What is Torticollis?

, ,

What is Torticollis ? 

Torticollis is the term used to describe the tightening of a muscle in baby’s neck. It is the shortening of one of the neck muscles, the sternocleidomastoid (SCM), which results in the baby’s head tilting slightly to the side and rotating in the opposite direction. 

What are some causes of torticollis?

  • Position of baby in utero (higher risk with twins or pregnancies with growth restrictions)
  • A long/difficult labour and delivery which can cause muscle spasms in baby’s neck
  • A preference of looking one direction over the other, eventually leading to the muscle shortening
  • Having a flat spot on the head may cause the baby to always rest in this position and over time, tightens the muscle

These are some conditions that appear like torticollis and are important to rule out: 

  • Vision difficulties
  • Hearing difficulties 
  • Reflux or GERD 
  • Viral infections 
  • Improper alignment of the spine 

How will torticollis impact my child?

Imagine your baby trying to develop their gross-motor milestones while their head is always tilted and looking one way. They will have difficulty with the following:

  • Learning to roll both directions
  • Learning how to sit independently
  • Discovering where the center of their body is (discovering midline)

Furthermore, torticollis can often lead to plagiocephaly – a flat spot on baby’s head, because of a preference to always rest in one position. See our plagiocephaly post here: Help! My baby has a flat head!

The neat thing about torticollis and plagiocephaly is it can be corrected quite easily, especially from a young age. EARLY INTERVENTION is key, and easiest to treat. 

What to expect during an assessment with your paediatric physiotherapist:

  • We will see how your baby’s neck moves to determine if there are any restrictions
  • Rule out the more complicated causes of torticollis
  • Provide tips to help to correct this and if warranted, give you stretches and strengthening exercises appropriate for the stage of your baby’s development
  • Depending on baby’s age and severity of the torticollis, we may also track your baby’s head shape to ensure they’re not developing a flat spot

Remember, the EARLIER the BETTER. It’s much easier to work on positioning and stretching exercises with younger babies, and that can allow us to introduce strength exercises at the optimal time. 

If you have any questions, please contact us at hello@playworksphysio.com! We’re able to provide assessments over video call until we get over the COVID-19 hurdle. You do not need a referral for physiotherapy.

Written by: Karly Dagys, Physiotherapist

/by

Help! My baby has a flat head!

, ,

My baby has a flat head…

Is this a common issue?

YES, this is a very common issue with babies. Flattening can be caused by the following:

  • Your baby has a preference of looking in one direction, resulting from tight neck muscles
  • Your baby prefers looking in a certain direction but there are no neck restrictions
  • Your baby is a good sleeper and doesn’t move much when sleeping

 3 Types of Flattening

Plagiocephaly is flattening on one side of the head from your baby preferring to look left or right. It is often associated with tight neck muscles (torticollis). Things you may notice:

  • Flattening on the back when washing your baby’s hair
  • One cheek appears larger
  • One side of your baby’s forehead is more prominent than the other
  • One eye is slightly larger than the other

Brachycephaly is flattening directly on the back of your baby’s head and is often seen with babies who sleep for long stretches without turning their head to either side. It causes baby’s head to be wider than average.

Scaphycephaly is the rarest type of head shape issues we see and is when the head is more narrow than average. It is most commonly seen in babies who spent long periods of time in the NICU because their heads are being turned from one side to the other.

How will a flat head impact my child?

  • Depending on the severity of flattening, your child may have difficulty fitting helmets, because these are made for the average shaped head.
  • Plagiocephaly can result in a forward shift of the facial bones, which can be purely aesthetic or in severe cases can lead to jaw issues.

What can we do?

  • A paediatric physiotherapist can measure your baby’s head to determine if there are any concerns and provide you with education to best manage your baby’s head shape.
  • When recommended, we can refer you and your baby to an orthoptist for helmeting. This is dependent on your baby’s age and the severity of flattening.

When is it best to seek help?

  • The earlier the better! This provides more time to track your baby’s head growth and improvements in flattening. The earlier you come in the more likely we can address the flattening conservatively (with positioning, education and stretches if needed).
  • If a helmet referral is required, seeking help earlier is better to optimize the amount of change obtained with the helmet.

 If you have any questions about your baby’s head shape, feel free to contact us!

