Congenital Muscular Torticollis (CMT) is a common musculoskeletal condition observed in newborns or in infants. The infant with CMT typically presents with a head tilt to one side and a preference to turn the head to the opposite side. CMT is due to a unilateral shortening of the muscle that bends and turns the head and neck (the sternocleidomastoid muscle). Often, there is a corresponding flattening of the back of the baby’s head on the side they prefer to rotate to (known as flat head syndrome or plagiocephaly). In most cases, CMT is successfully managed conservatively with physical therapy and includes gently range of motion, strengthening exercises and a positioning and handling program. Parents and caregivers work closely with the physical therapist to learn those activities and exercises to perform at home between physical therapy sessions.
The HSS Pediatric Rehabilitation team of specialists offers the following five tips the parent or caregiver can perform at home to prevent CMT and plagiocephaly and to maximize the benefits of physical therapy:
- Engage your baby in play activities that promote midline orientation by repositioning your baby’s head and body to midline. Center you baby’s head and body when in the car seat, stroller, or on your lap facing you. Babies play by bringing their hands together or to their mouths or by bringing their feet up to their hands. When babies play like this they are practicing coming to midline. Encourage your baby to reach for toys, rattles and their legs equally with either hand.
- Encourage your baby to turn his/her head to look to both sides. Infants love to look at faces. When holding your baby, have him/her follow your face as you move your face all the way to the right and left. Toy placement also influences the direction your baby looks. Place toys on both sides of your baby and use toys with sounds and lights to attract your baby to actively turn the head from side to side. You can also play this activity with your baby on the tummy. Alternate the arm that you hold the baby with during each feeding. Whether breast or bottle feeding, it is important to change positions for each feeding session in order to have the baby turn the head to both sides.
- Place your baby on his/her back to sleep. When you place your baby on the back to sleep, alternate the side to which the head turns each night to prevent a flat spot from developing on one side. You can alternate which is the head of the crib each night to encourage the baby to turn the head to each side to see out of the crib.
- Tummy to Play! Infants should spend time on their tummy’s when they are awake to help with motor development and to prevent flat spots from developing on their heads. It is important that your baby is awake and supervised during tummy time. Tummy time helps babies strengthen the muscles around the neck, arms, and shoulders that are necessary for head control, to roll, sit and crawl. Tummy time is recommended for at least 15 minutes, 3 times a day. If your baby is unable to tolerate this position for the full time, use shorter intervals of tummy time and increase the frequency throughout the day until your baby can tolerate 15 minutes at a time. Babies love to look at human faces, so position your infant on the tummy on your chest so the baby will lift up the head to look at a familiar face, yours! Or try positioning your baby across your lap to help your baby tolerate tummy time more easily. Use a mirror, babies love to look at themselves.
- Minimize time baby spends in containers. Baby positioners such as car seats, swings, and bouncers can constrict an infant’s movements and cause prolonged pressure on the back of the baby’s head. Limit the time in positioning equipment to only the time your baby is being transported. Hold your baby in your arms or use a carrier. It is important to give the baby opportunities to move and play freely in a playpen or on a blanket on the floor with adult supervision.
- Coulter-O’Berry, C, Lima, D. Tummy time Tools.com. Academy of Pediatric Physical Therapy. Published 2007. Accessed September 9, 2019.
- Coulter-O’Berry C, Lima D. Tummy time: tips for parents. MoveForwardPT.com. Academy of Pediatric Physical Therapy. Accessed September 9, 2019.
- American Academy of Pediatrics Policy Statement SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. November 2016, 138/5.
Updated on September 16, 2019
Frances Baratta-Ziska is a pediatric physical therapist and clinical supervisor at the CA Technologies Rehabilitation Center within the HSS Lerner Children’s Pavilion. She is board certified by the American Physical Therapy Association as a Pediatric Clinical Specialist, and is also Neuro-Developmental Treatment (NDT) certified.
Magdalena Oledzka is a pediatric physical therapist and clinical supervisor at the CA Technologies Rehabilitation Center at the HSS Lerner Children’s Pavilion. She has a PhD in Pediatric Science, and is board certified as a Pediatric Clinical Specialist and is trained in Neuro-Developmental Treatment (NDT) in the management and care of children with cerebral palsy and other neuromotor disorders.