The Telltale Tilt

When babies don't spend enough time on their bellies, torticollis can develop

May 04, 2007|By Lisa Goldberg | Lisa Goldberg,Special to The Sun

Looking back at family photos, it should have been obvious. The tilted head - cocked to the left, slightly turned to the right - was there each time we snapped pictures of our sleeping newborn.

But we didn't see it then. Even when our daughter's skull flattened on the right side; even when, as a 4-month-old, she still had trouble holding her head up, my husband and I never imagined there was cause for alarm.

It wasn't until my out-loud musings caught the attention of another mother that we finally realized Ava had a problem, and that the problem had a name: torticollis.

It's a relatively benign condition, sometimes called "wry neck." Often, it's resolved through stretching and physical therapy not long after a youngster has begun toddling around. But untreated, it can result in more serious problems later in life.

Although torticollis has long been recognized in medical literature, therapists report an increase in the number of cases referred to them during the past several years. And that, they say, is a likely result of babies spending too little waking time on their bellies.

Some institutions, such as Baltimore's Kennedy Krieger Institute, have created clinics that focus on patients with the condition.

"During my first 20 years, if I saw 10 kids [with torticollis], it was a lot," said Diane Nemett, lead physical therapist with Kennedy Krieger's two-year-old Cranial Cervical Clinic. The clinic evaluates children with torticollis and plagiocephaly, a related condition that leaves children with an abnormally shaped head.

These days, Nemett says her caseload includes 10 torticollis patients "at any given time." In the past two years, the clinic has seen about 100 children.

Many doctors and therapists blame the increase on changes in the way modern parents handle their infants.

Concerns about SIDS (Sudden Infant Death Syndrome) have persuaded many parents to put their babies to sleep on their backs, instead of on their stomachs. In fact, a nationwide "Back to Sleep" campaign has promoted the practice since the early 1990s.

Meanwhile, a host of baby-oriented devices, from portable infant carriers to bouncy seats and toys designed to entertain infants from above, encourage babies to spend the majority of their waking time on their backs, according to therapists who treat the condition.

Less "tummy time" means fewer opportunities for babies to strengthen their neck and trunk muscles - exercise that may have helped resolve mild to moderate cases of torticollis 20 years ago without help from a doctor or physical therapist, experts say.

"No one is saying, `Don't back-to-sleep your kid,'" said Ann Marie Pace, a Cleveland-based therapist conducting a clinical study of babies with torticollis. "It's when babies are awake that we need to have parents aware of how important belly time is."

While the exact origins of torticollis are still murky, medical professionals believe that a variety of factors - from fetal position to the birth process - may result in an injury to or shortening of the sternocleidomastoid muscle, or SCM, on one side of the body. The muscle runs from just under each ear to the front base of the neck.

Other times, a flat spot on the back of the head, or plagiocephaly, makes it difficult for a newborn with poor head control to move around. That essentially locks the child - and the SCM - in one position, said Dr. Melissa Trovato, director of the Kennedy Krieger clinic.

In either case, the muscle on one side shortens or tightens, and the infant's head tilts toward the affected shoulder and rotates in the opposite direction. If left untreated, the condition can lead to scoliosis and lopsided facial features, according to medical literature.

Often, both torticollis and plagiocephaly occur in the same child - although therapists and doctors say they've seen children with one and not the other.

"It's hard to know which came first sometimes, but we have to treat both," Trovato said.

Experts say an evaluation can also rule out other causes for the tilt - causes rooted in underlying problems with the eyes, neurological system or skeleton.

The earlier the torticollis is noticed, the easier it is to treat, say doctors and therapists who deal with children with the condition.

But for some parents, a diagnosis can be hard to come by. Unlike other conditions and diseases, information about torticollis remains largely out of the mainstream, and some doctors still subscribe to an old line of thought - that babies will "grow out of it."

"In fairness to pediatricians ... prior to 1992, they did tend to grow out of it more than they do now," Nemett said. "We feel it is a value to start [therapy] as early as possible."

Jen Whiddon said she had to work hard to convince her former pediatrician that her younger son, Michael, needed help - even though the boy, now 2, had trouble turning his head to one side and was throwing up all over the floor.

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