Get in touch
562-600-0208
info@synergydpt.com

Serving Whittier, CA 
Follow us

Torticollis, What Now?

Dr. Hazel M. Legaspi, PT, DPT • August 20, 2021

A parent's guide to taking the next steps.

Having a child with torticollis can be stressful, especially if it is something that is noticed soon after your baby is born.  Torticollis can result from a few factors such as how the baby was delivered, how they were positioned in the womb, or how a baby is positioned after birth.  The great thing is that if it is identified early, treatment is more effective sooner and correction is generally quicker.  The difficult thing with torticollis is when it goes untreated and your baby is more independent and crawling or walking all over the place--- treatment is more difficult and progress is slower to correct the muscle imbalances related to torticollis.  But in either case, there are effective treatment options, we just have to figure out the next step!

If your child has been diagnosed with the condition of torticollis by their pediatrician, you probably already have an exercise sheet showing you how to stretch your child in at least two different ways.  One is a side bend and the other is a head rotation.  These stretches are great to be aware of but they need to be done correctly and throughout the day to make any sort of lasting change.  If you have noticed that your child is not improving after one or two weeks of these stretches and your baby's head tilt or head rotation is getting worse, it's a good idea to contact your pediatrician for more assistance.  

Depending on your location and what services are available, you may be referred to go see a physical therapist (PT) or an occupational therapist (OT).  PTs and OTs are specialized to treat torticollis and depending on the practitioner's style of treating, have the ability to make the experience enjoyable so that your baby is relaxed and actually getting a good stretch and is able to strengthen the correct muscles.  It take skill to be able to get a baby calm, engaged, and have targeted activities to make actual changes in their overall flexibility and strength.  

If you are unsure if your child needs therapy, check out the following. If one or more of the following are true for your baby, who is over one month old, it is highly recommended you have a discussion with your pediatrician regarding torticollis and treatment concerns so you can be referred to get professional assistance for your little one: 
(depending on your state, you may be able to schedule directly with a PT or OT without a physician referral)

- I have tried the stretches but my baby cries the whole time and resists the stretches
- My baby's whole body looks crooked when I lay them down 
- It is difficult to cleanse or dress my baby because of how they position their head close to their shoulder to one side
- My baby is moving one hand a lot more than their other hand
- My baby keeps one hand closed and fisted while the other hand opens and explores more
- My baby kicks one leg more than their other leg
- My baby only moves their eyes to follow me to one side but moves their head to follow me to the other side
- My baby only rolls one direction 
- My baby uses one hand to play with toys
- My baby has a hard time breastfeeding on one side compared to the other side
- My baby always moves to one side after I correct their position when they're in their car seat or when I lay them down to sleep 

If your baby is tolerating the stretches and you see improvement in how they're positioning their head and don't see any issues above, continue to monitor how your baby is doing until the next pediatrician appointment.  If you don't have an upcoming appointment scheduled, maybe schedule one 4 weeks after your pediatrician informed you about your child having torticollis so they can reassess. 

If you are a concerned parent who's child has not been assessed for torticollis by their pediatrician and you're seeing signs of torticollis, call your pediatrician (or in areas of direct access you can contact a PT or an OT) and have them asses your child.  In my experience, children who are seen for the treatment of torticollis at 0-3 months of age have overall better prognoses than children referred after 6 months of age.  Management of torticollis is A LOT easier to manage sooner than later, especially for baby and parents.

I hope this has been helpful.  If you have questions let me know!  
By Dr. Hazel M. Legaspi, PT, DPT August 26, 2021
You may have seen cute babies wearing a helmet after researching torticollis, plagiocephaly, flat head ... and wondered if your baby might need it. These helmets are called different things: baby helmet, cranial correction helmet, DOC Band or Starband (brands), or cranial reshaping orthoses. I will share my experience with what I have seen that results in the most amount of change in the shortest amount of time. Two things - early awareness of asymmetries and early tummy time play. First, EARLY AWARENESS: The day your baby is born and you're looking into their cute eyes and getting to know them, seeing and feeling how their head looks at all angles is something you're already doing. Noticing that there is a flat area on one side, both sides, or the forehead looks more rounded and forward are things we may be noticing from the start. Every baby's journey is different and sometimes the difference in head shapes are from babies positioning in the womb--- like having to share the space with a twin, not liking to move as much and so their head rests more on one side compared to the other side, other times it's related to how the bones of their head had to adjust to go through the birth canal during delivery. After birth, head shapes can take on a different shape as a baby develops habits of staying on one side of their head more than the other side. And sometimes, it's not just a baby's head shape that is affected but it's also their ears, face, jaw, and face. Second, TUMMY TIME: All babies, perfectly rounded head or not, benefit from tummy time play early on. How early, as early as baby's first day here! We already do it with our little ones. Think of how we burp our little one after they've had a bottle or been breastfed, we curl them up and gently hold them across our shoulder and rub or gently make circles to help them burp. This is the beginning of the tummy time journey! Practicing how to hold their head and neck up while on your shoulder! Tummy time play allows for so many great things to happen. It is the foundation of motor development that leads to so many things, but in this post, we will focus on head shape. As the days turn into weeks, all that practice of tummy time play adds up and your baby starts to develop stronger shoulder and neck muscles to hold up their head. This also provides opportunities to keep their head off of surfaces for longer periods, awareness of their surroundings causing visual exploration, and also self awareness with getting their hands into their mouths. So, you might be asking, when does a helmet come into play? In general, babies can start wearing helmets around 4-5 months old. The idea is that by this time, their strength to hold their head up during tummy time is strong enough and areas of flatness improved after the first few months of tummy time play (and specific neck exercises/stretches if torticollis is involved). If the first two things have been worked on for the first 3 months, most parents will see a big difference in their baby's head shape. For some babies, a helmet may be needed if the areas of flatness is still there and in most cases if there are areas of the face, ears, eyes, mouth, or forehead that are different in position between right and left sides. I typically recommend parents start the conversation with their pediatrician about helmets very early on so that by 4 months old, you have a referral. Helmets take time to get approved by insurance, it takes time to find a place that makes them, and then making the appointment adds up to days or weeks. With helmets, in general, the sooner they are able to be used, the less amount of weeks your baby will need to wear it. Every baby's situation is different but from my experience, early awareness and early tummy time are the key to success for any baby, but especially if a helmet is eventually needed. Some key points when looking into cranial orthotics aka baby helmets : -Do research with what types are available in your area -People that make the helmet are called Orthotists, usually will find a location as an Orthotics & Prosthetics clinic/business -Some places offer free consultations -There are different ways to measure for helmet fittings, digital or manually. If your baby tends to be very fussy, consider the options available and maybe the digital fitting will be better versus a manual fitting. -Ask how the helmets are fitted and monitored. If you are told it is only a 2 or 3 time visit total, that is concerning. Baby helmets are like braces, they need to be monitored and adjusted as baby's head shape changes. In general you should be asked to return to the clinic for reassessment within the first 2 weeks of your baby starting to wear the helmet and the number of return visits are numerous during the course of the helmet therapy. I hope this was helpful! Again, please don't hesitate to contact me or leave a message if you have questions.
Share by: