Torticollis in babies is a muscular condition in which the neck muscle of a baby becomes stiff and short. Also known as infant torticollis or congenital torticollis, this muscular condition affects about 16% of the neonatal population. It causes a noticeable tilt in the infants’ heads which might be either congenital or the result of an illness. In either situation, the infant torticollis causes the neck muscle to contract, resulting in a twisted and tilted head in a bay that persists until medical attention is sought. However, if the condition is detected early enough, it can be treated without surgery (1). Learn about the causes and symptoms of torticollis in infants, how it’s diagnosed and treated, and what happens if it’s left untreated.
What Is Torticollis?
Torticollis is the abnormal twisting of the neck due to shortening of the sternocleidomastoid (SCM) muscle (1). SCM is a long oblique muscle originating from two points, each from the sternum (chest bone) and clavicle (collarbone). It attaches to the temporal bone – the skull bone right underneath the ears. The SCM muscle is present on both sides of the head (2). When one muscle contracts, it pulls the neck towards its direction, while the SCM muscle on the other side expands. In torticollis, an SCM muscle contracts and remains so, thus twisting the neck towards its side. In fact, the name torticollis means “twisted neck” in Latin. Depending on the side to which the infant’s head is turned, torticollis may be referred to as “right torticollis”, “left torticollis”, and “positional torticollis”. Despite the tautness of the SCM muscle, torticollis is mostly painless, and infants only feel the discomfort caused by a stiff neck position. Hope now you got a clear idea of what torticollis is. Read on to know why the problem arises in babies and what you can do about it.
What Causes Torticollis In Infants?
There are two types of torticollis viz. congenital muscular torticollis and acquired torticollis. Following are the reasons for each condition:
I. Congenital muscular torticollis causes:
Congenital torticollis, also called congenital sternomastoid torticollis, happens when the baby is born with a twisted neck or develops in the first three months of their life. Here are the reasons for the occurrence of the condition:
Congenital muscular or skeletal abnormalities. For example, Klippel-Feil Syndrome, where bones of the neck fuse together thus causing a tilt in the head (4).
Intrauterine problems. Excessive uterine tissue may cause the fetus to cramp thus leading to the shortening of the SCM muscle.
Fetal injury. The physical impact to the womb may alter and affect the development of the fetus. It may cause defective shortening of the neck muscle, and the baby would be born with a head tilt.
II. Reasons for acquired torticollis in babies:
Acquired torticollis occurs as a side-effect of a health condition and is not seen at the birth of the infant. Below are the causes for acquired torticollis: Ocular torticollis is considered a non-musculoskeletal reason for torticollis since the baby would have been born with a healthy SCM muscle (6). Even the torticollis could be mild. However, the problem lies in the ocular muscles, which are responsible for the movement of the eyeballs. A twisted neck is the primary symptom of torticollis, but there are other signs to identify the condition.
What Are The Symptoms Of Torticollis In Babies?
Tilted neck is the classic symptom of torticollis. Nevertheless, parents can look for the following signs of probable torticollis: You can look out for these symptoms, which are clearly visible. If the signs are indicating torticollis, you need to go for a professional diagnosis to ensure that the baby is treated promptly.
How Is Torticollis Diagnosed?
The healthcare professional will use one of these three ways to diagnose torticollis in babies: Once the doctor confirms that it is torticollis, they will initiate the treatment right away.
How Is Torticollis Treated?
If the torticollis is acquired as a side effect of another disorder, then the doctor will treat that particular condition. If torticollis is a problem in itself, it could be treated in one of the below methods: Remember, a parent must never attempt head stretch and neck movement on the baby without medical guidance and training. Consultation with a medical professional is necessary before performing any move on the baby’s delicate neck. Stretches help release the tension in the SCM muscle and expand it back to its normal shape. The baby’s head is stretched gently in various directions thus reducing head tilt. An exercise regime ensures complete recovery of the muscle with its full range of motion. The TOT collar straightens the neck by putting gentle pressure on the opposite side of the tilt. It slowly brings the neck to the correct alignment by stretching the SCM muscle. The doctor will train the parents in putting on and taking off the collar. The baby will have to wear the collar for a prescribed number of hours every day. Most collars are washable since they are made from plastic or washable fabric. TOT collars are most likely to be recommended in combination with physical therapy. Botox is considered a midway between physical therapy and surgery since it is suitable for infants, who do not respond to physiotherapy but the condition is not severe enough for surgery. Botox is used for the treatment of spasmodic torticollis in adults, and researchers find botulinum injections effective even for babies with torticollis (18). However, the treatment is ideal for infants above six months of age. Surgical procedures are followed by intensive physiotherapy sessions that help reinforce the stretchiness of the muscle. The infant will also have to wear a brace to maintain the correct position of the head. Once the muscle heals and sets into place, the infant can be free of torticollis.
Recovery Time
The treatment works best when initiated before the age of six months when the baby has a flexible musculoskeletal system. Whereas physical exercises can take six months or more to show positive results, surgical intervention shows immediate results, but in the latter case, the baby will have to undergo physical therapy for more than three months to reinforce the muscle’s position. In either case, it can take months before the infant holds his head straight. It is worth the wait because if left untreated, torticollis can lead to other complications.
Long Term Effects Of Torticollis
If the baby suffers sustained torticollis then the following collateral problems may emerge: Timely initiation of torticollis treatment is all you need to do to prevent the above conditions. Parents can always play a part in helping the baby come out of the problem.
How Can Parents Help A Baby With Torticollis?
There are some baby-safe means to counteract the effects of torticollis right at home. Here is what you can do: The process of curing torticollis is slow and long. You need to deal with it carefully so that the muscles of the baby are not damaged. Now you know that torticollis is treatable but is it preventable?
Can We Prevent Torticollis?
There is no way to prevent congenital torticollis caused by genetic mutations. However, there are a couple of things parents can do to reduce the risk of torticollis in babies:
