Infant Torticollis

Infant Torticollis

Infant Torticollis

by Jennifer Spak, RMT

What is it?

Torticollis (wry neck) is a symptom that causes a child’s chin to be rotated to one side and his head tilted to the other. There are many causes of torticollis but the one most commonly affecting infants is known as congenital muscular torticollis.

Congenital muscular torticollis is a condition that occurs at birth or up to 2 months of age. The postural change occurs when the sternocleidomastoid (SCM) muscle on one side of the baby’s neck becomes tighter than the other. This will cause a shift of the head and neck and cause the familiar tilted position.

Causes There are a few common reasons why the SCM muscle may have become contracted and cause your infant’s head to tilt to one side:

  • The way your baby was positioned in the womb before birth
  • Abnormal development of the SCM muscle
  • Trauma or damage to the muscle and surrounding tissues during birth
  • GERD (Gastroesophageal reflux disease)

Interrupted or compromised blood flow to the area can cause the deterioration of the tissue resulting in scaring and fibrosing of the muscle and fascial tissue. This shortens the muscles and surrounding tissue to the point of pulling the head into a new position. The right side is involved in 75% of cases.

What does it look like If the right sternocleidomastoid muscle is affected, the infant will hold his head with his chin rotated to the left and his head leaning to the right. In addition to the head posture, you may be able to feel a lump in the affected area, which is usually most noticeable between 2 and 8 weeks of age. Unlike acquired torticollis, congenital muscular torticollis is usually painless.

Functional Complications of Torticollis Although pain may not be a factor, you may experience other difficulties with your infant.

  • Breastfeeding latches may be challenged due to the inability for the infants head to be held in a correct position. Efficiency and comfort may be affected for both mom and baby.
  • Digestive changes; There has been links of torticollis to GERD. Increased gas, bloating, difficulties burping and pain may be a result of the restricted tissues through the neck, chest and abdomen.

Treatment Congenital muscular torticollis usually improves with range of motion and stretching exercises as well as Myofascial Release massage, but it can lead to positional plagiocephaly (flattened head) and facial asymmetry if your child’s head lies in the same position all of the time. If it isn’t quickly improving, then your child may need to be evaluated by a qualified Registered Massage Therapist or Physiotherapist.  Treatment of the affected tissues as well as compensatory tissues is vital. You should also be given helpful home care tips to encourage stretching and movement in the restricted ranges. Early manual therapy can increase the speed of recovery and the return to normal mobility to the head and neck. In cases that aren’t improving by 12-18 months, further medical intervention may be required.

Jennifer Spak R.M.T

Myofascial Release Therapist
Newell Physiotherapy Clinic
500-595 Montreal Road
613.746.8223
www.newellphysiotherapy.ca

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Comments:

Colic

You have the skills to help your child.  Every child should have what we are suggesting and what is particularly good for colic type situations, restlessness and reflux is a very light respiratory diaphragm release, thoracic inlet release and a very light cranial compression with some traction. If the child starts to unwind go with them.  Do this repeatedly, preferably once or twice a day and it should make an almost immediate, remarkable improvement.

Joyce Patterson, PT

Myofascial Healing Sanctuary/Malvern Myofascial Treatment Center

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I agree, I have found many of my newborn patients with symptoms of reflux also have torticollis and diaphragm restrictions and usually un-level pelvis, often also having constipation problems.  If you notice your baby is a very shallow, upper respiratory breather, and diaphragm tends to retract excessively with inspiration or does not move evenly on both sides, that is likely the case.  Even gentle leg and arm pulls may help.  If you have taken the peds course, check out the pectoral release and iliopsoas release.

Sheri Brimm, PT

Curt Redd

About Curt Redd

Expert Level MFR Therapist: Myofascial Release (MFR), as taught by John F. Barnes, is a highly effective, full body, hands-on approach. It involves stretches and compressions, applied with gentle pressure, that are held until the restriction releases. The pressure used during treatment is gentle, and never done beyond a client’s tolerance. This manual therapy can provide amazing results for decreasing pain and increasing range of motion.
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3 Responses to Infant Torticollis

  1. Molly Rose Tucker says:

    My baby girl has been receiving treatment for torticillis. She is 14 weeks. Last week she started showing symptoms of reflux. This has never been an issue. I know the two can sometimes be related. I was wondering if through the treatment we have triggered the neck nerves and caused the reflux to flare. The reflux has definitely gotten increasingly worse. So I am looking for suggestions on reflux treatment and input on possible causes.

    • Curt Redd Curt Redd says:

      Hi Molly,
      I am going to refer you to the most knowledgeable person I know in this area, my colleague Jennifer Spak. She works with these cases every day. You can find her on Facebook and private message her from there. https://www.facebook.com/jennifer.spak .

    • Curt Redd Curt Redd says:

      “Hi Molly, my friend Curt has asked that I respond to you on his behalf. I work with the infant population on a daily basis and have seen this sort of outcome occur frequently. Well there is a possibility that there could be some nerve involvement due to the treatment that has been given for the torticollis, it may also be coming from a different source. Babies that have torticollis often have some difficulties with their latch during breast-feeding. If this has occurred, as well for you that may be what is causing the reflux. When there is a restriction it will translate to restriction in the tissue in the mouth, tongue and surrounding area. This may result in a clicking sound while the baby eats, this may also occur with bottle feeding. The result will be that the baby will swallow quite a bit of air during feeds which can lead to a swollen abdomen. This is known as aerophagia. If the baby has some digestive disturbance, constipation, gassy, very fussy as the day goes on. It is likely that there has been a lot of air that has been swallowed. This increased digested air will cause a back pressure on the diaphragm as well as the stomach which will make it harder for the top of the stomach to remain closed. When the baby eats or move about, then it’s very challenging for the valve at the top to remain closed and ultimately a spit up occurs. Sometimes there is no spit up and instead just a mucousy sounding nasal cavity. This is when the baby spits up at swallows it before it exits but not before it goes up into the nasal cavity irritating the lining and creating mucus.

      I would suggest that you have your baby’s latch properly assessed by an IBCLC (lactation consultant). The infant needs to be cleared for tongue ties, lip ties and any other oral restrictions. As for the torticollis treatment, it is very important that the infant is assessed from head to toe and misalignments are noted in other areas such as the pelvis. If the baby has been swallowing a lot of air then there is likely a swollen belly. A newborn belly should be relatively soft to the touch unless they are actively contracting.

      If it is more of a true Gerd or acid reflux then they still need to be assessed for function and position of the abdominal organs to ensure there isn’t unnecessary tension or back pressure present.
      A therapist who is trained in Myofascial Release and cranial sacral therapy as well as visceral manipulation would be quite helpful in the situation.
      If you have any additional questions please do not hesitate to contact me at Jenniferspak@yahoo.ca. Well I do work out of Canada, and often times I can refer you to a therapist like Curt who could do some of the work for you.

      Molly, I hope this helps. Isn’t Jennifer great? Good luck and let me know if I can be of any further assistance. Curt

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