how should a baby with torticollis sleep

How Should A Baby With Torticollis Sleep?

A bad night's sleep can mean waking up with a stiff neck, making it hard or painful to turn your head. This is called torticollis (Latin for "twisted neck").

In newborns, torticollis can happen due to the baby's position in the womb or after a difficult childbirth. This is called infant torticollis or congenital muscular torticollis.

It can be upsetting to see that your baby has a tilted head or trouble turning their neck. But most babies don't feel any pain from torticollis. And the problem usually gets better with simple position changes or stretching exercises done at home.

Congenital Muscular Torticollis (CMT) is a common musculoskeletal condition observed in newborns or infants. The infant with CMT typically presents with a head tilt to one side and a preference to turn the head to the opposite side. 

CMT is due to a unilateral shortening of the muscle that bends and turns the head and neck (the sternocleidomastoid muscle). Often, there is a corresponding flattening of the back of the baby’s head on the side they prefer to rotate to (known as flat head syndrome or plagiocephaly). 

In most cases, CMT is successfully managed conservatively with physical therapy and includes a gentle range of motion, strengthening exercises and a positioning and handling program. 

Parents and caregivers work closely with the physical therapist to learn those activities and exercises to perform at home between physical therapy sessions.

The HSS Pediatric Rehabilitation team of specialists offers the following five tips the parent or caregiver can perform at home to prevent CMT and plagiocephaly and to maximise the benefits of physical therapy:

  • Engage your baby in play activities that promote midline orientation by repositioning your baby’s head and body to the midline. Centre your baby’s head and body when in the car seat, stroller, or on your lap facing you. Babies play by bringing their hands together or to their mouths or bringing their feet up to their hands. When babies play like this, they are practising coming to the midline. Encourage your baby to reach for toys, rattles and their legs equally with either hand.
  • Encourage your baby to turn their head to look at both sides. Infants love to look at faces. When holding your baby, have them follow your face as you move your face to the right and left. Toy placement also influences the direction your baby looks. Place toys on both sides of your baby and use toys with sounds and lights to attract your baby to turn the head from side to side actively. You can also play this activity with your baby on the tummy. Alternate the arm that you hold the baby with during each feeding. Whether breast or bottle feeding, it is important to change positions for each feeding session to have the baby turn the head to both sides.
  • Place your baby on their back to sleep. When you place your baby on the back to sleep, alternate the side to which the head turns each night to prevent a flat spot from developing on one side. You can alternate which is the head of the crib each night to encourage the baby to turn the head to each side to see out of the crib.
  • Tummy to Play! Infants should spend time on their tummies when they are awake to help with motor development and prevent flat spots from developing on their heads. It is important that your baby is awake and supervised during tummy time. Tummy time helps babies strengthen the muscles around the neck, arms, and shoulders that are necessary for head control, to roll, sit and crawl. Tummy time is recommended for at least 15 minutes, three times a day. If your baby cannot tolerate this position for the full time, use shorter intervals of tummy time and increase the frequency throughout the day until your baby can tolerate 15 minutes at a time. Babies love to look at human faces, so position your infant on the tummy on your chest so the baby will lift the head to look at a familiar face, yours! Or try positioning your baby across your lap to help your baby tolerate tummy time more easily. Use a mirror. Babies love to look at themselves.
  • Minimise the time the baby spends in containers. Baby positioners such as car seats, swings, and bouncers can constrict an infant’s movements and cause prolonged pressure on the back of the baby’s head. Limit the time in positioning equipment to only the time your baby is being transported. Hold your baby in your arms or use a carrier. It is important to give the baby opportunities to move and play freely in a playpen or on a blanket on the floor with adult supervision.

While it can be easy to think that your baby favours one side over the other due to comfort reasons, the cause of this persistent head turn is often the result of a muscular condition called congenital muscular torticollis.

Baby Nursery FAQs

Provides head and neck support to address both Torticollis and Plagiocephaly. Offloading pressure on the head to address head shape and symmetry for young children.

Your infant can develop this condition, called plagiocephaly, simply from sleeping on one side. Your infant prefers to sleep on only one side because he doesn't have a full range of motion in his neck due to torticollis.

Most parents know that the safest way to put their baby to sleep is on its back. Babies who sleep on their backs are much less likely to die of sudden infant death syndrome (SIDS). Babies who always sleep with their heads to the same side can develop flat spots.

