Hylton I Lightman, MD, DCH (SA), FAAP

Your pediatrician has just informed you that your 7-month old has torticollis. What is this about? And what is a parent to do?

Either congenital at birth or acquired later on, torticollis is a spasm or shortening in the side of the neck. This can produce head-tilting. If congenital, torticollis can be due to birth trauma or a thickening of the neck muscles, appearing as a swelling. Invariably, most cases of torticollis are not life threatening.

It is important to diagnose torticollis early and to treat it early. If left untreated, your baby’s development may be compromised. For example, your baby will tend to hold his head to one side, with resulting deformity of his skull bones. This will necessitate the wearing of a helmet to remold the shape of his head. His motor milestones of rolling over can also be delayed.

Although the majority of torticollis cases are benign, there are instances when torticollis is associated with other diseases. Most important, the infant may be tilting his head to improve his visual acuity. Hence, an ophthalmology evaluation will rule out retinal and other visual problems. Only rarely, a CT scan of the brain is ordered.

Your pediatrician may determine that physical therapy is needed. The physical therapist will do stretching exercises on the neck muscles in order to alleviate the side with the muscle that is short and tight. Physical therapy will hopefully help the child to no longer have a head tilt. This bodes well for the child’s future development and appearance.

Regarding physical therapy, there is good news. Many states, including New York, have state and federally funded programs through certified early intervention agencies. Early intervention applies to children of school age or younger who are discovered to have or be at risk of developing a handicapping condition or other special need that may affect their development.Early intervention consists in providing services to such children and their families for the purpose of lessening the effects of the condition. Early intervention can be remedial or preventive in nature–remediating existing developmental problems or preventing their occurrence, and includes physical therapy. Your pediatrician should be able to refer you accordingly.

In summary, torticollis is usually a benign, self-limiting condition, if diagnosed and treated with the appropriate physical therapy. Through your pediatrician, you will have access to a competent cadre of professionals who will help your child.

As always, daven.