Plagiocephaly, torticollis, colic – some words you may or may not have ever been exposed to before becoming a parent. What are these common conditions in newborns, and how do you screen for them as a parent? Marie Shinmoto, physiotherapist and owner of M.A.P. Physiotherapy shares simple screening for common conditions in newborns with us.
I thank my lucky stars every day that I am a physiotherapist and that I have paediatric experience. If I didn’t then things would have turned out a whole lot differently for both my children. I often see parents with children with certain conditions that were caught late and thus more challenging to deal with than if they had been seen earlier. My own children had some of these issues that I would like to educate more parents about. If I hadn’t been on top of things from the very beginning they would have had more challenges later in life.
These things are quite easy to spot if you know what to look for. I would like you to know how so that you can get your children help early if they need it. Don’t be intimidated by the long medical names of some of these conditions. They really aren’t that complicated.
When your baby is lying on their back, simply look to see if things are symmetrical and lined up. Start with the trunk. It should be straight and not bent over towards one side. The head should be lined up straight with the trunk and freely able to turn to either side. The head should also be well rounded and balanced. All four limbs should be moving equally and freely.
The parents of pretty much every baby I have seen who has had issues tell me that one of the first things they noticed was some sort of asymmetry such as the head always turned to one side or the child always leaning over in the baby bucket car seat. Seeing issues with symmetry isn’t rocket science and you don’t need any special training to do it.
Let me be absolutely clear here. Babies should be symmetrical. Don’t let anyone tell you differently. A friend of ours noticed with her firstborn that he was completely crooked. He was always scrunched up on one side of his trunk and falling over to one side in his car seat. Her family doctor told her babies aren’t supposed to be symmetrical. Hunh? When she told me this I tried to keep a straight face and not throw the doctor under the bus, but I had to tell her that he needed treatment. Thankfully she allowed me to help him.
So what does it mean if something is out of whack? Well, let’s start at the top with the head and neck.
This is a condition in which babies are born with tightness in the muscles on one side of the neck. This causes the head to be rotated to one side and sometimes also tilted. Parents of babies with torticollis will notice right away that their baby always keeps their head turned to the same side. This can be to the point that issues develop in the skin folds on the side of the neck to which the head is always turned. Moms may even note that breastfeeding on one side is much more difficult.
While traditionally this has been treated as an issue isolated to the neck, it shouldn’t be. I have never seen a baby with torticollis who didn’t have tightness through the whole side of the body. When baby is on their back you can see that the trunk is also tight and shortened on the same side as the neck, so baby is curved to that side. I affectionately refer to this as a banana baby, meaning they are curved like a banana when on the back.
Torticollis is a full body issue. While it is the tightness and limited movement in the neck which draws the attention, it is not the primary problem. The problem is tightness through one entire side of the body and the neck is just the last pearl on the crooked string.
If caught early and treated as part of a full body pattern of movement, it is very quickly resolved. However, I have seen too many children who have had treatment aimed solely at stretching out the tight side of the neck. This is akin to trying to fix the cracks appearing in the 10th floor of a building when the problem is a crooked foundation. Not only is this not very effective, it is traumatic for both baby and parents as stretching out the neck causes discomfort or pain.
By addressing the issues in the trunk first, I find that the neck, in the end, needs very little treatment. Once the foundation of the building is straightened out then a quick plaster job on the 10th floor is all you need.
This is a condition in which the bones of the skull deform and cause asymmetry in the shape of the head. The skull of a baby is very pliable and so it is susceptible to outside forces. Sometimes children are born with an asymmetrical head shape due to position in utero. Particularly in the late stages of pregnancy when the baby’s head is usually wedged right down in mom’s pelvis, the head is susceptible to becoming misshapen, especially if mom has any asymmetry in her own pelvis. In effect the baby’s head will take on the form of mom’s pelvis. It is also more common in twins due to cramped quarters in utero.
Plagiocephaly can also develop in the early months of a baby’s life. This may be due to habitually lying in the same position all the time. It is quite common in babies who have torticollis as keeping their head turned always to the same side, one part of the head is subjected to more consistent pressure. It is also common in babies who have spent time in neonatal intensive care as their movements may be restricted by tubes and lines attached to them.
Here’s my basic rule of thumb on plagiocephaly – if you think your baby’s head is funny-shaped, then it is. We all know what a cute little perfectly rounded baby head looks like. If you think your baby’s head doesn’t look like this, get help. I have seen one baby whose parents were told that because he didn’t have a flat spot on his head he didn’t have plagiocephaly (which is sometimes referred to as flat head syndrome). While sometimes plagiocephaly involves an obvious flattened spot, usually on the back of the head, it is by definition any asymmetry in the shape of the head. Period. No flat spot required.
Because babies’ skulls are so pliable, treating plagiocephaly is successful if it is caught early. However, just as in torticollis it is important to recognize that this condition does not just involve the head. There are always asymmetries to be seen in the trunk and these are often also banana babies. We have seen great success with the combination of physiotherapy to straighten the trunk out as well as craniosacral therapy and osteopathic manual treatment to normalize the shape of the head. In some cases helmets are necessary but this is relatively rare.
