Plagiocephaly & Torticollis

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Due to the recommendation of infants sleeping on their back to prevent SIDS, the flattening of the occipital region due to chronic pressure has become more common. Parents may also notice malposition of the ears, deformation of the forehead and facial asymmetry. Important evaluations should initially include assessment of the fontanel, developmental milestones and frequent head circumference measurements. Parents should encourage tummy time as much as possible while infant is awake and being supervised. Parents should be assured that there is no effect on brain growth, development or intelligence. The ideal time to refer a patient to us is at 4 months of age. In moderate to severe cases, treatment is a helmet that is worn approximately 3-4 months, for 23 hours a day and should help in correcting a misshapen head. As the head grows, it fills out in the deficient areas.

It is impossible to achieve total correction with a helmet but it can variably improve the asymmetry of the head. The helmet is costly and not covered by all insurance companies. Many insurance companies consider Plagiocephaly to be a cosmetic issue and the decision by most insurance companies are final. The ideal time for a helmet is after the child can hold his head up on his/her own (for risk of suffocation) and prior to 1-year of age (before maximal head growth).


This condition, usually caused by a maintained position of the fetal head in utero, is best managed with prompt and frequent supervision. If a child is holding his head to one side, due to the tightness of the sternocleidomastoid muscle, or has signs of Plagiocephaly (flat head), the best treatment is early neck stretching. The SCM muscle that is tight needs to be stretched at least 5 times daily, holding for 5 seconds each time, preferably while the infant is on his/her back. While stabilizing the shoulder, the neck is stretched by touching ear to shoulder and turning the head so that the chin touches the shoulder. If the parent is unable to perform neck stretching exercises or not seeing benefit within 4 weeks, there should be no hesitation in recruiting a physical therapist for evaluation and treatment. If these methods fail, then we should see the patient for evaluation of release of the SCM muscle. Surgery (in very few cases) is considered after 1 year of age. In most cases, physical therapy, stretching and tummy time will improve this condition.

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