Torticollis in Infants

So you’re noticing that your child is constantly turned towards one side. You try turning the head back the other direction, but this is met with protests and crying and straight away they try to move it back again. You bring your bub in for their child health nurse appointment, or with a GP, or other health care professional, and they make a comment that your child has a torticollis.

So what is a torticollis?

Torticollis in technical terms is merely a description of the position of that child’s neck – its literal Latin translation is “twist in the neck”. What is more important is what could be causing this torticollis. There are many conditions that present with a torticollis ranging from infectious causes to traumatic causes to congenital causes, some of which are very common, some of which are incredibly rare. And that’s really one of the fun parts about our job; putting on our Sherlock Holmes hat and trying to determine what the cause of the torticollis may be.

What are the potential causes?

One of the more common ones that we see – and I have to say especially for practitioners like myself as a chiropractor working with musculoskeletal conditions – is torticollis caused by tightening of some of the muscles in the neck.

Now, this can be present from birth in which case it’s given the name of “Congenital Torticollis”, but it can also develop later on in life where it is just given the name of a Muscular Torticollis or a “Benign Positional Torticollis/Muscular Torticollis”. The trigger for this is not completely understood, however there is strong evidence suggesting that a little bit of birth trauma or difficulty in getting bub out can cause a little bit of tearing inside one of the muscles of the neck. As a response to this tear, the muscle tightens, leading to that contraction and positioning that we see described as the torticollis.

Sometimes a little lump can form inside this muscle which is given the interesting name of a tumour (and aside from the technical definition of tumour, this is one of those situations where you put on your best Arnie voice and copy his scene from kindergarten cop, “it’s not a tumour”), but this is merely just a little collection of fibrous tissue within the muscle as a part of the healing process.

Now, there is a second way that can cause Congenital or Muscular Torticollis, and that is changes to normal joint motion. It’s a very interesting scenario: we use muscles to move joints however joints themselves can become restricted in their motion also leading to this torticollis presentation. This one becomes more suspected in instances where those muscles involved in neck motion do not have that spasm feel to them yet on motion assessments, we find restrictions to passive ranges of motion.

So, is having a torticollis serious?

Again, this stems down to a couple of factors: are we aware of any other underlying conditions? Did it start suddenly? Has it been there for a long time? Is it starting to interfere with normal developmental milestones? These are questions that we will be asking to rule out any red flags in your child’s presentation as those questions may suggest something more serious and require further investigation and intervention.

Muscular torticollis is a relatively benign condition with a good chunk of kids spontaneously resolving. There are, however, always exceptions to that rule and some kids do require intervention for improvement.

The risk with not getting any intervention when it is required is that it may carry potential long term consequences such as a risk of neurodevelopmental delay (1,2) or changes to normal head shape due to being positioned in a particular spot for such a length of time. (3,4)  Compare this to other conditions that can present with the torticollis such as Grisel’s Syndrome or a Retropharyngeal Abscess, which when not managed correctly may become life threatening to the child.

But again, that’s going to the more serious side of things and really these serious conditions should be getting ruled out early with a thorough assessment.

What could you do for a baby who does seem to be experiencing a torticollis?

Again, I will just highlight that a good chunk of these do get better on their own.

Some people get advised stretching, where they have to tilt and turn the baby’s head to the side that’s restricted, but I have to advise caution with this as if it is done incorrectly there are risks of tearing the tight muscle and making things much worse again.

Stretches are more effective when we find there is a tightness in the neck muscles, but not all cases have that tight muscle – in which case it’s more likely a joint restriction causing this presentation. In those scenarios a more direct intervention may be required – interventions such as manual therapy as done by chiropractors, osteopaths, and physiotherapists – however the research supporting this kind of intervention shows while it is safe, further research directly assessing its effectiveness is still required. (5,6) The best way to go about this would be a trial of therapy as guided by your health care practitioner.

On a final note, it is important to state but there are some strong associations with this particular presentation – hip dysplasia and plagiocephaly are commonly associated with this twisting in the neck (more on this to come!).

So, in summary, if you’re seeing that your child has a twist present in their neck, it is important that your child is getting a full assessment by their health care practitioner to ensure the best possible outcomes.

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