The best way to treat torticollis is to encourage your baby to turn their head in both directions. This helps loosen tense neck muscles and tighten the loose ones. Rest assured that babies won't likely hurt themselves by turning their heads on their own.

Regardless of the patient's age, physical therapy is the primary treatment for all forms of torticollis. Physical therapists provide treatment to address the impairments caused by torticollis. The early treatment produces the best outcomes. If not treated, torticollis can become a permanent condition.

Signs Of Torticollis

The following are common signs of torticollis. Early treatment ensures the best results. 

Head Tilt In One Direction.

One of the most important parental activities is bonding with your baby. Looking into your baby’s eyes is important for bonding and attachment. 

Is your baby’s head turned slightly to the side so that he’s not looking at you straight on? This is a symptom of torticollis and one you must get checked out and treated. 

You may also notice your baby prefers to look only in one direction, even when it may be less stimulating (i.e. towards the wall in their crib), due to the tightness caused by torticollis. 

Trouble Moving Head Toward You. 

When you try to get your baby to look at you, does he have trouble moving his head to turn toward you? Does he get fussy if he has to move his head? This is a possible indication of torticollis.

Trouble Feeding From Both Breasts

If your baby prefers to feed on only one breast, it may be because he has to strain his neck to reach the other one. Of course, he doesn’t have the language to express his discomfort. 

Flat Skull In One Area 

Does your baby’s head look flat on one side? Your infant can develop this condition, called plagiocephaly, simply from sleeping on one side. Your infant prefers to sleep on only one side because he doesn’t have a full range of motion in his neck due to torticollis. 

Lump In The Neck

Does your baby have a small lump on one side of his neck? The muscle may be constricted and form a knot. You’ll see it dissipate when your baby receives occupational therapy. Please refrain from palpating or massaging the area, but you can let your therapist or position know. 

Trouble Turning Head Side To Side Or Up And Down.

If your baby doesn’t bend his neck to look up or down or resists moving his head side to side when presented with stimuli, this could be a symptom of torticollis. Most commonly, babies with torticollis tend always to prefer a single side when placed on their back to sleep, even if they are observed to look to both sides when away. 

Symptoms Of Infant Torticollis

how should a baby with torticollis sleep (2)

When your baby has torticollis, they were probably born with it (congenital torticollis). If that’s the case, it’s usually due to how your baby was positioned in utero. 

In some cases, infants develop torticollis after birth (acquired torticollis, which is normally caused by trauma or infection), but most cases can be traced back to birth. 

Understanding the symptoms of torticollis, congenital or acquired, will help you understand how to help your baby.

Babies with torticollis will act like most other babies except when it comes to activities that involve turning. A baby with torticollis might:

  • tilt the head in one direction (this can be hard to notice in very young infants)
  • prefer looking at you over one shoulder instead of turning to follow you with their eyes
  • if breastfed, have trouble breastfeeding on one side (or prefers one breast only)
  • work hard to turn toward you and get frustrated when unable to turn their head completely

Some babies with torticollis develop a flat head (positional plagiocephaly) on one or both sides from lying in one direction all the time. Some might develop a small neck lump or bump, which is similar to a "knot" in a tense muscle. Both of these conditions tend to go away as the torticollis gets better.

Congenital Torticollis

Although your baby may have been born with torticollis, you may not notice any signs or symptoms until your baby’s between 6-8 weeks old. Around this age, most infants begin to gain more control over their heads and neck. At this point, you may begin to notice the following symptoms:

  • Head tilts or rotates to one side.
  • Limited range of motion in head and neck
  • Asymmetry in your baby’s head and face (flattening on one side of the head)
  • Breastfed babies may prefer one side over the other.
  • Musculoskeletal problems may be present (hip dysplasia)
  • A small, soft lump in your infant’s neck
  • The most commonly noticed symptom is plagiocephaly, or a flat spot appearing behind one ear and on the side. The child likes to look toward

Acquired Torticollis

Symptoms of acquired torticollis are:

  • Head tilts to one side.
  • Limited range of motion in the head and neck
  • Recurrent episodes of head tilting. During these episodes, your child may also experience drowsiness, irritability, or vomiting.

Causes Of Torticollis

Infant torticollis happens when the muscles that connect the breastbone and collarbone to the skull (sternocleidomastoid muscle) are shortened. Because your baby’s neck muscle is shortened on one side of the neck, it pulls their head into a tilt or rotation, and often both. 

