When Should I Worry About the Shape of My Baby’s Head?

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Congenital torticollis is a shortening of the sternocleidomastoid (SCM) muscle in the neck of infants. There is a small lump seen in the muscle at times. This can be genetic, or from the baby’s position in the womb. It’s commonly seen in twins or larger babies where space may be tight and the baby can’t move his or her head around as easily.

The SCM muscle performs two movements. It tips the head to one shoulder and turns it to the opposite shoulder. Most commonly, a doctor will notice a flattening on the back of the head on one side due to the baby keeping their head turned one way. The flattening may be worse in babies who spend a lot of time on their back, or in car seats and swings. As a baby’s head control improves, the tipping of the head to one side may become more noticeable.

As a baby develops, their preference to turn their head in one direction will lead to them wanting to use that hand, as that’s the one they see more. They may have difficulty supporting the shoulder that their head is tipped toward, as it’s uncomfortable to pick their head up away from their shoulder. The baby may not enjoy being on his or her tummy, even though it’s critical to do so in order to develop shoulder and core strength. Babies start to shift their weight with head movements and this will be delayed if the baby isn’t turning their head side to side.

If a baby has a strong preference to look in one direction, you’ll notice an asymmetry in development with a relative delay on the side they don’t look to or support as well.

It’s important to address torticollis early. At home, encourage the baby to turn their head to the opposite side using a bottle or pacifier or blocking the view to the preferred side. Early tummy time is critical to encouraging head turning.

If early at home treatment is not effective, physical therapy would be beneficial to stretch the baby’s neck muscles. A physical therapist can also provide parents with a home program to promote normal, symmetric motor development. If you feel as though your baby would benefit from physical therapy, ask your pediatrician about a referral to a pediatric physical therapist.

Eileen McMahon, M.S.P.T., is a physical therapist at MidMichigan Health.

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