Torticollis and plagiocephaly/brachycephaly in babies. Stiff necks and flat heads!

First of all, what is torticollis and plagiocephaly/brachycephaly?

Torticollis, also known as wry neck, affects the muscles in babies’ necks, making it difficult for them to turn their heads. Position while in the uterus or a difficult birth can cause torticollis in babies. Signs of torticollis include a head tilt in a certain direction or they preference to face a particular direction, effort and frustration when turning to the affected direction and preference of feeding on a particular side. Another indication of torticollis is also plagiocephaly or brachycephaly.

Plagiocephaly presents as a flattened or misshapen area of the head, and can be linked with torticollis, as a baby may be constantly lying on one side of their head due to tight muscles.

Plagiocephaly occurs as baby’s skulls are made up of different segments, which move to allow them to fit through the pelvis during birth, however after birth can mold incorrectly if impacted by head position. Brachycephaly is similar to plagiocephaly but is indicated when the flat spot is located directly on back of the head rather than a particular side.

Up to 1 in every 2 babies will have some degree of flat spot on their heads due to the safe sleeping guidelines, however it is important to know if these is being further impacted by torticollis.

What to do if you suspect torticollis, plagiocephaly or brachycephaly.

If you suspect your baby has torticollis, a physical assessment with a physiotherapist will help diagnosis the condition.

During the assessment for torticollis, the physiotherapists will look at range of motion of your baby’s head, as well as whether there are any flat spots or tension through the neck. After the assessment, manual therapy can help to release any tight muscles and you may be provided with some exericeses, activities or modifications to help even out your baby's head shape.

In cases where there has been more progression of plagiocephaly or brachycephaly, a helmet may be required to help correct flat spots. For these situations, you may be asked to wear a helmet for up to 23 hours a day for several months, as well as requiring several adjustments as baby’s head grows.

As this can be an involved and costly option, early intervention is always recommended to minimise the affects of plagiocephaly/brachycephaly. Some mild cases can resolve on its own as the head grows and focus is placed on preventative techniques.

Preventing/Minimising plagiocephaly and brachycephaly

It is important to follow the safe sleeping guides, by sleeping babies on their back, without a pillow. While babies are young, they will typically keep their heads in the same position while sleeping, so ensuring to alternate head direction is important.

Ensure that their toys and other forms or visual/aural stimulus are positioned on both left and right sides equally, so there is reason to turn their head in both directions. It is also important that babies spend enough time on their bellies having tummy time, as this will help the essential development neck control and strength.

There is evidence to suggest that the extended use of a capsule car seat can cause flat spots on baby’s heads, so limiting the use of the capsule for only travel is often recommended. It is also recommended that baby wearing can help strengthen babies’ necks, and limit pressure to the head when baby is lying down.

Annie treats a whole range of paediatric conditions including torticollis, plagiocephaly or brachycephaly, find out more information here. By the end of the session for these conditions you will have a better understanding of how to manage your child’s concerns, and a tailored plan for ongoing management, including at home management for parents.

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