Pretty much everything you read will tell you that the cause of colic is unknown and that there is really no effective treatment for it. Personally, when I hear the phrase “cause unknown” I consider it a challenge. My journey with treating colic began with babies of friends. I have since discovered that every baby I have seen who has colic has asymmetries and restrictions in the trunk and hips.
When baby is lying on their back and kicking their little legs (and really, what else do they do all day?), babies with colic demonstrate visible tightness in the lower abdomen and into the hip such that when they kick one leg (almost always the left) the abdomen on that side scrunches up and twists. These are also banana babies with the short side being the side with the tight hip. When I fist saw this it was so obvious to me, and it was also obvious that twisting the abdomen with each kick could not be good for the digestion.
So I set out to test a theory. I treated the whole tight side and then focused in on releasing the restrictions in the lower abdomen and into the hip. Amazingly the symptoms of colic resolved, sometimes with one single treatment.
If your baby has colic, lay them on their back and check to see if the trunk is curved to one side like a banana. Then watch carefully while they kick their legs. You may notice a twisting in the lower abdomen on one side. You can also gently pump their legs up and down and if there is tightness in one hip you will feel more resistance in that leg when you try to straighten it. If you look carefully, you may also see that when you bend that hip it scrunches up the whole side of the body. These restrictions can be treated and the results are amazing!
Check That Six Pack
Many women who have been pregnant will be familiar with a condition called diastasis recti. This is just a fancy medical term for when the two sides of the abdominal six pack muscles split down the middle. They are normally held together by strong fibrous tissue, but at the end stages of pregnancy when things are stretched to the hilt, sometimes this tissue down the middle gives. In pregnant women this isn’t usually noticed until after giving birth when a bulge can be seen here when using the abdominal muscles for things such as sitting up or coughing.
Well, it turns out babies can be born with this. I didn’t even know this until my son was born. I noticed that when he cried there was a significant bulge right down the middle of his abdomen. It was then that I realized that his six pack was split down the middle the whole length from just under his rib cage almost to his pubic bone, so when he cried his abdominal contents pushed up through this huge opening in quite dramatic fashion.
Being a physiotherapist I was quite concerned. Remarkably, no one else was. This connection through the middle is crucial, particularly in a developing baby. So much of what we do involves connection diagonally across the abdomen. Walking is a diagonal pattern (meaning we move opposite arm and leg together) as is crawling. Rolling over also means we have to connect across the middle.
Someone with diastasis recti (whether it be an adult or a baby) can never physically reconnect the two sides of the six pack unless they have surgery. However, with treatment we can teach the muscles to connect functionally across the midline. This helps to minimize the gap and most importantly teaches the brain to connect diagonally across the middle. If this doesn’t happen, the right side literally doesn’t know what the left side is doing.
I decided to treat my son early simply because I believed it was a crucial connection to make. Looking at him now you wouldn’t know he still has a diastasis recti, but I can still feel it and I know it’s physically there. Functionally, however, he is doing just fine. I patted myself on the back and figured I’d avoided something that may have caused him some issues down the line.
It wasn’t until years later when an 11 month old boy came into my clinic that I discovered the extent to which this condition could impact a child’s mobility if left untreated. This little boy was perfectly normal neurologically but had started rolling over quite late, at 11 months couldn’t sit on his own, and couldn’t stand up even holding onto something. It was like he didn’t know even how to get his feet under him. The sole reason for this? A huge diastasis recti like my son had.
Because the two sides of his abdominal muscles weren’t speaking to each other he had no trunk stability. He had developed with the left side not knowing what the right side was doing. Because this was discovered so late, the challenge to correct it was much greater.
So just check out your baby’s six pack. The best time to see if your baby has a diastasis recti is unfortunately when they are crying, since the pressure they create will push the abdominal contents out the opening. If it’s there, you will see it right away. Be sure to check along the whole length of the midline from just under the ribs right down to the pubic bone. A very small opening is likely not significant, but babies born with this tend to be split from stem to stern, so if you see it be sure to get some treatment for your baby.
Follow Your Instincts
On the rare occasion that I have seen babies with something more serious going on, parents have always instinctively known something was off. Whether it be a funny breathing pattern, an unusual walking pattern, or balance issues, parents know when things aren’t right. If you feel there is an issue with your child keep pursuing it until you find someone who will take you seriously. Chances are you are right.
Marie is a physiotherapist and owner of M.A.P. Physiotherapy. She has extensive experience working with babies and children as well as mothers prenatally and post-partum. Marie’s daughter was born with torticollis and her son with plagiocephaly and diastasis recti. Marie believes that every issue we experience involves the whole body and treating piecemeal doesn’t address the underlying cause of a problem.
You can follow Marie on the M.A.P. Physiotherapy Facebook page and reach out to her via her website to schedule a consult.