Plagiocephaly and Torticollis are common, non-life-threatening conditions affecting infants, concerning the shape of the head and the movement of the neck, respectively. These conditions often occur together, creating a cycle where one can worsen the other. Understanding these issues is the first step toward effective management, which is typically straightforward and highly successful when intervention begins early. Both plagiocephaly and torticollis are generally considered cosmetic or musculoskeletal issues that do not affect a child’s neurological development. Early recognition of the signs is important for a quick, conservative treatment plan that helps ensure the infant develops a symmetrical head shape and full range of neck motion.
Understanding Plagiocephaly and Torticollis
Plagiocephaly, often called “flat head syndrome,” is a deformational asymmetry of the skull caused by external pressure on the soft, malleable bones of an infant’s cranium. The most common form is positional plagiocephaly, where a flat spot develops on the back or side of the head. This flattening occurs because the infant’s skull is highly susceptible to molding during the first few months of life. Positional plagiocephaly does not involve premature fusion of the skull plates and does not affect brain development.
Torticollis, meaning “twisted neck,” involves a shortening or tightening of the muscles on one side of the neck. It specifically affects the sternocleidomastoid (SCM) muscle, which connects the skull to the collarbone and breastbone. This tightness causes the infant’s head to tilt toward the affected side while the chin rotates in the opposite direction, limiting the baby’s ability to turn their head equally in both directions.
These two conditions are closely linked, as Torticollis is a primary cause of Plagiocephaly. A baby with a tight neck muscle consistently favors resting their head on the same spot, which puts prolonged pressure on that area of the skull. This positional preference leads directly to the characteristic flattening associated with plagiocephaly.
Shared Etiology and Risk Factors
The development of both plagiocephaly and torticollis is often rooted in mechanical factors occurring both before and after birth. A major contributing factor is intrauterine constraint, where a lack of space in the womb places constant pressure on the fetus. This constraint is more common in first pregnancies, multiple gestations, or breech positions, and can contribute to congenital torticollis and initial head flattening.
Difficult or assisted deliveries are also risk factors. The physical stress of the birth process, particularly with the use of forceps or vacuum extraction, can injure or strain the SCM muscle, leading to torticollis. Postnatally, the biggest factor is positional preference, heavily influenced by the “Back to Sleep” campaign. While placing infants on their backs to sleep is necessary for reducing the risk of sudden infant death syndrome (SIDS), the time spent lying supine increases the risk of deformational plagiocephaly.
The underlying mechanism connecting the conditions is the infant’s limited ability to move their head. Whether the limitation stems from a tight SCM muscle or a consistent preference for one side, sustained pressure on the same part of the soft skull causes flattening. Prolonged time spent in stationary devices like car seats, swings, or bouncers also contributes to this positional preference by restricting movement and encouraging a fixed head position.
Identifying the Distinct Signs
Parents can look for specific visual and functional signs to identify these conditions in their infant. Plagiocephaly presents as a visible asymmetry of the skull, typically with a flattened spot on the back or side of the head, giving the skull a parallelogram shape when viewed from above.
The flattening may cause compensatory changes in facial features. These signs include the ear on the flattened side appearing pushed forward or misaligned compared to the other ear. The forehead may also bulge slightly on the same side as the flattening. A bald spot or area of thinner hair where the head rests can indicate consistent pressure.
The signs of Torticollis relate to restricted movement and posture. The most noticeable sign is a consistent head tilt toward one shoulder, with the chin rotated toward the opposite shoulder. The infant may have difficulty turning their head fully to one side, showing a clear preference for looking in one direction. This limitation is often observed during feeding. In some cases, a small, soft lump may be felt in the affected SCM muscle, which usually resolves on its own within a few months.
Intervention Strategies and Management
Management of plagiocephaly and torticollis primarily involves non-surgical, conservative methods, with the best outcomes achieved through early intervention.
Repositioning and Tummy Time
The first line of approach involves repositioning techniques to relieve pressure on the flattened area of the skull. This includes changing the orientation of the crib so the infant must turn their head away from the flat spot to look at stimuli. Maximizing supervised, awake tummy time is an important treatment and prevention strategy. Tummy time strengthens the neck and upper body muscles, improving head control. Parents should also minimize the infant’s time in restrictive equipment like car seats and swings outside of travel, as these encourage static head positioning.
Physical Therapy for Torticollis
Physical therapy is the standard and most effective treatment for Torticollis, particularly congenital muscular torticollis. A physical therapist provides parents with specific stretching and strengthening exercises to lengthen the tight SCM muscle and restore full range of motion. Consistent, daily performance of these home exercises is crucial for success, with high success rates reported when intervention begins early.
Cranial Orthosis (Helmet Therapy)
For moderate to severe plagiocephaly that does not adequately respond to repositioning and physical therapy, a custom-molded cranial orthosis, or helmet, may be recommended. This treatment works by providing gentle pressure on the bulging areas while allowing space for growth in the flattened areas. Helmet therapy is time-sensitive, with the best results occurring when treatment is initiated during the period of rapid head growth, typically between four and six months of age.