Physical Therapy for Children

An initial evaluation for a baby with torticollis with a physical therapist will most likely include a reflex screen (to make sure all reflexes are present and integrating appropriately), a range of motion assessment of the neck, and overall gross motor movement assessment.

The INFANIB is one of the tests used to assess the reflexes of babies at Child and Family Development.  There are 20 reflexes that are demonstrated during the first year of a babies life- most will integrate or disappear throughout the first year of life and some will become the cornerstone of movement; for instance, catching yourself when you fall by throwing your hands out.  These reflexes are important to the development of your baby and the physical therapist will be able to guide you through each test and explain why each test is being completed. 

I also like to use the Alberta Infant Motor Scale (AIMS) or Peabody Developmental Motor Scales- 2nd edition (PDMS-2) to assess the overall gross motor movements of the baby- depending on the age of the baby.  They look at the overall picture of movement:

Skills your child is completing lying on his/her back (these are a few):
- bringing his/her hands to midline
- holding the head in midline
- arm movement, reaching for toys
- chin tuck, neck flexors are active
- hands to knees, hands to feet and feet to mouth

Skills your child is completing lying on his/her stomach (these are a few):
- lifting head asymmetrically/symmetrically
- propped on elbows with head extended
- lifts head and maintains posture
- weight shifting on elbows and reaching for toys

- The physical therapist will also assess the way your baby is moving through space and in positions like sitting and supported standing.

Finally, the physical therapist will assess the range of motion and strength of the neck musculature.  Typically the right or left sternocleidomastoid muscle (SCM) will be tight and there will be weakness in the opposite SCM- this muscle and its action are talked about in an earlier blog-"My baby has torticollis...what does that mean?"

- If the right SCM is tight then your baby will tilt his/her head to the right and rotate to the left, predominantly.  The tilt component is the harder component to treat and will resolve slower than the rotating component.  Sometimes babies only have the tilt component.   

- With active rotation to the restricted side and applied ovepressure, as instructed by a physical therapist your baby will start to look to the restricted side more freely.  Placing his/her favorite toys on the restricted side constantly when lying on his/her stomach or lying on his/her back will increase active rotation to that side and improved range of motion over time.  

- With passive stretches that sidebend through the restriction, as instructed by a physical therapist and varying positioning during feeding and sleeping- the tilt will begin to resolve.  Again, the tilt usually takes longer to resolve than the rotation component.  

If you suspect your child has torticollis or is holding his/her head tilted to one side please ask your pediatrician for a referral to a pediatric physical therapist.  The earlier your baby is evaluated and treatment is started, the better the outcome.