Treating torticollis in children

The sternocleidomastoid muscle is shortened on the same side as the tilt. For example, if the newborn or infant's neck tilts toward his right side, than the muscle between the cranial condyle (bony prominent just behind the ear) to the front of the clavicle (collar bone) are shortened. If you look closed to your son or daughter's chin; you may also notice that his/her chin or face is also rotated toward the left side (usually toward to opposite side of the tilt). Do not be alarmed; this is very common muscle tightness that can be successfully treated with physical therapy as proven by the article titled "Management of congenital muscular torticollis in a child: a case report and review" by Ta JH, Krishnan M. from PubMed.gov

I will give you some basic tips on how to help your child with Torticollis: (Beginners lesson)

  1. First, position his head and neck on proper alignment.  It must be carefully positioned straight even if the child continues to tilt toward his/her comfortable side.  You can fold a burp cloth or small blanket into a cylinder shape and place it toward his tilted side in order to straighten the neck. The cylinder shape clothe will be upright in a vertical position as to encourage the spine to be aligned. Think of it as a tilting tree with side supports next to the angle that is bent.
  2. Massage the baby’s neck with  natural oil (olive oil, almond oil, etc). Avoid body lotion or baby oil since they may dry-up too soon or be extremely slippery. The organic oil you choose will have the best mid-range consistency.  Most newborns do not like their first bath and nevertheless their first massage.  Start with warming up your hands and taking the onesie off. Keep a blanket over his legs and belly for draping and comfort.  Pretend you are a massage therapist.  Take a deep breath and be calm…your goal is to relax the babies tense neck even if their crying tell you otherwise. You will apply extra virgin olive oil over your hands and rub; gently place your cup-like fingers together hand position over each side of his neck, just behind the ears and slowly (light pressure as touching a rose pedal) stroke toward his/her clavicle and shoulder. This light stroke is called "effleurage" which should be done 3 to 4 times in a row, slowly as you would be releasing all the tension off the neck and out thought the shoulders.
  3. Moving the baby's head from side to side or up & down also known as Cervical range of motion.  The sooner the baby is confident to move his neck, the less muscle stiffness or thickness he/she will have. Refer to article: "The cervical range of motion as a factor affecting outcome in patients with congenital muscular torticollis." by Lee JYKoh SELee ISJung HLee JKang JIBang H.

With torticollis, his/her neck is limited in 1) side-bending and 2) rotation.

Neck side bending: the goal is to open the side in which he/she is tilted. Gentle oscillate (slow rhythmical movement from side to side) counting 6 seconds to one side and 6 seconds to the other side. For example, the baby is facing up, laying on the changing table; with one hand, you cup his cranium (back of his head-skull bone) as holding a football; with the over hand, you stabilize the upper back and shoulder (spread your fingers from shoulder to shoulder as palm secured upper spine). Do this four times each diaper change. Remember, the baby will stop crying after his daily diaper change exercise. At any time; you can stop and pick up your baby, soothing him/her with love-hugs.

Neck rotation: the goal is for the infant to follow a rattle with his eyes and turn his neck 180 degrees (from right to left side) on his own. As a beginner, do not turn his head passively….start with letting the baby do it on his own.  You need to prepare are play area for your newborn/infant.  Placing a mat or folded quilt on a clean floor is best.  Avoid these play exercises over a bed…before you know it, he/she will be rolling off the bed.  Also, scientifically the bed is too soft of a surface. You need a gather all toy rattles, visual cards, small black/white objects and place them in a basket. Once the baby is on the floor, facing up and facing you; choose any toy from the basket and shake it 12 inches from his face.  Starts from his favorite side and rattle it toward his side of neglect; you will be 12 inches away from his eyes to avoid cross-eyes and move the toy 180 degree arc in 6 seconds. For example, the baby/infant will turn his cheek from touching the mat/quilt over his right side to rotation the head and eyes tracking the toy (rattle or index card) toward his left side as the cheek will get closer toward the mat/quilt.

Move the neck up and down: the goal is for the infant to visually gaze from a downward position to passing his/her horizontal line and gaze upward. This is very difficult for a baby to do if he/she is always in a carrier or swing share. Play with baby face to face (12 inches away) as he/she is on a flat surface. Make eye contact and funny facial expressions as he/she looks at you over or below his/her horizon. Do this 5 times; maybe you will get a smile in return for your efforts to help them improve.