Plagiocephaly and Torticollis are two common, often related, conditions seen in infants. Plagiocephaly, commonly known as flat head syndrome, affects the shape of the skull, while torticollis involves tightness in the neck muscles. Both conditions are manageable, and early identification followed by appropriate intervention typically leads to a favorable outcome. Understanding the nature of each condition is key to effective management and ensuring a baby’s symmetrical development.
Defining Positional Plagiocephaly
Positional plagiocephaly is a type of skull flattening that occurs when consistent external pressure is placed on one area of the soft infant skull. The condition is characterized by an asymmetrical head shape, often seen as a flattening on the back or side of the head. The flexibility of an infant’s skull bones, which are not yet fused, makes them susceptible to this external molding force. Visual signs include the flattening itself, along with potential facial asymmetry, such as the ear on the flattened side appearing pushed forward. This condition is common in the post-“Back to Sleep” era, as infants spend significant time lying on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). Positional plagiocephaly is a cosmetic, non-syndromic condition where the skull sutures remain open, separating it from craniosynostosis, a rarer condition where one or more skull sutures prematurely fuse, requiring surgical intervention.
Defining Congenital Muscular Torticollis
Congenital Muscular Torticollis (CMT) is a condition present at or shortly after birth involving the neck muscles. The condition stems from a shortening or tightness of the sternocleidomastoid muscle (SCM), which runs from behind the ear to the collarbone and breastbone. This muscular imbalance causes the infant’s head to consistently tilt to one side while the chin rotates toward the opposite shoulder. Parents might first notice a limited range of motion, difficulty turning the head, or a preference for feeding on one side. In some cases, a small, firm, non-tender lump can be felt within the tight SCM muscle. The condition is often linked to positioning within the womb, such as limited intrauterine space or breech presentation, or to birth trauma that causes injury to the SCM muscle.
Why the Conditions Often Co-Exist
The relationship between plagiocephaly and torticollis is often a direct causal one, where the neck condition leads to the head shape issue. When an infant has congenital muscular torticollis, the tight sternocleidomastoid muscle restricts the neck’s movement, making it difficult to turn the head fully in one direction. This restriction forces the baby to rest their head consistently on the same spot, typically the side that allows for the most comfort. The prolonged, repetitive pressure on this single area of the soft skull then causes the development of positional plagiocephaly. Torticollis and plagiocephaly co-exist in as many as 90% of babies diagnosed with torticollis. Repositioning efforts alone will be ineffective until the underlying torticollis is addressed.
Treatment Pathways and Management Strategies
Management of both conditions focuses on non-surgical, conservative strategies, with early intervention being key.
Torticollis Treatment
For congenital muscular torticollis, the primary treatment is physical therapy (PT), which aims to restore the full range of motion in the neck. A physical therapist provides specific stretching and strengthening exercises to lengthen the tight SCM muscle, which parents are instructed to perform at home multiple times daily.
Plagiocephaly Treatment
Treatment for positional plagiocephaly begins with counter-positioning to relieve pressure on the flat spot. This includes increasing supervised tummy time, changing the direction the baby faces in the crib, and minimizing the time spent in restrictive devices like car seats. For moderate to severe cases that do not respond sufficiently to repositioning, a cranial orthosis, or helmet therapy, may be recommended. These custom-fitted helmets apply gentle pressure to encourage growth in the flattened areas and are most effective when started between four and six months of age. Both plagiocephaly and torticollis generally resolve well, often within several months, provided the treatment plan is initiated early and followed consistently.