Positional Plagiocephaly and Torticollis

Each one of our three babies has experienced positional plagiocephaly and positional torticollis. Believe me, when I first heard the term being used by our children’s doctor I had a million thoughts going through my head. What is that? How did I not notice all of these things? What did I do to cause this? Is this ‘condition’ permanent or what can I do about it now?

What is Positional Plagiocephaly and Positional Torticollis?

Positional plagiocephaly and positional torticollis are two common conditions in infants that can be a result of numerous things. In our situation, each one of our kiddos experienced it as infants due to their position inside of the womb. Torticollis is an imbalance of strength and/or length in a baby’s neck muscles. The neck muscles are so tight and contracted that it limits a baby’s range of head and neck motion. Early intervention is recommended through physical therapy and, at times, surgery may be needed to fix it.

Positional plagiocephaly, also known as flat head syndrome, is when the head’s shape is uneven due to pressure on the baby’s skull. In the case of having positional torticollis and positional plagiocephaly, if a baby has tight neck muscles and doesn’t have a wide range of movement, then more pressure may be applied to one side of the head. This causes the head to appear asymmetric or flat…which is what happened to our three kids.

My Girls

When Mattisyn, my oldest daughter, was 3 months old she had a mild case of positional plagiocephaly and positional torticollis. Her doctor noticed that she preferred to turn and tilt her head to one side due to a slight tightness in her neck muscles. We were told that we needed to correct it or she would have a misshapen head. We were given some stretches to do at home and used a positioner in her crib to change the direction in which she was laying each night (this was 10 years ago…positioners are no longer recommended to use). With her situation she didn’t have any difficulties with correcting herself.

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When Ava was a baby, her diagnosis of toriticollis wasn’t noticed until her four month check up. At this point, she had already started rolling over, so this made the process in correcting her plagiocephaly and torticollis difficult. Due to the severity of her situation, we were referred to a baby physical therapist. The therapist would show us specific stretches and positions to complete at home to loosen her neck muscles and allow her to straighten out while correcting the flatter part of her head.

The physical therapist that helped us provided services at our home. This was so convenient! The therapist would come to our house on a scheduled basis to show us stretches and check Ava’s progress. The purpose of physical therapy was to try and correct the tight neck muscles and even the shape of her head to avoid needing a helmet. Through all our hard work, Ava respond successfully to the treatment.

Rhett

After going through all of this with both girls, we knew some of the signs to look out for when Rhett was born. It was about 2 weeks after he was born that we noticed he preferred to turn his head to the right side when sleeping. We tried changing the position he slept in his bassinet. We wanted to to see if he would turn his head more toward the left, but he didn’t. Due to this, the back of his head was beginning to shape disproportionately. It was totally noticeable and started to concern us.

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At his 2 month checkup the doctor noticed what we were seeing. We were referred to the same baby physical therapist who helped us with Ava and started treatment right away. The stretches we were taught would help loosen his tight muscles throughout his neck and shoulders. This would allow him to move his head towards his non preferred side and even out the shape of his head. Babies’ heads are soft, so constant pressure applied to one side will cause it to flatten while the other side stays rounded. This creates a concern for asymmetry with facial features. Our therapist would always check Rhett’s eyes and ears to make sure his facial features were not being affected by his plagiocephaly.

The Challenges We Faced With Rhett

Although we had gone through this same experience with the girls, it was still so stressful and concerning. Rhett resisted the stretches because of the stress it was causing on his tight neck muscles. During his therapy session they also noticed he had a lot of tightness in his lower back, and he would hold himself up improperly during tummy time. Rhett wouldn’t use his arms to hold himself up when lying on his tummy. He would use his stomach which caused him to arch his back. Tummy time would only last a few minutes before he was worn out. He ended up HATING tummy time. Tummy time is not only crucial for babies to strengthen all of those muscles needed to sit up, crawl and eventually walk, but also crucial to help fix his plagiocephaly.

The therapist showed us a way to get him to use his arms to support himself rather than his tummy to prevent the arching of his back. We would take his arms, which were usually out to the side like an airplane, and tuck them in under him right below his chin with his forearms on the floor. We would then shake this lower back and rear to get him to hold himself up correctly and release all of the pressure he was putting on his lower back.

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To correct his positional plagiocephaly and positional torticollis we had to take pressure off the back of his head throughout the day. So lots of tummy time was encouraged to correct the back of his head. We were told if we didn’t fix all of this before he started rolling over (which was only a few weeks away), he could be behind on his physical developments throughout his entire first year. Trying to correct two issues at once in such a small window of time was challenging and stressful to say the least.

The Greatest Piece of Advise

The one piece of advice that stuck out the most from the physical therapist is that the most important thing to do was to make sure that he was always on his floor mat or play pen rather than his bouncer (or any other baby holding device). Baby holding devices limited his head movement versus lying on the floor where he had more opportunities to turn his head from side-to-side by looking at things around him. Doing this would add more pressure on the more rounded part of his head and correct the flat spot.

Makes sense doesn’t it…why didn’t I think about this before?

During naps and bed time, we also had to make sure he was putting pressure on the correct side of his head. This was another crucial moment in his daily routine to help fix his flat spot. The therapist showed us a clever way of doing this without using any sleep positioners.

We took a thick baby blanket (such as one of the hospital blankets he came home with after he was born) and rolled it up. The blanket was placed underneath his right shoulder inside the swaddle. This prevented him from looking in this direction. We used the Halo swaddle during this time which zipped up keeping his body inside of the sack and preventing the blanket from moving around. Rhett hated this in the beginning, especially due to the uncomfortable stress it put on his tight neck muscles to look in the direction that he least desired. However, we were consistent with this strategy every time he slept.

I was astonished by this method and again asked myself…why did I not think of this before?

Throughout the day, we would encourage him to look towards his left side as much as possible. This would help loosen those tight neck muscles. We would talk to him, sing to him, and place toys in that direction. We also made sure he was completing tummy time 5-6 times per day.

We consistently used all of these methods the therapist gave us. As time went on, Rhett wasn’t resisting the stretches on his left side anymore and his head was really beginning to even out. We took him back to see the therapist 7 weeks later. The therapist was AMAZED at his progress! She couldn’t believe how well his head had shaped and how much he had improved. Within a little over a month, Rhett was twisting his head in both directions without a tilt or resistance. He was also completing tummy time without arching his back and he was rolling over and grabbing for toys with both arms without any tightness in his shoulders. Considering where he started with limited range in one direction he had made tremendous advances.

We will continue to see the therapist as needed. Right now, we are not completing physical therapy on a scheduled basis. We stay in contact with the therapist for questions, tips, and updates until he needs to be seen in person again. I am so proud of how far Rhett has come. I am so happy that he responded well to therapy, and I am astounded at his speedy progress. He is a fighter.

With all three of my babies having experienced positional plagiocephaly and positional torticollis, it has been challenging, tiring, and expensive. Yet we have been so blessed to have such a good team of people to assist us in this journey. God is so good.