Baby's Head Always Tilted? Complete Torticollis Treatment Guide (Pediatric PT)

Is your baby constantly tilting their head or only looking in one direction? If so, you might be dealing with infant torticollis. If you're new to the podcast, my name is Charrick Gordon. I'm a pediatric physical therapist with over 25 years of experience in early intervention, and I've helped thousands of families navigate this. Today, I'm giving you a full masterclass on all things torticollis or congenital muscular torticollis, which is the correct technical name. We're going to talk about how often torticollis occurs. We're also going to talk about the three most effective stretches, which are the rotation stretch, the side bending stretch, and the football hold. But I want you to stick around until the eight minute mark, because I'm revealing a common car seat mistake that could be undoing all your hard work. Let's get started. Before we stretch, we have to understand the why. According to the American Physical Therapy Association, congenital muscular torticollis affects about one out of every 250 babies born in the United States, and that number varies around the world. Now, what causes torticollis? A lot of babies are born and they already have torticollis. It could be that baby was cramped in the womb and torticollis may have happened during the delivery process. The main culprit for torticollis is a muscle that runs along the sides of your baby's neck. There's muscles on both sides of your baby's neck called the sternocleomastoid muscle. I know that's a mouthful. From here on moving forward, we'll just call it the SCM. Now, when your baby is in a neutral position, these muscles are balanced. But with torticollis, one side becomes tight like a tight rope and pulls the SCM. And so the tight sternocleomastoid muscle will actually pull your baby's head towards one side and simultaneously cause your baby to rotate their head to where it looks like they're looking in the direction. Now, there is a particular point where there's a lot of confusion with regards to which side to stretch. And that confusion comes with identifying which side torticollis your baby actually has. There's a simple way to end the confusion. Rather than focusing on both the tilt and the rotation at the same time, when it comes to naming and identifying your torticollis, if that's what your baby has, just focus on the tilt. The tilt is the way the torticollis is named. So if your baby is tilting your head to the left, your baby has left side torticollis. If your baby's head is tilting towards the right side, your baby has right side torticollis. Now, that's the way to keep track of the name. So now that we've talked about the anatomy of torticollis, let's get into the stretches. So the first stretch is the rotation stretch. I am going to be using my dining room table because this just makes it easier. So I'm going to move baby's head so the baby's head is this way. You can see the top of baby's head. And if your baby has a left side torticollis, so baby's head will be tilted towards her left side. What I want you to do is take your right hand, put it on baby's left shoulder and stabilize baby's left shoulder. Then use your left hand, put it on the left side of your baby's head and gently tilt your baby's head as if you're trying to move baby's right ear to touch baby's right shoulder. And you want to bring the neck this way and now you're effectively stretching baby's left sternocleidomastoid muscle or left SCM muscle. Once you do that, you hold this position for 30 to 60 seconds. I like to rub baby's head, talk to baby, look directly at baby, get close to baby's face so that you can make eye contact and talk to baby, sing to baby in this position while you're stretching. That would allow you to extend the stretch and be able to stretch baby longer. I get a lot of questions on YouTube asking if this condition can be corrected at 14, 15 months. And the answer is yes. There's a caveat. The sooner you notice it, the moment you notice that your baby seems to be tilting their head one way or the other, that's the time to start taking action right away. Don't wait. It's much easier to stretch a two-month-old baby than it is to stretch an active 14-month-old. Simply because once your baby starts moving, your baby's not going to be willing to just lay there passively and let you stretch their neck. As a matter of fact, your baby gets used to the position that they're in that starts to feel comfortable over time and they'll be much more resistant to the stretch. So you want to start stretching your baby as soon as you uncover that baby has a torticollis. Next, we're going to talk about the rotation stretch. This rotation stretch is a really good one and I like it. You're going to put your baby laying flat on their back. You can do this on the ground. And what you want to do, take your hand. Let's say your baby has a left-side torticollis, right? Baby's head will be tilted to the left, but their neck will be rotated to the right. And so in fact, what you want to do is put your hand on baby's right shoulder and use your other hand, cup the back of baby's head, and gently rotate baby's head so the baby is looking towards the side that they don't like to look towards. So essentially, baby will be looking towards her left shoulder while you're holding down baby's right shoulder. And that's the way you do the rotation stretch. Stretch number three is what's called the football hold. And this is one of my favorite stretches. This again addresses the side tilting component of torticollis. So I'm going to show you how to do this stretch right now. What you want to do is stand. You can also do this stretch sitting. You don't have to stand. Let's say we keep our stretching consistent. Keep the side with the torticollis consistent. We said that baby has a left-side torticollis. So baby has her head tilted towards her left side. And what I want you to do, baby has a left-side torticollis. Her head is tilted this way. I want you to put baby like this up against your body. You're going to take your right hand, pass it in between baby's legs, and hold down baby's left shoulder. You're holding down baby's left shoulder with your right hand to stabilize it and pin baby up against your body the way I am right now. Then you're going to take your left hand, put baby's head in the elbow of your left arm, and put that left arm across the front of baby's chest. And now if you look at just what happened right there, you can see that baby's right ear came up towards her right shoulder. And essentially, you're effectively, I'm going to move my left arm out of the way, so you can see you're effectively stretching that left sternocleidomastoid or SCM muscle. And you could hold this position. I like to hold baby in this position, rock baby side to side, talk to baby, sing to baby. You can walk around the house with baby in this position. That way baby is looking around. Baby is looking at things that are going on. Go to a window, have baby look outside. Anything to be able to extend the amount of time that you're actually doing this stretch and working through it. You might find initially that baby might start squirming. You'll see some movement in the legs. You might see some movement in the hands as baby is beginning to resist it. If you continue to rock baby, talk to baby, sing to baby, and comfort baby, eventually they will get used to it and be able to tolerate it and do an extended stretch for about 30 to 60 seconds. And then let baby take a break. Now, if you incorporate these stretches into your baby's daily routine, you can add it to a particular part of your baby's daily routine. I wrote a book a while ago called Atomic Habits. Atomic Habits does this thing called habit stacking, where if you have one good habit and you want to add another habit to it, you just stack the new habit onto a good habit. So, I would suggest, like I do in my recommendations for baby with tummy time, do a little bit of tummy time after every diaper change. Now, if you do a little bit of tummy time after every diaper change and now we stack some stretching on top of that, now we have a little diaper change tummy time toward the collar stretch routine happening. And you can be consistent without dedicating a separate bit of time to where you're stretching your baby's tight sternocleidomastoid muscle. That is my pro PT tip when it comes to incorporating the stretches into your daily routine. Now, for that car seat mistake I mentioned. Many parents use aftermarket head positioning pillows or a rolled up towel to keep their baby's head straight in the car. Not only can these be a safety hazard in a crash, but they also mask the tilt rather than treating the muscle. They allow the muscle to stay tight. Instead, focus on the stretches we did today and ensure the car seat harness is properly tightened according to the manufacturer's guide. Torticalis takes time, but with these three stretches, you are making progress every single day. If you're worried about a flat spot developing on your baby's head, watch my next video on plagiocephaly and how to prevent it right here or here. Don't forget to subscribe for more baby master PT tips and I'll see you in the next one.