Torticollis Part II; What you can do if your baby has been diagnosed with CMT
Torticollis overview:
Torticollis can be described as a condition when your baby’s neck muscles cause their head to tilt to one side and look to the opposite side. In general torticollis is classified as either congenital (present at birth) or acquired (occurring later in infancy or childhood). The most common type of torticollis congenital muscular torticollis (CMT).
Congenital muscle torticollis is fairly common, occurring in 1 out of every 300 births. Experts suspect this number is even larger however is undiagnosed. There are several suspected causes of CMT which may include the way your baby was positioning in the womb before birth, abnormal development of the SCM muscle, trauma or damage during birth with the use of equipment such as a vacuum or forceps, and multiple births causing for decrease space to move in utero. In far less common causes, CMT may occur as a symptom of an underlying condition such as congenital boney abnormalities of the upper spine, Klippel-Feil syndrome, and dachondroplasia, to name a few. Types of CMT (in order of mildest to most severe form) include:
Postural CMT: in which an infant holds his/her head tilted and/or turned one way to due to a postural preference. There is no associated muscle tightness and neck range of motion is not limited
Muscular CMT: in which an infant holds his/her head tilted due to muscle tightness of the Sternocleidomastoid muscle (SCM).
SCM mass: in which an infant holds his/her tilted and or turned one way and SCM muscle has a mass (small bump) that may even be seen or felt
For acquired torticollis the cause can vary widely and range in severity. Some causes of acquired torticollis include: an infection, trauma to the head and neck, severe reflux, respiratory and soft-tissue infections of the neck, vision problems (called ocular torticollis), and abnormal reaction to certain medication to name a few.
Because there are different types of torticollis, it is important to know the cause so that your child can get the proper care as quick as possible. Those with CMT respond very well to conservative intervention (physical and occupational therapy). Research has shown that the earlier treatment is initiated the better the prognosis.
What can I do now that my baby has been diagnosed with CMT?
Making changes to your environment. Think about the way your child needs to face in the bassinet or crib when you walk into a room or to look at you. While on the changing table, does your child always look towards the easier side to face you? Make it so that your baby needs to look at you towards the more difficult side. This will encourage that rotation frequently throughout the day. Being mindful of the side your child needs to look while being fed a bottle is another great opportunity to encourage rotation towards the more difficult side.
There are several different stretches and strengthening activities that should be incorporated throughout the day. A good rule of thumb is to complete these activities (or at least some of the activities) at each diaper change. Such activities include active neck rotation towards the more difficult side, gentle passive rotation to the more difficult side, gentle passive neck lateral flexion, and strengthening the weaker side of the neck. A trained therapist can walk you through these activities to ensure proper hand placement and ways to improve comfort and tolerance.
Encouraging as much tummy time as possible. Tummy time is any activity or position where your baby is on his or her stomach. It is important for developing back and neck muscles needed to achieve gross motor milestones, preventing flat spots from developing on your baby’s head, and developing your baby’s sensory awareness and vision.
Limit use of “containers”. Although the use of seats, jumpers, and standers are tempting and of course loved by all babies, the best thing you can do for your baby with CMT is to encourage as much floor and tummy time as possible. By providing ample opportunities for tummy time and freedom of movement you are allowing your little one to strengthen and stretch their neck. Also, these containers can contribute the misshapen head shape that can be caused by the torticollis.