“My baby will only turn his head in one direction. Should I be concerned?”
While more commonly noticed in babies who are born prematurely, babies born at any gestational age may show a head-turn preference. A head-turn preference occurs when a baby keeps his/her head turned toward the same direction for long periods of time. In most cases, babies will have a right-side head-turn preference, but it is possible for babies to have a left-side preference. Being aware of your baby’s head position is the first step to preventing future complications.
During the first few weeks of life, babies have very little head and neck control; therefore, they are dependent on their caregivers to support and position their heads. You may not notice a head-turn preference until your baby is around 6-8 weeks of age, as this is when babies begin to briefly lift and rotate their heads.
Your baby should be able to fully turn her head in both directions without signs of discomfort or fussiness and should turn her head equally in both directions in response to environmental stimuli (noise, faces, toys, lights, etc.). If your baby is not turning his head in both directions in response to stimuli, and seems to prefer looking toward one side, then he could have a condition called torticollis.
What is Torticollis?
Torticollis is sometimes called “wryneck” or “twisted neck”. Torticollis is diagnosed when the sternocleidomastoid (SCM) muscle (a muscle on the side of the neck that runs from the ear to the collarbone) becomes contracted and shortened. The tight muscle will cause baby’s head to tilt toward the shoulder and make it difficult or uncomfortable for baby to turn his/her head. As a result, the SCM muscle on the opposite side of the neck will stretch and may become weak, leading to muscular imbalance.
Signs of Torticollis:
- Baby prefers looking one direction over the other
- Baby appears uncomfortable when turning his/her head
- Baby isn’t using his/her eyes to following toys
- Baby prefers using one arm/hand more than the other
- If breastfed, baby seems to favor one breast over the other breast
- Baby is developing a flat spot on one side of the head
How is Torticollis Diagnosed?
Torticollis can be diagnosed with a physical examination. Your child’s pediatrician will conduct a physical examination and will likely ask questions about your pregnancy and delivery. Your physician may also request an X-ray to check your baby’s spine.
What Causes Torticollis?
Torticollis can be present at birth (congenital) or occur after birth (acquired). Congenital torticollis occurs when baby’s SCM muscle is impaired at birth, likely due to awkward positioning in utero or sometimes due to muscular or spinal trauma during delivery. Congenital torticollis is sometimes associated with abnormal hip positioning or hip dysplasia. Acquired torticollis may occur when baby’s head is frequently placed in an awkward position (e.g. during sleep), and could also occur due to abnormal muscle tone, injury, visual impairments, or from a viral infection.
The Importance of Early Treatment
When treated early by a licensed therapist, baby’s symptoms will usually improve with simple stretching and positioning modifications, and complications typically resolve within six months. If treatment is delayed, a more intensive stretching program may be needed, in addition to using a helmet to correct skull asymmetries. In fewer cases, conservative therapy cannot correct the torticollis, in which your child’s pediatrician may recommend intramuscular injections or lengthening of the SCM muscle with surgery. Early treatment is important to avoid developmental complications and to help your baby meet his/her milestones.
Developmental complications may include the following:
- Limited reaching with the arm on the affected side
- Feeding difficulties
- Limited visual scanning
- Facial asymmetries
- Muscular imbalances and spinal misalignments that interfere with gross motor milestones such as rolling, crawling, and walking
- Cognitive delays due to interference with engaging in purposeful play
- Development of a very pronounced flat spot on one side of the head- called plagiocephaly (Sometimes this flat spot will resolve with specific exercises and positional modifications; however, in other cases, baby may be prescribed a helmet to keep pressure off the skull.)
How can Occupational Therapy (OT) Help
Torticollis can usually be corrected with implementation of specific stretches and positioning modifications. An occupational therapist will help your baby stretch out the tight side of his/her neck and strengthen the weaker side to balance out the neck muscles. Positional modifications will keep baby’s head centered and reduce pressure on the back of the skull. Play-based activities will be used to strengthen baby’s neck and encourage head-turning. OT will also help your baby engage in functional tasks such as feeding, reaching for toys, following objects with his/her eyes, social engagement, and also help with sleep positioning.
If you are concerned about the positioning of your child’s head, we are here to help your baby regain range of motion and improve his/her functional engagement!