Often this muscle is shortened or tightened by abnormal fetal positions, injury during birth, abnormalities or bone problems in the neck portion of the spine, and in rare cases by inherited diseases that can cause damage to the nervous system or muscles.

Treatment For Infant Torticollis

The best way to treat torticollis is to encourage your baby to turn their head in both directions. This helps loosen tense neck muscles and tighten the loose ones. Rest assured that babies won’t likely hurt themselves by turning their heads on their own.

Torticollis Exercises

Laying your baby on the stomach for brief periods while awake (known as "tummy time") is an important exercise because it helps strengthen neck and shoulder muscles and prepares your baby for crawling.

This exercise is especially useful for a baby with torticollis and a flat head — and can help treat both problems at once. Here's how to do it:

  • Lay your baby on your lap or chest for tummy time
  • Position your baby so their head is turned away from you.
  • Then talk or sing to your baby and encourage them to turn and face you.
  • Practice this exercise for 10 to 15 minutes several times a day once your baby lays their head down for 10-15 seconds. They’re tired and need a rest.

Stretching exercises to treat torticollis are likely to work well if they start when a baby is between 2 to 6 months of age. If you find your baby's torticollis isn’t improving with stretching, talk to your doctor or physical therapist.

In addition to tummy time, do what you can to encourage your baby to move to their affected side. For example, if your infant normally turns his head to the left, stand to his right when changing him. 

Please do the same when you place him in his crib. For breastfeeding mothers, encourage your baby to feed on the side he doesn’t normally enjoy. All of these movements can strengthen your baby’s neck.

Here Are Some Other Exercises To Try:

  • When your baby wants to eat, offer the bottle or your breast in a way that encourages your baby to turn away from the favoured side. (Use your child's desire to eat to encourage them along!)
  • When putting your baby down to sleep, position them to face the wall while facing the direction they like to look. Since babies prefer to look out into the room, your baby will actively turn away from the wall, stretching the tightened muscles of the neck. Remember always to put your baby to sleep on their back, which reduces the risk of SIDS
  • During play, draw your baby's attention with toys and sounds to make them turn in both directions

How Can You Help A Baby With Torticollis?

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Because torticollis is often caused by issues with a muscle, you can help address torticollis in your baby through stretching, carrying your baby properly, and correctly positioning your baby for play and feeding.

Here are five simple things you can try at home to help improve your baby’s movement and development:

  • Position your baby in the crib or changing table so that activities in the room encourage the baby to look away from the preferred side.
  • Hold toys or talk to your baby in a way that causes the baby to look in the direction that neck mobility is limited.
  • Limit the amount of time your baby spends in places where the head will rest in the same spot, like a swing, bouncy seat, or car seat. Additionally, using head support may help align your baby’s head while in the car seat.
  • Hold your baby at your shoulder or chest to encourage lifting and turning away from the preferred side.
  • Tummy time! Tummy time will help develop your baby’s neck and upper body strength, along with developing the adequate tone needed for rolling, reaching, sitting, and crawling.

Tummy Time Tips For Babies

When your baby is awake and supervised, start by placing your baby on their belly — you can do short periods, in the beginning, to help your baby get used to tummy time.

If your baby needs additional support, you can also use a nursing pillow or infant lounger.

Use brightly coloured toys, mirrors, or even siblings to get the baby's attention and encourage them to look up and away from the preferred side.

Your baby doesn't need to lay on the floor or a blanket! Using your chest to prop your baby on their belly counts as tummy time.

Physical Therapy For Infant Torticollis

In certain cases, the doctor may suggest taking a baby to a physical therapist for more intensive treatment. After treatment has started, the therapist may examine your baby every 2 to 4 weeks to see how the treatment is going. 

At these follow-up visits, the physical therapist will measure how many degrees the baby can turn their head, then help strengthen the muscles in their neck to increase their range of motion. 

They will also track any head shape issues and recommend decreasing any flatness that may be present. Some children will require a helmet, but most will not.

Surgical Options

Surgery may be required when physical therapy and home exercises don’t correct your child’s head tilt. Thankfully, this rarely happens with babies who have persistent torticollis that doesn’t respond to conservative treatment. 

Very few children with congenital torticollis will require surgery. The surgery lengthens the sternocleidomastoid muscle and corrects the torticollis. Typically, your doctor will wait until your child reaches preschool years before recommending surgery.

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