Pediatric Physical Therapy: Torticollis and Plagiocephaly

Torticollis and plagiocephaly are medical conditions involving the neck and head of a baby, sometimes causing the head to tilt to one side or appear ‘flat’. Thankfully, if treated early, they do not cause brain damage or long-term problems. A script is not required to set up an evaluation, and most insurance plans cover physical therapy at Holistic Healing Center, so getting this treated right away will prevent brain and orthopedic problems down the line.

Dr. Nancy treating a baby for torticollis and plagiocephaly. She is performing gentle, fun stretches that are painless for this infant. This child’s lactation consultant found feeding issues during breastfeeding. This child had a tongue-tie that the mother chose to get released. Dr. Nancy performed craniosacral therapy. This body work can help calm a baby. She also found torticollis and plagiocephaly. Within a few treatments, this baby could breastfeed no problem. Within a few weeks, this child’s issues were completely resolved.
No one wants to think about their baby having any medical issues once they’re born. Unfortunately, it does happen, and if that’s the case, it’s important to take immediate action whenever possible.

In the case of torticollis and plagiocephaly, they are two different conditions that can impact one another. But, they are also fairly common. Some studies suggest that 1 in 3 babies will have torticollis, while congenital plagiocephaly occurs in one out of every 2,000-2,500 births.

Thankfully, both of these conditions are treatable, and the earlier they are diagnosed, the better.

With that in mind, let’s break down both conditions individually, including symptoms to look for, and how pediatric physical therapy can help.

What is Torticollis?

Torticollis is Latin for “twisted neck,” which is a fairly accurate description of what the condition entails. Infant torticollis occurs when your baby has trouble turning his or her neck. It is sometimes referred to as “wry neck,” because it can make it seem as though the head is tilted to one side.

Torticollis in babies is typically due to an irregular position in the womb, or difficult childbirth. For some, it may be present right away after birth, but it can take some babies up to 3 months to show any signs. Sometimes parents have a preference for the side they hold or feed the baby, thereby causing the baby to always tilt or turn their head to one side. Breastfeeding issues can also be a sign of torticollis. Some babies will only latch on one side, while others won’t latch at all. While a great lactation consultant is an important part to successful breastfeeding, so is a trained physical therapist. Some babies are tense and need craniosacral therapy to calm down their central nervous system. Other babies have anklyglossia, or a tongue tie, preventing them from latching. Infants with torticollis can also have trouble latching due to inability to extend the neck in certain directions. The good news? We have specialists in torticollis, plagiocephaly, and tongue-ties. Our expert pediatric physical therapists have extensive training in gently, naturally, and successfully treating these issues. Torticollis doesn’t have to cause your child any pain. But, if it isn’t properly treated, it can lead to bigger health concerns later on in life.


What Are the Symptoms?

Some of the most common symptoms of torticollis in babies include:

  • Head tilting in one direction
  • Will look at things over their shoulder rather than following with their eyes
  • May only want to breastfeed on one side
  • Shows frustration when they can’t turn their head
  • Trouble latching. Breastfeeding issues. Fussy around feeding times.
  • Acid Reflux. Excessive spit up after feedings.

Symptoms can sometimes be hard to see, especially in newborns. Setting up an evaluation with one of our experts is an easy, worthwhile, first step. Some pediatricians are verybusy, and have to move quickly to keep up with the intense demands of attending to so many children. Our specialists set up a thorough, hands-on 1:1 evaluation to check all of the child’s milestones. They are not just checking for and treating torticollis and plagiocephaly. We will also check for and treat any other developmental issues.

You can learn more about how your baby might be screened for torticollis by watching the video below:

What is Plagiocephaly?

Pediatric plagiocephaly is a condition that refers to the ‘flattening’ of a baby’s head on one side, or in the front or back. There are two types of plagiocephaly that can occur: It can either be congenital, which means the condition was present at birth, or it can develop during infancy if a young child lays on their back or one side too often.

Early on, plagiocephaly isn’t painful for your child, and in most cases, it will go away with the proper treatment. However, not treating plagiocephaly can be dangerous for your baby and can lead to further health complications, including:

Dr. Nancy loves treating babies. It’s one of her favorite populations to treat. Here, she is strengthening head and neck control for this infant with plagiocephaly and torticollis. Babies typically get better quickly, with just a few treatments. Sometimes they need weeks or months of therapy, but getting in for an evaluation as soon as possible is the best thing to ensure a quick resolution.

