Why your baby needs tummy play time

Does your baby keep his or her head tilted or turned to one side? Does the head shape appear flatter on one side than another? If so, these may be signs that he or she has a condition called congenital torticollis.

Torticollis is a result of the shortening of a muscle in the neck. If the tightened or shortened muscle is not treated and stretched it may result in permanent, limited neck range of motion and/or flattening of the head and face. In some other cases, a flattening of the skull, called plagiocephaly, can occur.

How common is it?
Since 1992, the incidence of torticollis has increased five times its previous rate. Experts link the increase to public education on sudden infant death syndrome (SIDS), which recommends that parents put their child to sleep on their backs instead of their tummy. This sleeping change has reduced SIDS, thankfully, but is correlated to the rise in torticollis because parents have become fearful of providing any awake tummy time play with their child. In addition to reduced "tummy time," infants also spend more time in car seats, swings, bouncers and rockers, and less time playing on their tummy or being held, all of which can be linked to the rise in torticollis.

What should I look for?
Because this condition limits the range of motion in the neck, infants with torticollis typically keep the head positioned to one side. One ear may always be closer to one shoulder, or the chin may be turned always to one direction, or both.  Other warning signs include a flattened area on one side of the face or skull, and possibly a lump or swelling in the neck muscle.

How soon should therapy start?
As soon as possible. A 2010 study showed that the likelihood of a good outcome is increased by 69 percent when a child begins therapy at one to three months of age.

How is torticollis treated?
A pediatric physical therapist, with special training in torticollis, will assess your child's neck range of motion, neck and body strength and motor skills. Typically, families start with once a week appointments, reducing therapy as the baby's skills and strength develop. You will also be given a home exercise program that includes gentle stretches, positioning techniques, and strengthening exercises and activities.

The therapist may also suggest methods for carrying and holding your child and tips on how to use the child's environment to stretch and strengthen muscles.

What kind of things can I do at home to help?

• Position your child in the crib so he or she is forced to turn and use the weaker side's neck muscles. You can also place toys, mobiles and other objects on the side that the infant does not prefer to look toward.
• Promote awake tummy time play and activities with your child.
• Limit time spent in swings, bouncers and car seats (when not in the car).