Infant Torticollis Part II- WHAT IS INFANT TORTICOLLIS?

Torticollis as I touched on in last weeks blog comes in different forms.  Congentital torticollis, when you baby is born with a twisted neck and the reason may be due to his/her position in utero or a congenital deformation of the bones in the spine or a neurological problem. Congenital torticollis ought to be reviewed by a paediatrician who may chose to send a baby for x-ray or ultrasound scans to rule out any pathological or genetic reason for the torticollis.

Then there is congenital muscular torticollis (CMT) this is develops after the child's birth (usually 2-4 weeks) and involves your baby's head tilting to one side and there chin pointing to the opposite shoulder.

Many practitioners like to subdivide.  This can vary but a straight forward guide increasing in severity is:

●Postural – Your baby prefers to have their head in a certain position but can happily move their head in all directions when stimulated by a toy or food etc It is also possible for you to turn your baby's head in both directions.  This may be due to a flat patch on the back on the baby's head from lying in one position too long or as a result of natural birth pressures through the child's cranium.

●Muscular – This is when there is tightness in a muscle called sternocleidomastoid (see diagram) your baby cannot move their head fully round in one direction, even if you are gently aiding them.  Again this could be as a result of birth strain or assisted birth e.g forceps

●Sternocleidomastoid mass  – This is when there is a thickening in the belly of the sternocleidomastoid (SCM) muscle.  There is limited range of movement in your baby's neck when they try to move themselves and when they are gently aided.  The mass could be due to a tumour but if detected your GP will have referred on for investigation.  More likely the mass is due to a rupture (or tear) in the belly of the SCM.  The tear could have occurred if the baby's shoulders were stuck and the head and neck wedged against opposing forces during birth, or from forceps/ventouse delivery.

If there is a rupture of the SCM osteopathic treatment and daily exercises for your baby are very important.  There muscle looses it's elasticity because of scar tissue from the tear.  Next week I will go through the excersises you can do at home with your baby and describe what osteopaths do to help aid the recovery of an SCM injury in CMT.

Infant Torticollis Part I- WHEN WILL MY BABY BE BETTER!?

Torticollis is one of the most frequently occurring asymmetries of infancy and unlike plagiocephaly (flat spot on your baby's head) seems to really worry parents.  So, I hope  this blog will straighten some of the confusion out of torticollis (that was an osteopathic joke there)

Broken down torticollis means "tortus" twisted and "collum" neck.  Occasionally you will hear it referred to as wry neck.

There are two types: 

• Congentital Torticollis; baby born with a twisted neck.
• Congenital Muscular Torticollis  (CMT) baby born straight and ends up wonky.

Now, for this article I have gone to the Gods of cranial osteopathy and also to a Paediatrician, I shall tell you why.  

Most mothers come to me worried that their baby's head is so twisted the only possible solution can be surgery, and I suppose to a mother, they would expect me, an osteopath to disagree with them.  By speaking to a Paediatric registrar as well as osteopaths I have collected a balanced point of view on the course of treatment advised that will improve if not completely resolve your baby's wonky head.

When should I take my baby to the doctor for Torticollis?

There are no NICE (National Institute of Clinical Excellence) guidelines on when exactly you should take your baby to a GP for torticollis.  In  a paper written by Charles G Macias, MD, MPH et al (All the letters mean he's a Doctor) on Infant torticollis it recommends intervention at 3 months of age or older if there is no improvement before that time.  However, if you are concerned you can take your baby to a GP or paediatric osteopath at any point as they should be able to asses whether it is CMT or Congential Torticollis and more importantly spot if there are any nerve palsy's (nerves exiting the brian and spine being affected by abnormalities in the spine) or eye issues as a result or the torticollis.  Occasionally there can be a sternocleidomastoid (neck muscle) tumour/cyst causing the torticolllis.

The above has probably freaked you out, but the study also mentioned that out of 1086 infants with torticollis 90% who were treated by a manual therapist and stretches taught to parents at home improved their head tilt and did not need surgery.  

Well how long will it be until my baby is no longer wonky?!

Good question.  Depending on what you read the answer will be different and of course, depending on who you speak to and the severity of your child's torticollis.   Referring to Charles G Macias, MD, MPH et al again, the majority of CMT resolve after 4-5 months of manual therapy and home stretching.  The study showed that the earlier treatment started the faster the recovery.  

Paediatric osteopaths Giles Cleghorn (DO MSc (Ost) MSCC) and Eva Moeckel (DO MRO MSCC) subdivide CMT in to functional torticollis which is where the wonky head is caused because of muscle spasm or contracture and Torticollis caused by muscular tear.  This is significant as functional torticollis can be treated effectively over a 3-4 month period but muscle tear can take significantly longer.  If your baby tore a muscle during birth for example, it can result in a haematoma (bleeding in the muscle belly) and scarring, this reduces elasticity in the muscle.  Treatment success can not be guaranteed in this case but will reduce the severity of the twist in the neck.

So the above is a bit of a politicians answer, but there really is no way of saying, "Yes, that will be 4 treatments over a 4 week period."  but hopefully you have a better idea of the factors involved in your baby's recovery. 

These two questions are the most frequently asked and it is why I have begun with them.  Next I shall explain as clearly as I can, what exactly torticollis is....with a picture and minimal confusing wording!

Most important of all I will demonstrate the vital home stretching you need to practise with you baby to help speed up recovery.