What are plagiocephaly and torticollis?

By Chelsey Koga, a contributing writer for Sharp Health News and a senior digital producer for Sharp HealthCare.

As a mother of two young children, I remember the tendency for infants to favor a specific side of their head. My oldest daughter tended to tilt her head to the right. We worked on having her look to the left by switching the direction of her bassinet each night, which did the trick. However, my youngest daughter favored her left side, to the point that she developed a flat spot and wore a helmet for four months.

Tami Shaffer, a physical therapist with Sharp Rees-Stealy’s pediatric rehabilitation program, explains why infants prefer a specific side and how you can avoid plagiocephaly and torticollis, conditions my youngest experienced.

What is plagiocephaly?
Plagiocephaly is a condition characterized by an abnormal head shape or a flattening of one side of the skull. It can occur during pregnancy, especially with multiples, because there is less room in the uterus.

What causes plagiocephaly?
The increase in plagiocephaly is related to having newborns sleep on their backs. When an infant’s head or skull is in a fixed position for an extended period, the soft and pliable bones of their skull flattens.

“If a child is born with a flat spot, there is a tendency to gravitate to that spot while sleeping because they lack control of their neck muscles,” says Shaffer. “This preference to turn to the same position can also lead to muscle tightness. Over time, the child may develop torticollis.”

What is torticollis?
Torticollis is a condition in which the overuse, tightness or shortening of the sternocleidomastoid muscle in an infant’s neck causes their head to both tip and turn in a specific direction. Usually the head tilts to one direction but rotates to the opposite direction.

How are plagiocephaly and torticollis treated?
Plagiocephaly and torticollis can improve or resolve with physical therapy and repositioning the infant to keep them off the flattened portion of their head. Shaffer shares the following recommendations for helping your infant throughout the day.

During sleep

• Always place your infant on their back. Place their head at different ends of the crib on alternating nights.

• If your infant sucks their thumb to self-soothe, help them use their non-preferred hand.

• After your infant falls asleep, reposition their head to face their non-preferred side.

During play

• Give your child lots of tummy time, which keeps them off the flattened portion of their head.
  - Aim for multiple times a day. Your baby’s strength will improve with repetition.
  - Start with one minute and increase by 15 seconds with each attempt.
  - By 3 months, your baby should tolerate 15 minutes on their belly.

• Encourage your baby to sit. A baby can learn to sit with support by 5 months and should be independent by 6 months.

• Minimize the amount of time spent in swings, bouncy chairs or other carriers.

During travel

• In the car seat, place blankets or towels to prevent the tipping and turning of the head.
  - Most infants will turn to look out the window so ensure that they are turning to their non-preferred side.

• Use a front carrier, which allows for closeness without pressure on the head.

At home

• During diaper changes, encourage your baby to look at their non-preferred side.

• Alternate head positions while nursing to ensure equal use of neck rotation.

• When using a bottle, help your infant to turn their head to the non-preferred side.

• While soothing or rocking your infant, place their head on your shoulder in the non-preferred direction. Put your hand gently over the head to maintain this position, which allows for stretching the tight muscle.

If repositioning and these interventions don’t work, your child’s physical therapist may recommend a special helmet for moderate and severe positional plagiocephaly.

If your child is experiencing any of these issues, please talk with your child’s doctor, who may recommend a referral to a physical therapist.

Chelsey Koga is a senior digital producer with Sharp HealthCare, and the mom of two young children.