Treating Torticollis and Plagiocephaly

Question: “My three-month-old has mild torticollis and plagiocephaly…We are in physical therapy, but would love to know what others’ experiences are, as I know flat head is quite common. Thanks!”

Editor’s Note: Torticollis is an asymmetrical head or neck position (below), which is usually caused by birth trauma or intrauterine malposition.

Plagiocephaly is commonly known as “flat head,” which is a flat spot in the back or side of a baby’s head, as seen below.

Flat head is increasingly common due to babies sleeping on their backs, as instructed. “Does this mean I should put my baby down on his tummy?” — logical question, but the answer is heck, no. Since the “back to sleep” SIDS prevention campaign began in the mid 90s, SIDS deaths have been drastically reduced. While flat head is a major drag, back sleeping is still the safest! In fact, 70% of SIDS deaths occur to babies sleeping on their tummies. Read more about SIDS prevention at FirstCandle.org.

To reduce the pressure on your baby’s skull (for 0-4 months only!), check out the Lifenest Sleep System (below).

Another option is the Lovenest by Babymoov. Just keep in mind that it’s not recommended for use in the crib – it’s designed for strollers, bouncers, swings and play time.

*Also available on Amazon.

Note that these products are only good for about 4 months or so and must not be used once baby starts rolling over. Not everyone needs them, but if your young infant is developing a flat spot, discuss with your pediatrician. As a friend noted, “A $130 mattress is cheaper than a $2,000 helmet!” True that, sister.

*Keep in mind while reading reviews, that most plagiocephaly or torticollis products on the market don’t have very high ratings.

Ok, enough background info. Here are the answers:

Top Answers:

1. Jade Elwess  I would suggest asking your pediatrician for a referral to a specialist for plagiocephaly. If it’s mild, the therapy might be fine on its own. If a cranial band (helmet) is recommended, the sooner you can start, the better. We didn’t get our referral until 9 months, and the head growth had slowed down by then. We did tummy time early on, but mine was breech, so the flat spot had evidently been there all along. At least you are aware and can keep monitoring it to see if it gets worse.

2. Rebecca Carlson My son had a flat spot and we opted to not use a cranial band (helmet) to reshape it. In most cases, it is only a cosmetic issue and depending on the severity their hair will cover any areas of concern. I am an occupational therapy assistant and the American Occupational Therapy Association just released an article about there being no real difference between using a band and time alone (with plenty of tummy time). My advice is to consider how important it is for your child to have a perfectly round head. If the plagiocephaly is not severe enough to cause facial abnormalities then I would wait at least until 6 months to make any decision regarding a band. You have plenty of time for the head to grow and reshape. We chose no helmet and by the 9 month checkup the doctor said his head looked great! Best of luck!

• Rebecca Carlson Also go to a neurosurgeon instead of a helmet specialist if you haven’t already. The helmet specialist makes money from prescribing bands and the neurosurgeon can offer a more objective opinion about actual bone growth and development.

3. Chrissy Partee Mazer My daughter was born with a flat spot, meaning no amount of tummy time would help. It’s simply how she laid in utero. We did the helmet route around 5 months old! The sooner you start the helmet, the more successful you’ll be! Before the appointment, I struggled and decided if she qualified via insurance I would do it! I’m glad I did; it seemed like forever but it was over pretty quick!

• Jessica Graham My daughter was born with a flat spot and torticollis. She’s 5 months and we get her helmet on Aug 4th. I’m not looking forward to it, but we’ve tried everything to correct it naturally too. Her torticollis is almost gone but the flat spot hasn’t changed. How long did your daughter have to wear it?
• Chrissy Partee Mazer Hi Jessica – my daughter wore it for 10 weeks. The hardest part was putting it on and taking it off. It also develops a horrible smell. Chances are she’ll hit a growth spurt and you’ll see great change. I will say we were pretty strict and followed the rules and didn’t cheat at all. I also stopped carrying around her car seat and wore her more often; I was so worried her head would go flat again.

4. Jenny Brannen Larson Best thing we ever did was cranial band and PT…you only have a small window to mold the head! Our pediatrician said the same thing but we finally realized that it was getting worse, not better. We thought of it like braces for our daughter’s teeth!

5. Katherine Heller Hamm Our son was starting to get a flat spot and we used the Tortle Repositioning Beanie for naps and nothing further ever needed to be done. His head is perfectly round now.

Editor’s Note: There are different instructions for using the Tortle depending on whether you would like to prevent flat head or treat mild to moderate flat head or head preference. Check the Tortle website for more details. Tortle suggests newborns (or young infants) wear their repositioning beanie for no less than 8 hours/day during the first 6 months (and never at night while unsupervised).

6. Lauren Bjork My 10-month-old son has torticollis and had pretty severe plagiocephaly. An early referral (at 3 months) to a cranio-facial surgeon and in-home PT program was key. They originally thought he would need to be in the cranial band (helmet) for 3-6 months, but he hit a growth spurt while having the band and we saw complete correction in just 2.5 months. For our situation, the helmet was totally worth it. I think for us what also really made a difference was allowing tons of floor time, which just allows for lots of movement and stretching. He is just about ready to be discharged from PT too! A couple of caveats about the whole experience: 1) Check with your insurance to see if they will cover the helmet and PT…our insurance covered the helmet, but that is not always the case (and our co-pay was still almost $1000), 2) In some states the Dept. of Public Health will cover PT (this was the case for us in MA…and they come right to our home), 3) Be prepared for stupid comments from lots of judgmental folks…I constantly felt like people in public stared at us because of the helmet…and some made really sad comments. Every situation is different. For us, I am really glad we made the decision to get the band and do PT.

7. Tori Carras My guy went through the exact same thing. PT straightened and strengthened his neck. He wore a corrective helmet for 7 months and now has a more beautiful head than all his friends (but I might have a mother’s bias about that). Seems like a big thing at the time, but it goes real fast. In the grand scheme of things, it’s a blip.

8. Kati Couture My daughter had a very flat back of her head. Our chiropractor referred us to a cranial sacral therapist at about 5 months, and by about 9 months (with monthly treatments), her head was normal again.

See all the answers here.

Related: Our Flat Head Helmet Story