The word 'torticollis' means 'twisted neck'. It can be caused by a variety of underlying conditions. Congenital Muscular Torticollis (CMT) is one of the common conditions that can cause torticollis in babies. When CMT is identified early, gentle, non-surgical treatment is usually very effective.
CMT is relatively common, affecting approximately 1 in 250 babies. Babies with this condition have a preference to turn their head to one side only. This is usually because one of the muscles at the front of the neck, called the Sternocleidomastoid (SCM), becomes tight on one side. Often there is also a flat spot on the baby's head. The tightness in the neck muscles and the tendency to rest on the flat spot when lying face up can make it hard for babies with CMT to move freely and build the strength needed to achieve motor milestones.
Some babies with CMT have a lump in the SCM muscle. The lump usually first appears when the baby is 2-3 weeks old. Although the lump is referred to as a 'tumour', it is almost always non- cancerous and generally disappears by around 6 months without the need for surgery.
The exact cause of CMT is unknown, but it is more common following a difficult birth, or when the baby is crowded in-utero (e.g., twins or growth restriction). It is also more common in first born babies. Approximately 20% of babies with CMT also have a condition called 'Developmental Dysplasia of the Hip' (DDH), where the hip joints don't develop properly. All babies are screened for this condition at birth, but when babies are diagnosed with CMT their hips will be checked more often to make sure they are developing properly.
If you notice your baby has a preference to turn their head to one side only, or a flat spot on their head, you should let your GP, Maternal Child Health Nurse, Paediatrician or Paediatric Physiotherapist know so that they can assess and refer as required. Thorough assessment helps to rule out the possibility of more serious conditions and make an accurate diagnosis.
When treatment for CMT begins early it is more effective. Over 90% of babies with CMT have a good to excellent outcome with conservative (non-surgical) treatment if the treatment begins before 12 months of age. The aim of treatment is to restore normal neck movement, prevent gross motor delay, and regain round head shape if the baby has a flat spot. This can be achieved by making some changes to the environment and learning to position your baby to play in ways that stretch and strengthen the muscles in the neck, trunk and shoulders.
Important note: If you notice that your baby has a preference to turn their head to one side, it is important to consult your health practitioner so that an accurate diagnosis about the underlying cause can be made. Most of the time the underlying cause of torticollis is effectively treated but sometimes the underlying cause is more serious.
References
Cheng, J. C., Tang, S. P., Chen, T. M.,Wong, M. W., & Wong, E. M. (2000). The clinical presentation and outcome of treatment of congenital muscular torticollis in infants--a study of 1,086 cases. Journal of Pediatric Surgery, vol. 35(7), pp: 1091-1096.
Cheng, J. C., Wong, M. W., Tang, S. P., Chen, T. M., Shum, S. L., & Wong, E. M. (2001). Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants: A prospective study of eight hundred and twenty-one cases. Journal of Bone Joint Surgery, Vol. 83(5), pp: 679-687.
Emery, C. (1994). The determinants of treatment duration for congenital muscular torticollis. Physical Therapy, Vol. 74(10), pp:921-929.
Freed, S. (2004). Identification and treatment of congenital muscular torticollis in infants. Journal of Prosthetics and Orthotics, 16(4), pp:18.
Do, T. T. (2006). Congenital muscular torticollis: current concepts and review of treatment. Current Opinion on Pediatrics, 18(1), pp:26-29.
Oleszek, J. L., Chang, N., Apkon, S. D. & Wilson, P. E. (2005). Botulinum toxin type a in the treatment of children with congenital muscular torticollis. American Journal of Physical Medicine & Rehabilitation, Vol. 84(10), pp:813-816.
Pleva, A. (2010). Practical treatment of torticollis. Retrieved from La Trobe University Library, Alexander Street Press on 19th May 2016.