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Torticollis and Plagiocephaly Treatment San Diego


Torticollis and plagiocephaly are neck and skull disorders that present in infants that cause dysfunctions in head position and appearance. Torticollis is a neck issue in infants that presents as a head tilt while plagiocephaly is when the head becomes a parallelogram shape due to forces on one side of the skull usually because of a torticollis. Infants that have torticollis will have a head tilt to one side and a neck rotation to the opposite side. Many times, they are not able to move their heads out of these positions due to muscles that are either too tight, weak, or both. There are multiple causes of torticollis including head position in utero, trauma during delivery, muscle imbalances post-delivery, as well as positions and daily activities of the infant after delivery. Babies that present with this type of head tilt should be treated with physical therapy which will include parent education regarding positioning of the baby, activity modification and or promotion, neck stretching, as well as an assessment of developmental milestones. In some cases of torticollis, the facial and tongue muscles may be affected which can lead to eating and oral motor control issues. Untreated torticollis can also affect developmental skills of the baby such as shifting gaze of the eyes, learning to turn head on own, rolling, being able to tolerate tummy time, as well as sitting, kneeling, crawling, and standing skills later on. The American Academy or Orthotists and Prosthetists reports that the prevalence of torticollis among infants is 18%.

Plagiocephaly is the misshaping of the head due to weight bearing forces on the soft cranium (bones) of infants. The condition can be caused by in utero positioning, lack of amniotic fluid in utero, increased uterine pressure, or by torticollis. In 1992 the American Academy of Pediatrics recommended that babies should be positioned on their back to sleep to reduce SIDS. Since this back to sleep campaign there has been a documented decrease in the amount of SIDS related deaths. However, there has been a marked increase in the incidence of babies with positional plagiocephaly. In 1992 the rate of plagiocephaly was 1 in 300. In 1999 the incidence was 1 in 60. Also of the 18% of infants that present with torticollis, around 90% of them also exhibit plagiocephaly. Treatments for plagiocephaly include, stretching of the neck (if needed), parent education, positioning, encouraging appropriate developmental milestones, cranial remodeling helmets, and in severe cases surgery.

In both conditions, the earlier treatment is begun, the easier the resolution with physical therapy alone. The American Academy of Pediatrics recommends that infants be treated as soon as possible for torticollis or plagiocephaly and before three months is ideal. Infants that have plagiocephaly and are older than 5 months may need a remodeling helmet in conjunction with physical therapy to reshape the skull where children over the age of 2 would most likely need surgery as the skull has already begun to harden. To ensure that your child meets all of their developmental milestones, please talk to your physician if you notice that your newborn only holds their head to one side or if there is any flatness or deformation in the skull. The earlier treatment begins, the easier the problem is to resolve.

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