • Sitting and standing (supported or independent):
  • Encourage head turning to the non-preferred side with toys or objects that are brightly colored or made with contrasting colors.
  • Encourage looking and reaching with the baby's non-preferred hand.
  • Encourage two hand play after about 6 months of age.

Carry your baby

  • Against your chest with baby facing out.
  • Over or up against your shoulder.
  • From under their tummy like a football.

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Illnesses & Symptoms