Torticollis / Head turning preference / Plagiocephaly

Intra-uterine positioning and a prolonged or difficult labour can cause newborn babies to have a misshapen head.

This is common and will usually improve within the first few weeks after birth. However, if associated with a loss of range of movement in the neck (torticollis), and/or a strong preferential head turn, the problem may persist and the head shape may worsen. for signs of plagiocephaly or craniosynostosis.

• Positional plagiocephaly is an asymmetrical distortion of the skull caused by uneven external pressures
• A sternomastoid mass (Fibromatosis Coli) is a haematoma in the sternocleidomastoid muscle due to birth trauma. This is replaced with fibrous scar tissue and can cause progressive muscle shortening and restriction of movement. A palpable lump can appear up to 2-6 weeks after birth.
• Craniosynostosis is a rare condition and is defined as the premature fusion of one or more of the cranial sutures. It can cause cranial and facial asymmetry.​

Action: Key assessment points

• Assess neck range of movement (passive and active) checking both neck rotation and side flexion
• Palpate neck for lumps/ swelling indicating a Sternomastoid tumour (SMT)
• Observe head shape and palpate fontanelles and sutures, for signs of plagiocephaly or craniosynostosis

Action: Referral not indicated

• Mild plagiocephaly with full neck range of movement

Educate re) encouraging equal movement to right and left when awake,  and repositioning baby’s head when asleep, to less preferred side. Encourage regular supervised tummy time. Give appropriate leaflet Parent Leaflet - Head Turning Preference and Plagiocephaly (2020) | Association of Paediatric Chartered Physiotherapists (csp.org.uk)

Action: Refer to Paediatric Physiotherapy

• Decreased neck range of movement / congenital torticollis
• Palpable lump in neck; Sternomastoid mass (Fibromatosis Coli)
• Significant head turning preference
• Mod- severe plagiocephaly

Action: Refer to Paediatrician

• Craniosynostosis
• Abnormal fontanelle / cranial sutures
• Dysmorphic features
• Abnormal neurology

Action: Refer to Community Paediatrician

• Abnormal neurology
• Developmental delay
• Dysmorphic features