Ten Things You Should Know

Ten things you should know about Torticollis & Plagiocephaly

1. It only affects between 15-20% of all babies, so back sleeping is not the primary risk factor. Back sleeping merely accelerates the rate of deformation in at-risk babies.
   
   
2. At-risk babies share a common element – limited head mobility in the first several months of life.
   
   
3. All described risk factors fall into four major categories – torticollis; prematurity; developmental delay; and iatrogenic causes (e.g. intubation, swaddling)
   
   
4. Torticollis is the largest risk factor by far and is grossly under-recognized even by clinicians; the earliest marker is a consistent head rotation preference (favourite side) early in life.
   
   
5. Torticollis is self-resolving in almost all instances and does not require aggressive management; Botox and surgery for torticollis should only be considered in a child older than one year of age who still has a persistent head rotation discrepancy (NOT intermittent head tilt). Physiotherapy is recommended for torticollis.
   
   
6. Repositioning is impractical and ineffective for at-risk babies (especially those with torticollis). It works great for the 80% of infants who were never going to develop flattening anyway!
   
   
7. The most efficient management of an at-risk baby is sleep surface alteration to replace the flat (non contoured) mattress surface with a concave surface.
   
   
8. Helmet therapy is very effective if done properly – studies to the contrary use oblique cranial ratios which artificially dilute asymmetry as the head grows.
   
   
9. Helmets work best if done at a younger age (but work as long as there is growth remaining), if they are made well, and if they are worn consistently (>20 hours/day).
   
   
10. There is no credible evidence that plagiocephaly CAUSES developmental delay, dental issues, TMJ dysfunction, visual loss, spinal deformity, or any other medical issue.