What is Torticollis?

What is Torticollis?

By Nichole Hagerty, DPT

Bringing home your precious newborn is an exciting yet nerve wrecking experience.  Parents will lay awake staring at their little girl, conscious of all their movements.  Her baby pictures will fill your walls, office spaces, and phones.  You will spend endless amounts of time hoping and praying she is perfect.

But then something seems off.  She only looks to the left.  In all of the pictures, her ear is constantly on her shoulder.  When she is placed on her stomach, she will continue to look left, but never right.  As the sleepless nights continue, you begin to notice her head shape is changing.  She begins to have a small flat spot because she is consistently looking left while keeping her ear tilted toward the left shoulder.

You become concerned.  Others may tell you not to worry, that your baby will grow out of it.  But your gut instinct is telling you something is wrong.  A pediatric physical therapy evaluation will determine if your child is affected by torticollis.

Torticollis, derived from the Latin words tortus for twisted and collum for neck, is the tightening of the sternocleidomastoid (SCM).  The SCM is a muscle that goes from the mastoid process of skull to the sternum and clavicle.  You have a right and left side SCM.  When the muscles work together, they flex the head forward.  However, when one is working alone, you bend your head sideways to the right and rotate your head to the left.  This is what occurs when a child has torticollis.  One of the muscles is tight, possibly due to positioning in the womb, birth trauma, or positioning after birth.

The incidence of Torticollis has been steadily increasing since 1997 with the introduction of the “Back to Sleep” campaign.  Not only is your child sleeping on her back, she is often times spending a lot of time in her car seat, her swing, her bouncer, and all of this wonderful baby holding equipment.  However, she is not spending enough time on her stomach.  She is not learning how her body works.  She has difficulty with being on her stomach and has not developed the neck extensors to lift her head that will allow her to explore her world.  Once these are developed, she needs to learn to play on her tummy without as much support, but still being supervised.  She needs to be able to reach and play with both of her hands equal. She needs to discover her body. The best way to do this is to spend time on her stomach.

Torticollis is typically treated with changes in positioning at home, as well as specific strengthening and stretching exercises.   A physical therapist can teach you simple stretching exercises to perform daily at home with your baby.  As time continues, physical therapy will progress to more strengthening exercises.

The best way to decrease continued pressure on the back of the head is to increase the tummy time.  For more reading on tummy time, read our blog post from Kids Place’s Teri Roberts, DPT.

Torticollis is not preventable, but it is treatable with an early referral to a Pediatric Physical Therapist and committed parents who follow the home exercise program recommended by the therapist.  Ask your pediatrician for a physical therapy evaluation if you are concerned your newborn is suffering from torticollis.



Articles referenced:

• Boere-Boonekamp M, van der Linden-Kuiper L. Postional preference: prevelance in infants and follow-up after two years. Pediatrics. 2001 Feb; 107 (2):339-43
• deChalain T, Park S. Torticollis associated with positional plagiocephally: a growing epidemic, J. Craniofac Sugery. 2005 May; 16(3): 411-8
• Do T. Congenital Muscular Torticollis: Current concepts and review of treatment. Curr Opin Pediatr. 2006 Feb; 18(1):26-9.

Outdoor Activities That Will Engage the Whole Family!

Outdoor Activities That Will Engage the Whole Family!

By Nichole Hagerty

The unbearable heat has passed us, and cooler, nice weather is here!  What a perfect time to engage our children with fun, outdoor family activities.  I have put together a list of activities that will help improve gross motor skills while having fun in your front or back yard!  A quick trip to a local park will increase the number of activities your family can enjoy.  So take a look at our ideas, head outdoors with your children, and enjoy the weather!

This is just a sampling of games and activities, but we know there are a lot of other ideas out there.  We’d love to hear from you.  Leave us your ideas or fun activities in the comments section below! 

Follow the Leader 

These games not only challenge coordination and balance, but also listening skills and following directions.  Here is a list of some of my favorite childhood games:

• Simon Says (stand on one foot, touch your toes, jump 5 times - the opportunities are endless)   

• Red light / Green light (quick start and stop reaction times)

• Ring around the rosy (fun and following directions)

• Mother May I (take 10 steps forward, 2 hops, 5 steps to the left - the first person to the “mother” wins!)

• Hide and Seek 

Play Hopscotch
Hopscotch is great for balance, strength, and coordination.  Jumping on one foot will work the core muscles.  Straddle jumping will improve strength and conditioning.  In fact, hopping may improve "overall lower extremity mobility given the different movement planes (forward-back, sideways, and rotational)," says Fabio Comana, MA, MS, an exercise physiologist for the American Council on Exercise.  You don’t just have to make a basic hopscotch; you can make a variety of boxes.  You can jump through with two feet in the box, or out of the box.  You can jump on 1 foot the whole way down. Work to the ability of yourself and your child.

Create your own Obstacle course 

This, too, will improve overall strength and conditioning.  Walk along the edge of your driveway, or a line on the sidewalk.  Jump over cracks, run around a tree or cactus (be careful not to touch it!) kick a ball in a goal, climb under the bush, and jump over a small/large rock - make it up as you go.  You can measure results and improvement by timing yourself, your kids, and your neighbor’s kids.  Most importantly, have fun! 

Go for a bike ride 

With younger children who are unable to pedal a bicycle, I recommend a tricycle.  A bicycle with training wheels helps only with the balance of the bike.  A tricycle’s pedals are attached to the front wheel, which will increase motor memory and learning when you push the tricycle.  As your child grows and is able to push the peddles on their own, it becomes similar to riding a bike.  Your child will now have the motor memory and motor planning to perform this skill, allowing the child to move to a bicycle with training wheels.  Riding a bike is an excellent, lifelong physical activity that most children love to learn how to do. 

Play Catch/Kick a ball

Little boys love playing ball with their fathers, but did you know little girls do, too.  Playing catch or kicking a ball works on foot-eye or hand-eye coordination.  These coordination skills will show in a variety of school tasks, such as handwriting.  You can start this activity at a young age by rolling a ball back and forth with your child.  Eventually, you will progress to bouncing a ball back and forth.  Then work on throwing and catching.  Start with a playground-sized ball and progressively work towards a tennis/baseball-sized ball.  When kicking a ball, start with a stopped ball, progress to kicking a moving ball, and finally, moving while kicking a moving ball. 

Go to the park 

There are a ton of fun activities at a park for you and your family.  These activities will allow your child to play, but at the same time work on strengthening throughout the core and extremities, along with vestibular reflexes.  Work on climbing ladders, going down slides, swinging, and walking across and through unstable surfaces.  All these activities work on many of the tasks we like to see kids able to perform when they come into therapy. 

Other ideas for you and your child

• Walk through the zoo

• Go for a hike

• Go to Encanto Park

• Go on “treasure hunts”

• Go Geocaching

• As the temperature rises, go to a splash pad

All of these activities improve basic gross motor developmental skills.  Just as important, your child and you will be outside and active!  Most importantly, they allow you all to have fun!!!

I realize this is just a small sampling of games and activities.  We know there are a lot of other ideas out there.  We’d love to hear from you.  What activities do you enjoy outdoors with your children?