I was fortunate to attend an in-service aranged by an IBCLC in our area, to 
hear a pediatric physical therapist whose special interest is torticollis.  
I knew of this condition , but I still learned a lot.  Here is how I wrote 
it up for our ILCA affiliate newsletter:

The condition involves the large sternocleidomastoid muscle that runs from 
ear to clavicle.
Take this test:  Dip your right ear down toward your right shoulder.  Now, 
try to twist your chin up toward the ceiling (it’ll be hard to do).  Feel 
that large, bulging, tight muscle running all along the left side of your 
neck?  That’s the muscle involved in torticollis.

There are several causes: odd positions in utero (especially where it is 
cramped, as with twins); use of forceps or suction; 
large-baby-to-small-mommy -- and “who knows.”

PTs are seeing more and more cases of torticollis these days.  In the “good 
old days,” cases of torticollis likely worked themselves out in early weeks 
as baby was placed tummy-down on the floor, learning to raise her head and 
push up on her arms.  Now, we put babies to sleep on their backs (where they 
turn left and right only, without lifting the head) – and place them while 
awake in stationary “baby rings,” swings or bouncy seats.  Ironically, the 
force of gravity when having babies in these upright positions actually 
reinforces the strain on the already-cockeyed muscle.

As IBCLCs, we might suspect torticollis when a baby has odd BF behaviors: 
significantly preferring one breast (which better accommodates the 
twisted-neck-posture); babies who look “tilted” or who strongly bias looking 
in one direction only; those who are “chewing” rather than suck-swallowing 
(because of poor head position).

If you suspect torticollis, encourage Mom to see her pediatrician for 
diagnosis, and referral for physical therapy.  The earlier the PT sees a 
baby, the easier therapy and intervention can be.  Parents are educated; 
home exercise programs are developed to complement in-house stretching, 
strengthening and movement.  Tummy time is incredibly important for all 
babies!


Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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