Updated: Nov 4, 2020
In treating torticollis and plagiocephaly, I speak with parents who are referred by many different pediatricians. One of the biggest misconceptions I hear is the phrase, "The doctor said she will outgrow it and we shouldn't worry about it." This is not only false but can be detrimental to the development and growth of a child. In my seventeen years of pediatric practice, I have never seen a problem just go away by ignoring it. Usually, the problem gets worse and starts to affect different areas. Torticollis is a head tilt or favored head position often due to tight neck muscles. Plagiocephaly is a flattening of the skull in one or more areas.
Speaking specifically about torticollis, if it is ignored, as the child continues to grow it will likely get worse as bone typically grows before muscle. The bone grows, the muscle gets tighter. The resulting head tilt can cause issues with the jaw opening and closing which could lead to future TMJ issues. A head tilt can also cause an altered sense of upright in the inner ear. If the head is always tilted to one side, the brain resets this plane as horizontal so when the head is actually straight, it will give the sensation of leaning to the opposite side. This is how habitual torticollis develops. Along with the inner ear being altered, vision can be adversely affected for the same reasons. Untreated torticollis can also lead to shoulder issues and the mechanics of the shoulder-neck complex can be compromised as the child grows. The spine is at increased risk of scoliosis due to the compensation of the rest of the back for the head tilt. All of these issues can contribute to developmental delay and abnormal movement patterns of a developing child. Untreated moderate to severe plagiocephaly can lead to various issues as well. A shifted forehead will affect vision. Preferred head rotation with plagiocephaly can lead to opposite side neglect in a developing infant which would have significant ramifications on the development of motor milestones with underlying muscle imbalances. A flattening of one side of the head can affect facial features as well leading again to TMJ issues. Once the fontanel or soft spot closes, the head shape will remain largely unchanged through the life of the child making that window of opportunity as an infant so critical in obtaining a rounded head shape. Shifted facial features or a flattening of one side of the head will make it difficult to wear glasses, properly fitted football, softball, baseball or motorcycle helmets increasing the risk of head injury during those activities. The bottom line is this: if nothing changes with the way the infant is cared for, torticollis and plagiocephaly will not improve on their own. Something must be different for issues to resolve. If you are advised that a condition with your child will "just go away", dig further and seek treatment from a physical therapist with pediatric experience. You will be glad you did!