 

Written by: Maegan Mak

 

 

/by

In-toeing and what to do about it

,

Something we hear a lot as a paediatric physiotherapist is “My kid walks with their toes turned in – is this normal?”

What is in-toeing?

In-toeing is the appearance of one, or both, feet turning in when standing or walking.  This can be a little bit or a lot.  In-toeing typically comes from the position of either the foot, the shin bone or the thigh bone. Each part influences the final position of the foot when walking. Young children naturally have some internal rotation of the leg and this makes the leg appear turned in. This internal rotation is at its greatest at 2 years of age which also happens to coincide with when children are becoming more mobile with running, jumping and climbing. Parents tend to also start noticing those little legs more and the concern about in-toeing comes up. The good news is that after age 2, the leg naturally starts to ‘de-rotate’, meaning that over a number of years, the leg and foot slowly turn toward straight and then even turn out slightly.  This occurs naturally for most children without any complications.

What does a physiotherapist look at?

Foot position– we assess the curve of the foot and whether or not this is contributing to the in-toeing.  A curved foot generally comes from in-utero positioning and resolves with time.

Tibial torsion– this is the turning in of the lower leg bone (tibia) observed when the kneecaps face forward but the foot turns in.  This is a normal presentation in young children and this typically resolves naturally with time up walking.

Femoral torsion– this is the angle of the thighbone (femur) and how it fits into the hip joint at the pelvis.  It is normal at birth for this angle to result in the leg turning in.  This usually resolves naturally over the first 10 years of life.  Femoral torsion can result in kneecaps pointing toward each other, an awkward run, or your child preferring to W sit.

What can be done about it?

In most cases, children that in-toe when walking will naturally grow out of it over years.  This is not a change that you will see in a few weeks! Thanks to the natural development of our bodies, the legs go from turning in as young children to a slight turning out in adolescence.

When you should bring your child in for an assessment:

See a paediatric physiotherapist for an assessment if:

  • the in-toeing appears to be only on one leg
  • the foot is not flexible or iscurved in significantly
  • your child complains of pain in the legs
  • you notice excessive tripping or poor balance
  • your child has trouble keeping up with peers
  • you are concerned that your child’s in-toeing is greater than normal

The physiotherapist will help determine if their in-toeing falls within typical ranges and give you some strategies to help make sure your child develops strong hip and core muscles.

Written by: Lindsay Eriksson, PT

/by

Concussion Baseline Testing for Kids and Teens: What You Need to Know

, , , , , , , , , ,
Read more
/1 Comment/by

What is Torticollis?

,

Our first post was on infant motor milestone assessment and one of the things we also screen for in this assessment is torticollis, the shortening of neck muscles that causes a preference in the direction baby looks.

Understanding Toricollis.

Torticollis: shortening of one of the neck muscles, usually the sternocleidomastoid (SCM), resulting in the baby’s head tilting slightly to the side and rotating in the opposite direction.

Do you need a doctor’s referral?

We see these referrals from doctors, chiropractors, midwives and parents who have noticed that their baby looks one way more than the other. You do not need a doctor’s referral to book an appointment. If you have extended benefits that cover physiotherapy, you can use these to cover your session.

What does a torticollis assessment involve?

When you come into physiotherapy for this issue we assess how much baby moves their head on their own to each side and also how much we are able to passively move their head. If there are any restrictions we can teach you some stretches and strengthening exercises, as well as positioning techniques that would be best for your child.

We find this a great opportunity for the you to gain education on positioning, gross motor milestones and ask any questions you may have about development of your baby. When we are assessing a baby for torticollis we are always monitoring their gross motor skills and development for their age. If there are any concerns, we can have the you work on these areas as well!

Often times the families were unaware of the skills noted as needing improvement, or they noticed and were unsure of who to ask. This “one on one” time with your family is beneficial to decrease the stress for you and allow any questions to be answered. If we are unable to answer your questions we can refer you to someone who would be more knowledgeable in that area.

When is the best time to get assessed?

The earlier torticollis is identified the easier it is to resolve. Early identification also reduces the likelihood of secondary issues of torticollis such as plagiocephaly. If you are unsure if your baby should be assessed, feel free to call or email us and we can answer any questions!

/by