Congenital torticollis of the baby and osteopathy

Congenital torticollis affects 16% of newborns, which makes it the 3rd most frequent pathology in a baby on the musculoskeletal level.

Torticollis can be postural, muscular or bony in origin and it is the clinical examination that will lead to the diagnosis.

It is a soft torticollis, which means that even if the baby has a preferred position, the torticollis is reducible, so we can put the head back on straight. However, the baby will want to return to his preferred position, so it is very important to treat him.

Congenital muscular torticollis is related to excessive tension of the SCOM muscle (Sterno Cleido Occipito Mastoid muscle) and reduction is much more difficult. Muscular work is quickly required. In this torticollis, it happens that a swelling (also called "olive") is felt on the muscle body of the SCOM at the level of the distal 1/3. It is rarely visible at birth but can be seen during the first month. Correctly treated, it will disappear.

This torticollis is much rarer and is secondary to bone malformations found in certain pathologies (bone dysplasia, Klippel-Feil syndrome). It is irreducible and the best physiotherapist and osteopath will not be able to do anything with their hands. 

Osteopathy is a manual therapy that aims to remove all the dysfunctions of the body that would prevent it from functioning properly. The osteopath will then test the different structures of your child's body, from head to toe. Because even if your baby has a congenital torticollis, it can be linked to a bad positioning of the rest of the body, it is the case for example in many postural torticollis. Due to the position they had in their mother's womb, some babies are "comma-shaped", i.e. their head is tilted to the same side as their body. Treating the neck without first treating the rest of the body is almost like working in a vacuum.

Early osteo treatment is important. The earlier the child is treated, the easier it is to avoid the repercussions of imbalances. This is why it is advisable to see infants as soon as possible, usually within the first week. 

If your child is older and you are reading this article, don't worry, it will just take longer to process.

Don't worry, an osteopath specialized in pediatrics uses very gentle mobilization techniques that will not hurt your little one. I invite you to read below the course of an osteopathic consultation for a baby.

Multidisciplinary osteopathy and physiotherapy are essential. The work is not the same and is complementary. Physiotherapy sessions should be frequent, 1 to 3 per week, depending on the torticollis. The osteopathy sessions will be much more spaced out; for example, 1 per month for severe torticollis, to one per quarter, everything will depend on the progress of your little one and also on your involvement as parents...

Physical therapy is essential for muscular torticollis and some postural torticollis.

It is tedious to take your child to the physiotherapist, but the sooner his torticollis is resolved, the less repercussions there will be, so get organized and hang in there!

Cases of surgery are extremely rare and concern mainly bony torticollis that is not improved by other treatments.

The goal of all the exercises is to stimulate the rotation and tilt of the head opposite to the direction in which he puts his head: For example if your child turns his head to the left, stimulate him to turn it to the right. In the tips below, I will use the example of stimulating the right side rotation

To do this, you have multiple possibilities and I invite you to use them to the maximum:

I know that it is very demanding for parents to exercise their child, as well as having to take him to all his medical appointments. But believe me, it's better to invest some time now, right from the start, it's a matter of a few weeks or months at most. Don't think of these exercises as a chore, but use them when you play with your little one.

Do not hesitate to explain the importance of these exercises to all the people who are in contact with your child so that they too can participate in the treatment (brother, sister, grandparents, but also nursery assistants, nursery nurses, etc.)

If your child is sleeping in your room, turn your baby's crib (or your baby) so that you are on the side where you want your child to turn his or her head. Your baby will usually turn his or her head to see you and fall asleep looking at you. If your baby turns his head to the right, move to his left so that he tries to look at you.

If your child is sleeping in his room, he will tend to turn his head toward the door because he knows you will come in that way. Turn the bed to force him to look toward the door. In our example, place the crib and your baby so that the door is to his right.

When feeding, try to turn your child's head very slightly to the side you want them to turn their head. Don't forget to put your child in a vertical position.

When bathing, position yourself so that you are on the side where you want your baby's head to turn.

When you change him on the changing table, place your baby so that on the side where he turns his head (left in our example), there is nothing interesting like a wall. On the other side, you can place elements that will attract his eyes like black and white toys, or a lighted fish, etc.

When playing with your child, place the games and yourself on the side where you want your child to turn their head. Don't be afraid to ask big brother or sister for help by telling them to play on the right side.

When he is in the car seat or lying down under supervision, you can install a small headrest to guide him to the desired movement both in tilt and rotation. The same applies when he is in the carrycot. Avoid leaving your child too long in a maxi cosi, try to limit its use to the car.

When the baby is sleeping or relaxed, with your hands gently move his head to the desired tilt and/or rotation. Be careful not to force it, just guide it with your hands. If he refuses, don't worry, you will try again.

Even with all this, your child will have a preferred head position, so it is very important to put your child in different positions to avoid flattening the skull. This advice applies to all babies, even those who do not have congenital torticollis.

To do this, put your baby on his side (both sides) but preferably the one he refuses to go to. In our example, lay your baby on his right side. 

Put your baby on his stomach as much as possible during the awakening period under supervision! When your baby is sleeping, he should be placed on his back to prevent sudden infant death syndrome, but under supervision, don't hesitate to put him on his stomach. The whole time he is in this position, not only will his skull not flatten but he will also be able to raise his head. The neck muscles are located on the back of the skull on the occiput bone. Therefore, the more your baby is on his stomach, the more he raises his head and the more he pulls the occiput, thus allowing the skull to curve. In Canada, it is recommended to put your baby on his stomach for a minimum of 20 minutes per day: for example, 5 minutes when playing, 2 minutes when changing him, 3 minutes after bathing, etc.

An untreated torticollis will cause a flattening of the skull on the back of the skull on the side of the head rotation in 70 to 90% of the cases. For example, if your little one turns his head mostly to the left, the skull will flatten to the back on the left in just a few weeks.

We can also find a forehead that is bulging on one side (more bulging on the forehead on the side of the posterior flattening of the skull). In the medium term, the whole body will adapt, one shoulder will be higher than the other, the back will bend. Indeed, we look for the horizontality of the glance to see, if the head is not well right, our body, our back will "twist" to compensate and try to facilitate the sight.

A congenital torticollis taken care of early has a very favorable evolution because taken care of before 1 month, we note 98% of improvement in 1,5 months. A congenital torticollis treated after 6 months will require a treatment of about 10 months for the same result!

So don't wait... 

Marie Messager
Osteopath specialized in pediatrics
in Versailles Chantiers
78 - Yvelines