As a new parent, it’s overwhelming to understand all of the recommendations and advice being shared. One sound piece of advice is to do “tummy time” with your baby.
Tummy time is actually a form of exercise, when you play with your baby while they are their tummy. This helps prevent two conditions seen in infants: plagiocephaly and torticollis. Although many new parents may not know what these conditions are, they are fairly common and respond well to treatment when caught early.
David Cancel, MD, JD
David Cancel, MD, JD, a pediatric rehabilitation medicine specialist and Director of Pediatric Rehabilitation Medicine at Mount Sinai, answers common questions about preventing plagiocephaly and torticollis and the best way to treat them.
“Early awareness of torticollis and plagiocephaly is important,” says Dr. Cancel. “Fortunately, most cases of plagiocephaly and torticollis respond well to conservative treatment. This is the reason we recommend early positioning and stretching.”
What is Plagiocephaly?
Plagiocephaly is a condition characterized by an abnormal head shape or a flattening of one side of the skull. Since the “Back to Sleep” campaign for babies started in the 1990s, there has been an increase in cases of plagiocephaly.
What causes plagiocephaly?
The most common cause is known as “positional plagiocephaly.” The skull of a newborn is softer and more flexible than in an adult. If the baby is laying in one position for long periods of time, usually on their backs, the head takes on a flattened shape in these areas. There are other risk factors including having a first child, having a premature birth, and having twins or triplets. Less common causes are medical conditions or genetic syndromes that may cause abnormal positioning in the womb.
What else should I be on the lookout for?
Older studies have shown that in about five percent of plagiocephaly cases, there are also associated hip abnormalities. In other cases, if there is a preference to turn the head to the same position, this can also lead to neck muscle tightness. This might lead to a condition called “torticollis.” These conditions are not always seen together, and one can be seen without the other.
What is Torticollis?
Torticollis is also known as a “wry neck” in which tightness at the neck muscles cause the head to tilt, turn, or rotate to one side. It may look like your infant’s neck is rotated at an odd angle. The top of their head may be tilted to one side, and their chin may be tilted to the opposite side.
What causes Torticollis?
Sometimes it can occur with plagiocephaly. Other times infants will turn their head to one side out of habit. It can also result from traumatic deliveries where an injured neck muscle limits head turning. In rare cases, it may be related to impaired vision, where the head is tilted to compensate for the difficulty in eye tracking. This is known as “ocular torticollis”.
What signs should parents look for?
For plagiocephaly:
- Your baby sleeps with their head in the same position.
- Baby’s head appears uneven when seen from above.
- There is a bald spot on the back of the head where it is flattened.
- The ear on the flat side appears “pushed forward.”
- One eye appears to be “squinting” because the cheeks are uneven.
For torticollis:
- A small bruise or “olive shaped” mass at the neck muscle (especially after difficult delivery).
- The head tilts to one side and chin tilts to the other side.
- Your baby seems to always “look” in the same direction.
- Baby has tightness or lacks full range of movement with their neck to one side.
- One of your baby’s shoulders is higher than the other.
What is the treatment for plagiocephaly and torticollis?
Both plagiocephaly and torticollis are treated using similar positioning techniques. For plagiocephaly, positioning is the key component. For torticollis, stretching is the main element parents learn to do at home. The earlier that the baby is treated with these techniques, the lower the risk of long-term problems affecting the head, neck, and face.
This is because over time torticollis can affect spinal alignment and impair hand/eye coordination and balance. In severe cases both plagiocephaly and torticollis can lead to an uneven shape of the head, jaw and, facial bones.
Some of the techniques include:
- Stretching exercises to loosen tight muscles and proper positioning to stretch the neck muscles. With consistent and daily practice, most babies are able to move their necks completely and build up equal strength on both sides of the body.
- Turning their heads to the non-preferred side. Babies can’t hurt themselves if they are turning their heads by themselves, so this should be encouraged.
- Carrying the baby in a position that gently stretches the neck while being carried.
- Playing with the baby to develop good motor skills and good hand coordination.
Some things your physical therapist might ask you to do at home include:
- Lots of tummy time.
- Positioning overhead mobiles or objects slightly towards the non-preferred side.
- Changing baby’s position or where they are sleeping, if they are turning their head towards sounds they hear.
- Teach therapy activities to your family and other caregivers.
- Practice some gentle massage techniques.
- Make the therapy and visual activities part of your child’s routine. Try to work therapy into all activities such as bath time, diaper changes, feeding, and carrying. This includes playtime.
One important note: You should do all therapy activities gradually and with gentleness. Do not move your child’s head forcefully. You may need to gradually build up tolerance to being stretched.
What if the head shape does not improve with therapy?
If the plagiocephaly still persists after these interventions, a physician or therapist will refer your child to have a cranial remolding helmet (plagiocephaly helmet) to help reshape their head. Most helmets are provided at about five months of age and must be worn 23 hours per day. In the most severe cases, if these measures are not successful, then the next step would be surgery to help reshape the bones of the skull (for plagiocephaly) or lengthen the affected neck muscles (in torticollis).
If you have concerns or questions, please call 212-241-3029 to schedule an appointment.
Learn more about Pediatrics at Mount Sinai: https://www.mountsinai.org/care/pediatrics