When the Back to Sleep campaign kicked off in 1994, there was a noted decrease in SIDS. However, the number of babies with developmental delays rose. Interestingly enough, the cases of torticollis and flat-head syndrome (aka plagiocephaly) dramatically increased as well. Coincidence? I think NOT!

The correlations mean that these conditions have a strong influence on child development, and there’s research to support it. A 2017 study found that plagiocephaly is linked to not only motor delays (like sitting up or crawling), but to language and cognitive skills as well. This makes sense since movement serves as a catalyst and organizer to speech and language.  While pediatricians encourage as much tummy time as possible to counter the effects of “back is best”, there is still a disconnect somewhere between parents and med professionals resulting in many babies with wrynecks and flat heads.

Such a Twist in the Neck

Torticollis is an abnormal condition where the baby’s head is twisted and tilted to one side because of tightness in their neck muscles. Although there are various types, they fall under two categories:

• Congenital(the most common type), like fetal positioning in the womb
• Acquired (occurs in the first four to six months of life), as result from GERD (gastroesophageal reflux), visual issues, or ear infection

The shortening of the sternocleidomastoid muscle (SCM) on one side is typically to blame as it’s responsible for head tilts and rotation, but it may not be the only muscle contributing to the head twist. Aside from other neck muscles that function to flex, extend or rotate the head, other muscles who serve another primary function (like the trapezius whose purpose is to stabilize and move the shoulder) may also be involved.

Kid and Plagiocephaly

Plagiocephaly, commonly known as “flat-head syndrome”, is a condition where the infant’s head is misshapen due to flatness on one or more of its sides. The term itself has become a catch-all to describe a skull deformity. The three main causes are:

• Brain abnormalities – unusual growth of the brain, like microcephaly or hydrocephalus, that affects the shape of the skull
• Premature closing or fusing of skull sutures – like craniosynostosis (it’s rare btw)
• Postnatal – external forces can misshapen the skull, like the floor or car seats

The postnatal type is the most common and therefore the one that is mostly addressed. It’s a result of baby lying in one position for a disproportionate amount of time, such as on their back or in an infant container. During the first 12 to 18 months, the bones of the skull are “open” so that the infant can squeeze their noggin through the birth canal. Because of this malleability, gravitational forces and external pressure from hard surfaces can alter an infant’s head shape and face. That includes:

• Holding baby on the same side for every feeding
• Increase use of car seats
• Babies who spend most of their day in a bouncer or swing
• Difficulties affecting infant’s ability to rotate their head

The Connection to Developmental Delay

The rise of torticollis and plagiocephaly since 1994 is significant. Torticollis incidences increased by 84% while current reports indicate that plagiocephaly occurrence is about 47% infants (compared to 0.33% before 1994). Additionally, these two conditions usually roll together 80-90% of the time. So, if an infant presents with torticollis, more than likely, they have a form of plagiocephaly as well.

However, torticollis and plagiocephaly aren’t the only factors causing developmental delays. Another contributor is the excessive use of baby containers (think car seats, swings, bouncers, etc.). While these are a godsend to hold and entertain your infant as you complete other personal/professional obligations for short periods of time, the problem arises when they are spending an enormous amount of time in a stationary position that limits their natural movement. Why did baby containers become so popular? You guessed it, the Back to Sleep program. The heavy emphasis on placing babies on their back to prevent SIDS caused many parents to become fearful of putting their own infants on their bellies for tummy time, even with supervision. It soon became common practice to put your baby in a container instead of the floor during play. If they have torticollis and/or plagiocephaly, it just worsens these conditions.

If a baby isn’t exposed to various positions (tummy, side, upright) or are restricted in movement and exploration, it limits their:

• Sensory experience, specifically with proprioception (body awareness) and vestibular sense (movement).
• Muscle strength and coordination, delaying achievement in motor skills like head control, rolling, sitting, crawling, even walking.
• Speech/language acquisition and cognitive skills.

What Can Be Done

For the most part, stretching and repositioning are effective in treating most infants with torticollis and/or plagiocephaly.  However, carryover at home is paramount for success. For example, reports state that 95% of babies recover from torticollis in the first year with a consistent stretching program. Because there are so many variations of these conditions, it’s best to discuss intervention options with your pediatrician. They may also refer to a PT or OT to address developmental delays.

Life’s Tough, Wear a Helmet

When people talk about flat head syndrome, helmets are what come to mind. Cranial remodeling helmets act as a mold for the infant’s head by restricting asymmetric growth while allowing flattened areas to grow. It essentially provides a tight round space for the head to develop appropriately. This option is recommended when conservative means of treatment are not effective. As great as this sounds, it does have some downsides:

• Must be worn 23 hours a day, except when bathing. But other than that, your baby is eating, sleeping, and playing in that helmet for two to nine months (depending on age and severity)
• Although it doesn’t hurt them, there is an adjustment period to get used to it so be prepared
• Most insurance providers do not automatically cover helmet therapy as flat head syndrome is seen more as a cosmetic issue

Take Home Message

SIDS is a scary thought, but that fear shouldn’t hinder our baby’s growth and development. So, do lots of tummy time, limit the use of baby containers, allow them to move around and explore, and trust that they will be alright.

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