  • Head deformities
  • Dangerous pressure inside the head
  • Developmental issues
  • Sensory processing disorders
  • Balance issues
  • Possible ADD/ADHD
  • Behavioral Issues
  • Headaches
  • Neck / Spine issues in the future

There is no one known cause for congenital plagiocephaly. However, some studies suggest that it may be part of a genetic syndrome, especially if there are no other symptoms present. The most common reason for plagiocephaly is spending too much side on that baby’s back or one side. This is referred to as positional plagiocephaly. Tummy time and avoiding excessive time in the baby carrier are important. Some researches say a baby should be on their belly as much as they are on their back. Many pediatric therapists believe babies should only be in their car seat when they are in the car. Using a donut-shaped pressure-relieving pillow under the child’s head can help off-load pressure while in the car seat. Talk with a trained therapist before putting anything in the car seat. Be weary of suffocation hazards by placing anything in the car seat or sleeping areas. Supervision is important to prevent SIDS (Sudden Infant Death Syndrome)

What Are the Symptoms?

It’s important to pay attention to any abnormalities on your baby’s head because it could be a sign of plagiocephaly. The symptoms of plagiocephaly include:

  • Flattening of one area of the head
  • An ear that looks “pushed in”
  • Facial disformities or abnormalities
  • A slightly “sqooshed” eye or cheek
  • Uneven cheekbones
  • Lower jaw
  • Other facial abnormalities
  • Visible blood vessels on the scalp
  • Projectile vomiting
  • Seizures

How is it Diagnosed?

Unlike torticollis that can be easily diagnosed often just by looking at the child and knowing some of the symptoms, plagiocephaly typically requires a more formal diagnosis and a few different processes to go through.

That diagnosis can include taking X-rays so a pediatrician can determine what the bone structure of your child’s head is like. If there are any rigid or missing sutures, they will receive the diagnosis and will likely have to go through some type of treatment. Most commonly, a pediatric physical therapist can diagnose and treat plagiocephaly right away without X-rays. To expedite results and prevention of a helmet, a pediatric physical therapist can evaluate your child without a script from a pediatrician. Prevention of a helmet is important as wearing a helmet to address plagiocephaly is quite burdensome. Typically, if plagiocephaly is not addressed early on, i.e. between 2 weeks and 6 months of age, it may require your child to wear a helmet 23 hours a day to correct the flattened head. The child’s skull hardens and fuses together around 8-10 months old, so making an appointment with a physical therapist right away is the best way to prevent a helmet or long-term issues.


Torticollis and Plagiocephaly Treatment

Thankfully, the best treatment for both of these conditions is usually various exercises and stretches that can be done in the home once they are learned by the parents. A trained physical therapist can show you how to safely perform these at home for your child. A customized evaluation is important as doing stretches improperly can worsen your child’s condition. Typically a child undergoes an evaluation and a few treatments for simple torticollis & plagiocephaly. In more serious cases, a few weeks or months of physical therapy is required to correct the head position and shape of young children.

TorticollisMinor treatment for positional plagiocephaly typically includes repositioning the baby as they sleep and increasing tummy time. A physical therapist can help your baby to stay in certain positions for longer periods of time, reducing the pressure on the flat spot of their head. The positions typically include more tummy time and periods of sitting up. A physical therapist might also urge you to hold your child more, rather than setting them down while you do things. Switching sides that you hold your child is important. Feeding on different sides, even if the child is bottle-fed, is important to improve the full range of motion of your child’s head.

In some extreme cases, helmet therapy might also be recommended for your child as their bone structure continues to develop. A helmet encourages the skull to develop the right way without flat spots or other abnormalities. This is typically a last resort near the 8-10 month mark when the bones fuse and harden. Getting an evaluation and treatment early can prevent this.

The same type of treatment can be done for children with torticollis. According to Johns Hopkins University, the goals of physical therapy for torticollis include giving a child the ability to turn their head from side to side and to tilt their chin down to their chest. Essentially, PT will help to build up your child’s muscle strength and range of motion.

For either condition, a physical therapist will let you know what you can continue to do at home. With the right treatment, these conditions can fade and your child can live a perfectly healthy and happy life.

If you would like more information about pediatric physical therapy for torticollis or plagiocephaly, please contact The Holistic Healing Center at 732-252-6155 or email us.

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Meet Our Torticollis Team Member

Dr. Brianna Pitre

Dr. Bri specializes in joint mobilization, strengthening, sports-specific training, and balance.

How Do We Help Babies?

What Should I do if My Baby has Torticollis?

Dr. Nancy explains what Torticollis is and why it is important to correct Torticollis sooner rather than later!

LIVE FOOTAGE: Treating Baby with Torticollis

Hear what one of our patients has to say about our practice and watch how Dr. Nancy treats an infant with Torticollis!

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