Intervention Visits, Practical Strategies

Strategies for Working with Children with Torticollis

What Does the Research Tell Us?

Physical therapy and helmet treatment are considered the conservative strategies for positional torticollis, congenital muscular torticollis, and deformational plagiocephaly.1    Retrospective and prospective studies of conservative measures have reported, “good to excellent results, with success rates ranging from 61% to 99% when intervention was initiated before one year of age.”(p.370)2   Ellen Brennan, PT, DPT, physical therapist, Children’s Specialized Hospital stated, “successful intervention for the child with torticollis is fully dependent on how successful the caregivers are in integrating treatment strategies into the child’s daily routine.”3

Strategies for Stretching the Infant with Torticollis

Most of the infants I work with don’t like the stretches for torticollis, not because it causes them discomfort, but because they do not like being restrained.  If I can make the stretches and exercises more tolerable for the infant, then the likelihood that the caregivers will be successful with the exercise program will increase.  Below are some simple strategies to incorporate into an infant with torticollis’s daily routine.

If you are not a physical therapist, you can still help families implement these stretches but be sure that a PT shows you how to do them with the child and family first!

Rotation stretch: When holding the infant’s shoulder down and gently rotating the infant’s head all the way to one side until the chin is over the shoulder, encourage the infant to look to that side by:

  • Having a caregiver, peer or sibling play peek-a-boo
  • Activate a musical toy
  • Look at themselves in a safety mirror
  • Reach for a household pet

Side-bend stretch: When holding the infant’s shoulder down and gently, but firmly, side-bend the infant’s ear to the same shoulder, encourage the infant to maintain this position by encouraging the caregiver to:

  • Blow “raspberries” on the side of the neck that is being stretched
  • Give “Eskimo” kisses to their infant’s nose
  • Kiss the baby on the side of the neck that is being stretched
  • Chat with the infant
  • Sing songs so that the infant watches the caregiver’s face

Here’s a video illustrating both of these stretches:

Football hold: For example, if the infant has left torticollis, the infant’s left ear rests against your left forearm as they face away from you.  Place your other arm between the child’s legs and support the child’s body. Encourage caregivers to carry the infant in this hold as much as possible.

This video shows the “Football hold” – a great way to hold a baby with Torticollis to stretch the tight side (tight side is against the caregiver’s forearm):

 

Tummy time: Place the infant on their tummy and place toys to the opposite side of where the infant normally looks.  Encourage the infant to look to that side by:

  • Blowing bubbles for them to reach out to
  • Peers or siblings to entertain them
  • Activate musical toys
  • Look at themselves in a safety mirror
  • Tickles, songs, funny faces

Rolling:4 Encourage the infant to roll towards the tight side, first on flat surfaces then on inclines.  This exercise can be incorporated during:

  • Diaper changes
  • Changing clothes
  • Tummy time

Head/body righting reactions: Make a game of holding the infant facing you at eye level.  If they are heavy, you can rest their bottom on the top of your knees.  Slowly tilt the infant towards their tight side.  As you slowly tilt them back to eye level, encourage them to bring their weak side up by:

  • Chat with the infant
  • Sing songs (e.g. I’m a little teapot)
  • Make funny faces
  • Make silly noises                                                          

Feeding: When bottle feeding the infant, present the bottle so they look opposite to their preferred side.

  • Hold the bottle towards the tight side
  • Encourage the infant to finish the bottle in this position

Do you have some strategies to make torticollis exercises and stretches more tolerable for the infant or family?  Share your ideas on how to incorporate these exercises into the family’s daily routines!

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References

  1. Van Vlimmeren LA, Helders PJM, Van Adrichem LNA, Engelbert RHH.  Torticollis and plagiocephaly in infancy: Therapeutic strategies.  Pediatric Rehabilitation, January 2006; 9(1):40-46.
  2. Campbell  S, Vander Linden  D, & Palisano R. (2006). Physical Therapy for Children, third edition. St. Louis: Saunders Elservier.
  3. Mayer R.  Tackling Torticollis.  Advance for Physical Therapy & Rehab Medicine, January 2012.  Retrieved May 23, 2013 from: physical-therapy.advanceweb.com/Features/Articles/Tackling-Torticollis.aspx
  4. Long T, Toscano K.  (2002).  Handbook of Pediatric Physical Therapy, second edition.  Philadelphia:Lippincott Williams & Wilkins.

For more info on torticollis, motor delays and development, visit the VA Early Intervention Professional Development Center’s Motor Delays & Disabilities page.

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Kim Lephart, PT, DPT, MBA, PCS is a dynamic pediatric physical therapist with nearly 20 years of experience.  She is board certified Pediatric Clinical Specialist.  She is a team player who enjoys the collaborative model of working with parents, teachers, occupational, speech and vision therapists to meet a child’s individual therapeutic needs.  She has worked with children in a variety of clinical settings including private clinics, school systems, home health, outpatient rehabilitation, aquatics, and early intervention programs.  She currently works for Rappahannock Rapidan’s Early Intervention Program.  Of all of Dr. Lephart’s accomplishments both professionally and personally, she is most proud of her four children.  She is a busy mother of children ranging in ages from high schooler to pre-schooler.

 

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3 Comments to “Strategies for Working with Children with Torticollis”

  1. Torticollis can be secondary to Sandifer Syndrome (http://www.ncbi.nlm.nih.gov/pubmed/17168985), which is a response to painful reflux.

    Screening for reflux and referral ro GI should be part of a torticollis work up.

    Another nod to the team-based model.

    • That’s really interesting info, Janet. I’m curious…if the child is treated for Sandifer Syndrome, does the torticollis usually resolve itself or do you also have to treat the head tilt? Thanks for sharing the link and starting this discussion!

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