Are heads always round?...And what on earth are plagiocephaly and torticollis? 

 As a physiotherapist working in paediatrics, plagiocephaly and torticollis are BY FAR the two most common presentations in babies that I treat. 

So what are plagiocephaly and torticollis?

Plagiocephaly refers to an asymmetrical flattening of the baby’s head. This can also be associated with asymmetry of the facial features and ears.  This can be really subtle shift is the eyes or ears. Though the baby’s appearance can be concerning for parents, plagiocephaly is purely cosmetic and does not affect the development of the baby’s brain.

Torticollis is a tightness of the neck muscles restricting the baby’s ability to turn to one side. Though most people first notice torticollis as a head turn preference it often also causes the baby’s head to tilt to one side (often the opposite to the preferred turn side). You may notice this as baby’s ear sitting closer to one shoulder when their head is in the midline.  Plagiocephaly and torticollis are frequently but not always seen together. 

Both Plagiocephally and torticollis usually resolve with the implementation of some basic physiotherapy strategies like stretches and positioning. 

When does it develop? 

Sometimes plagiocephaly or torticollis are noticed from birth. This asymmetry is likely a result of the baby’s position in utero or their journey through the birth canal. In many cases this will be recognised by the midwife, child health nurse, hospital physiotherapist, or paediatrician in the baby’s first few days. They will recommend some exercises themselves or refer the baby to a physiotherapist.

In other cases the asymmetry develops after the baby is born. In their first few months babies are still developing their head control. For the first few weeks even on their backs babies are unable to hold their heads in the midline and when held upright their heads often lean to one side.  

Why does it develop?

• As adults we are all asymmetrical, whether left or right handed we quickly form habits and tend to hold or support our babies in the same way each day.
• As the baby’s vision is developing they are often particularly attracted to a particular toy, light through a window, or picture on the wall and will look towards it whenever they are placed in a certain place, like the cot or change table. 
• These factors together can create asymmetry in baby’s neck strength so they develop a preference to look to one side. 
• If the baby spends a lot of time on their back looking to the same side this can then lead to the development of a “flat spot”. 

Can we prevent it? 

If your baby isn’t born with a flat spot there are some things to try and prevent it developing 

• Sleep- place your baby down to sleep on their back, alternating their head turn position to left and right each sleep.  The SIDS website has lots of great information on safe sleep positioning http://www.sidsandkids.org/safe-sleeping/. Placing your baby at alternate ends of the cot to sleep may help if they are turning towards anything particular in the room for example you, or the light , or the door.
• Play- encourage active turning to the left and right when playing by encouraging baby to turn towards a toy or your face. 
• Tummy time- try and use a variety of different play positions like tummy time, side lying and supported sitting to play.
• Carrying- try and alternate the way you carry and handle your baby so they turn to both the left and right when in your arms.  

Who can help?

Sometimes no matter what you try you can’t get your baby to turn towards their non-preferred side, or they will turn a little bit but not the whole way. This may mean that your baby’s neck muscles are tight and need gentle stretching or some specific strengthening exercises. At this point I would definitely recommend some 1:1 physiotherapy for assessment and some specific exercises. 

The biggest thing is DON’T PANIC if your baby develops plagiocephaly or torticollis! It is very common and very easy to miss seeing it develop because there is SO MUCH GOING ON in those first few months! Physiotherapy is a fast and effective way to help get you back on track so please see your local paediatric physio as soon as you notice it!

If you want support with ideas for exactly how to position and carry your baby to avoid plagiocephaly and torticollis developing, we have something for you!

• Our Walky Talky Baby Membership is choc full of photos of carrying and play positions for babies of different ages. These positions will support your baby's development and help prevent a head turn preference or flat spot developing. 
• The Membership also includes a 48 page e book No Tears Tummy Time (also available for individual sale see below) written by us, a paediatric speech pathologist and physiotherapist to help get your baby loving tummy play!
• Our membership also includes an online Village so if you have any questions about your baby's head shape, playtime or anything else pop in any time to ask!

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