By Michelle Spevak
Some babies are born with neck tightness or a head shape that makes them develop a preference to look right or left, a muscle condition called congenital muscular torticollis (CMT). Infants with CMT have shortened neck muscles on one side of the body causing them to look and tilt their head in one direction more than the other. The muscle affected is the sternocleidomastoid (SCM).
Who is at risk?
A baby is at risk for CMT if they were larger or longer than normal at birth, if they were mom’s first baby carried to term, if they were in a breech position or if a forceps-assisted delivery was needed. Sometimes the reason why a baby gets CMT is not known. If your baby experienced more than one of these situations, it’s a good idea to ask your pediatrician for a referral to physical therapy.
What are the signs and symptoms?
If you’re concerned that your baby may have CMT, you can look for differences in head shape, folds in the skin on the back of the neck, arm movement, feeding or head direction. For example, do you notice if you baby’s head is always in the same position with the pictures that you take? Or does your baby only like to feed on one side? Or do they move one arm more than the other?
How is it treated?
If you notice any of the signs or symptoms of CMT, you should share your concern with your baby’s doctor. The doctor can refer the baby to a pediatric physical therapist. A physical therapist can help your baby if they have CMT, but they can also help with prevention by teaching you signs and symptoms that will assist you in recognizing the condition.
If your baby gets started with a physical therapist early in their life, they usually don’t need help as long, more of their neck motion returns and it keeps it from affecting other parts of the baby.
Different reasons determine how long it will take for the baby to get better. However, the sooner a baby starts receiving care, typically, the shorter amount of time is needed. For example, if babies start when they are younger than 3 months of age, they typically see a physical therapist for 1.5 to 3 months. Once a baby is older than 3 months he/she might have to see a physical therapist for 3 to 6 months.
According to a recent study , the younger babies start physical therapy the better success they have for a full recovery. Below are the ages that treatment started and the correlating likely success rate:
- Less than 3 months old = 100 percent neck motion recovery
- 3 to 6 months old = 75 percent neck motion recovery
- 6 to 18 months old = 30 percent neck motion recovery
Physical therapy treatment for CMT is critical to your baby’s health, and CMT is not just cosmetic head shape change. It impacts how a baby moves, thus potentially hindering their development of skills like rolling, sitting, crawling and hand use. If only cosmetic changes are present at the back of the head, CMT still can affect the area of the eye and the placement of the ears. For example, the ears might not be even with each other, affecting how a child will wear a bike helmet or glasses later in life.
Beware – you may hear your baby will grow out of it, or that their hair will cover it up as they grow. You may also think your baby can look all the way to the left or right, but they may actually be simply turning at the body, neck and eyes instead of at the neck. These basic misunderstandings or false assumptions can lead parents to avoid seeking medical care, or perhaps even cause doctors not to give a referral for physical therapy.
Early referral and family participation with the home program will set the baby up for the greatest success.
Michelle Spevak is a physical therapist with Huff Center Therapies of Mission Children’s Hospital.
Reference: American Physical Therapy Association’s Pediatric Physical Therapy Journal, Winter 2013, Volume 25, Number 4