There are many things new parents pick up instinctively, and one of the first is to protect a newborn baby’s head and neck. But when that doesn't happen, it increases the risk of Infant Torticollis.
In those first few weeks, babies are like a rag doll - all floppy with no control. That’s completely normal. But some mums and dads might notice the opposite - one side of bub’s neck can be tighter than the other causing the head to tilt or twist - as if they’re looking around a corner.
It’s not serious but it does need some understanding and management.
What is Congenital or Infant Torticollis?
Congenital torticollis, often called infantile torticollis, refers to tightness of one side of the muscles in the neck that leads to a head tilting deformity for baby. There are two main types:
Postural
Bub just loves to look one way. Here bub has a preferred head posture without any neck tightness and a full and normal range of movement of the head. This is nothing to be concerned about - just ensure you spend equal time playing or nursing bub on each side, otherwise those muscles can become secondarily tight.
Muscular
Here the big strap-like muscle at the front of the neck called the sternocleidomastoid muscle (SCM) becomes tight. This causes the ear to be drawn towards the affected side, leaving bubs with a reduced range of motion through the neck, and their chin pointing up and away to the opposite side.
Congenital torticollis is usually picked up in the first few weeks after birth, but if subtle, it may go unnoticed for months. You should suspect it if your baby seems to have a preferred feeding side, preferred head position when sleeping, or difficulty moving their neck fully.
If you’re worried, your doctor will do an examination. Whilst gently holding the baby, they should be able to rotate the baby’s neck from side to side, with the chin touching each shoulder. If bub can’t do that then it suggests torticollis. Your doctor should also pay close attention to their hips, as developmental dysplasia of the hips is more common for these babies.
We also need to pay close attention to the growth of their skull. The skull is made of a number of soft plates joined together.
If bub spends too much time in one position, it will squash that part of the skull leaving a flat bit – this is known as plagiocephaly. Correcting infant torticollis and allowing more neck movement with distribute pressure more evenly.
What if You Found a Lump in the Neck?
Many babies with torticollis are found to have a lump in the SCM called a Fibromatosis colli, also referred to as ‘pseudotumor of the sternocleidomastoid muscle of infancy’. It’s the associated issue sure to create the most panic. In fact, many parents notice the lump before the head tilt. But the good news is this lump is very, very rarely an issue, and is in fact just part of the whole bigger picture.
The lump is a bunch of muscle cells growing into an abnormal lump rather than the smooth straight muscle. More common on the right side and in boys, it’s felt as a firm lump in the muscle, usually closer to the chest than the skull. It’s not painful, so palpating it doesn’t cause any harm or distress to baby.
And the most important thing to remember is that it’s benign – which means it’s not cancer and it’s not dangerous.
We don’t really know what causes these lumps to occur, but they are associated more commonly with breech pregnancies, difficult labour, and the need to use forceps or vacuum extraction devices to assist the baby coming out safely. It’s believed that these issues all lead to some bruising in the SCM which grows into the lump and tightens the muscle.
An ultrasound or x-ray might be needed for to check for infant torticollis
Your doctor may consider getting an ultrasound of the baby’s neck if there is a more unusual feel to any lump or torticollis detected. There are some other lumps like branchial cleft cysts, enlarged lymph nodes, or rare cancers that need excluding. An x-ray will help exclude deformities in the cervical spine if they are suspected, but this is rarely necessary.
Management is super simple, and hardly ever drastic
The great news is that parents can manage the majority of infant torticollis issues at home with simple little tricks and exercises.
Firstly, parents should nurse bub from the affected side, encouraging them to look, turn, and twist more that way. Sometimes moving the cot so they are ‘forced’ to look that way helps too.
Exercises to Counter Infant Torticollis
Passive stretching is the mainstay of management. About three times a day parents should do some sets of stretching of the neck.
- Gently holding the head to the side for a few seconds, with ten seconds rest – repeating 15 times. You’ll notice as the days and weeks go on their range will slowly increase until it is normal – the chin can easily reach the shoulder.
These exercises will also encourage any SCM lump to slowly resolve. Research shows that if these exercises are started early, well over 90 per cent can expect a full resolution within three to four months.
If after about six weeks of home management there’s no improvement, or if the issue was severe to start with, a trip to the baby physio is needed. Physio should also be considered if the condition wasn’t picked up until they were three or four months old, as their little muscles can be more stubborn.
Rarely, severe tightness or large fibromatosis colli will need surgical correction. Your GP and physio will help guide when that’s required, but more severe plagiocephaly certainly increases the urgency for a referral.
In my experience, nearly every bub has a preferred side to gaze into mummy’s eyes. And the good news is that if there is some true tightness or a lump, it’s super easy to diagnose and manage at home. So if you’re worried about your precious one, then pop into your doctor for a check.
This article was first published in KidSpot and republished on theAsianparent with permission.
ALSO READ:
Strengthen Your Baby’s Neck Muscles to Build Head Control
Keeping Your Baby’s Head Upright Helps Promote Neck Development