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Infant & Toddler Development
Children develop gross motor milestones in a layered pattern, building on existing movement patterns and strength in order to further advance their independence with mobility as they grow. Development can be altered by many different causes including prematurity, breech positioning, genetic conditions, and asymmetries in strength. Physical therapy provides interventions to help a child learn and master new skills, build strength, and provides guidance and education for parents to empower them to be able to carry out interventions to promote their child's continued development.
Torticollis
Torticollis is a tightening of one side of the neck, and is one of the most commonly seen conditions in pediatric physical therapy. The restriction can be caused from positioning in utero, birth trauma, or use of "baby containers" (car seats, swings, jumpers, etc.) that constrict movement and allow a child to fall into an asymmetrical position. With torticollis, a child has a preference for tilting their head to one side and/or rotating their head to one side compared to the other due to a restriction in the Sternocleidomastoid muscle, or SCM for short. For example, a child with a tightness of the left side of the neck will prefer to tilt their head to the left and rotate the head to the right. Asymmetry in tilting or rotation of the head to only one side can result in a flattening of one side of the back of the head, called Plagiocephaly. Moderate and severe Plagiocephaly can result in the shifting of facial features including the eyes, ears, and cheeks.
Torticollis can sometimes be noticed shortly after birth, and is most responsive to treatment when treated early by a physical therapist with experience treating torticollis. Infants treated before age 4 months often have complete resolution of torticollis. However, no matter what age treatment starts, infants should continue to be monitored, per the 2018 Clinical Practice Guidelines for the treatment of Congenital Muscular Torticollis (Kaplan, et al.) until they begin walking, in order to address any asymmetry that may linger through gross motor skill development. For example, if a child has a preference for rotating their head to the right (due to a tightness of the left SCM muscle), they are more likely to use the right hand purely due to seeing that hand more. They will begin rolling from back to belly, and belly to back preferring rolling over the right shoulder, will reach when on their belly with the right hand 9 out of 10 times, and will pivot when on their belly to the right side. As the child learns to crawl, they may begin an unusual crawling pattern of propping the right foot while the left knee remains on the floor, and when pulling to stand will likely pull to stand bringing the right leg forward (into half kneeling). When cruising, cruising to the right side will be preferred, and to the left sill be more difficult.
Torticollis is easily treated with stretches and strengthening exercises to balance out the neck muscles, and gross motor exercises to facilitate symmetrical gross motor skill development. At KCGPPT we empower our families to be able to carry out interventions at home with confidence. Families are not only instructed in what to do to address the age-appropriate skills, but what to be looking out for next as their child develops in order to stop any asymmetry before it starts.
Torticollis can sometimes be noticed shortly after birth, and is most responsive to treatment when treated early by a physical therapist with experience treating torticollis. Infants treated before age 4 months often have complete resolution of torticollis. However, no matter what age treatment starts, infants should continue to be monitored, per the 2018 Clinical Practice Guidelines for the treatment of Congenital Muscular Torticollis (Kaplan, et al.) until they begin walking, in order to address any asymmetry that may linger through gross motor skill development. For example, if a child has a preference for rotating their head to the right (due to a tightness of the left SCM muscle), they are more likely to use the right hand purely due to seeing that hand more. They will begin rolling from back to belly, and belly to back preferring rolling over the right shoulder, will reach when on their belly with the right hand 9 out of 10 times, and will pivot when on their belly to the right side. As the child learns to crawl, they may begin an unusual crawling pattern of propping the right foot while the left knee remains on the floor, and when pulling to stand will likely pull to stand bringing the right leg forward (into half kneeling). When cruising, cruising to the right side will be preferred, and to the left sill be more difficult.
Torticollis is easily treated with stretches and strengthening exercises to balance out the neck muscles, and gross motor exercises to facilitate symmetrical gross motor skill development. At KCGPPT we empower our families to be able to carry out interventions at home with confidence. Families are not only instructed in what to do to address the age-appropriate skills, but what to be looking out for next as their child develops in order to stop any asymmetry before it starts.