Plagiocephaly and Torticollis: What is It and How to Fix It?

What is Plagiocephaly?

Plagiocephaly and brachycephaly, also known as flat head syndrome, are the flattening of the side and back of the head, respectfully. This is usually due to the positioning of the infant after birth when they prefer to look to one side. This can also be caused when the infant stays in one position or baby container (e.g., swing, rocker, bouncy seat, etc.) for extended periods of time with limited opportunity to move his/her head, neck, and body around.

The Back to Sleep campaign was initiated in 1994 to help reduce the risk of SIDS (Sudden Infant Death Syndrome), thus promoting infants to be positioned on their backs to sleep. Since this campaign and the use of containers (e.g., swing, rocker, bouncy seat, etc.), there have been more incidences of flat head syndrome. That led to more of a focus on tummy time play and positioning to allow the back of the infant’s head to not be on a surface. This also helps with strengthening the neck and trunk muscles which in turn helps the baby reach other milestones, such as rolling and crawling.

What is Torticollis?

Torticollis is the tightening of the sternocleidomastoid (SCM) muscle in the neck, usually caused by the positioning of the infant inside the womb (e.g., limited space, multiples). Tightening of this muscle causes the baby to tilt and/or rotate its head. After birth, this tightness can cause the infant to prefer to look to one side, which can lead to flattening of the skull if left untreated. The tightness in the neck muscles can also lead to tightness in the trunk muscles, since our whole body is connected, and can make it difficult for babies to roll and crawl. You may even notice that your baby leans to one side or curls into a “C” position or has trouble breastfeeding or bottle feeding on one side.

How to Fit it

Physical therapists can evaluate and treat flat head syndrome and torticollis as early as newborn age. Early intervention is key to addressing the flat head and tightness in the neck and trunk muscles. One of the most important activities to help treat and prevent flat head is positioning. So, if not diagnosed early (around 2-3 months of age), it might be more difficult to position since the baby will be more active.

Here are a few positioning tips:

1. Position your baby in a safe sleeping area so your baby has to look at parents/caregivers to the opposite side of the flattening. For instance, if your baby has a flat spot on his/her right side of the head, place your baby in a crib so that he/she has to look to the left when you come into the room.
2. Tummy time play: Tummy time can be on on the floor, Pack 'n Play, blanket, over a Boppy Pillow, chest to chest (i.e., tummy time on parents/caregivers), or airplane or football hold (pictured below).
3. Side-lying play: Allow time for your baby to play on their sides to help strengthen the neck and trunk muscles. This also allows more time off the flat spot.
4. Floor time: Allow time outside of containers for your baby to freely move around in a safe spot. This allows your baby to learn how to move his/her body and gives the opportunity to freely move without being restricted by containers.

It can be difficult to set up time for your baby to freely play outside of containers due to other siblings, chores around the house, showering, cooking, work, and busy schedules. It is best to limit time in containers to 10-15 minutes at a time so that your baby is given plenty of opportunity to freely move his/her body. You can also try to at least give the same amount of time for free moving play (floor time) as was given in containers (e.g., 30 minutes in a container - 30 minutes or more on the floor).

If you think your baby has a flat spot, tightness in the neck, prefers to look towards one side, trouble breastfeeding/feeding on one side, or has trouble with any gross motor skills (e.g., holding head up in tummy time, rolling, crawling, etc.), please talk to your pediatrician and recommend a physical therapy evaluation.

-Whitney Castle, PT, DPT

References:

https://pathways.org/positional-plagiocephaly-positional-torticollis/

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/7-great-achievements/Pages/Reducing-Sudden-Infant-Death-with-Back-to-.aspx