Number #1 Cause of Congenital Torticollis & Plagiocephaly is Intra-uterine Contraint due to carrying Multiples
There are several markers that allow us to determine if newborns and young infants are at risk for having congenital muscular torticollis and developing positional plagiocephaly.
I’ve listed the 12 risk factors in my previous blog so I won’t mention them all here. However I do want to explore ‘intra-uterine’ contraint and its relationship to mothers who give birth to multiples (twins, triplets, etc).
What is Intra-Uterine Contraint?
This term describes lack of required space in utero for the developing fetus to freely and naturally move its head and shoulders in all directions during the last trimester of a pregnancy.
What Causes Intra-Uterine Contraint?
There are several causes of intra-uterine contraint. Causes related to the Mother: small uterus (first pregnancy, first delivery), irregular shaped uterus, history of fibroids or intra-uterine scarring, petite overall size of the carrying mother relative to significantly larger/ taller biological father, short umbilical cord, etc. Causes related to the Fetus: Larger than average head size, longer than average body length, overdue delivery greater than 40 weeks, awkward head & body positioning during last trimester (breeched, diagonal, transverse) and limited space due to sharing with a sibling (twins, triplets, etc.)
What actually happens to the Head & Neck of a Fetus that is Constrained during the last trimester?
Within the last trimester, the fetus has differentiated musculature, ligaments, tendons and joints. The fetus is also the longest with the largest sized head circumference right before birth in the last trimester. More often than not, the fetus can ‘out-grow’ the space provided just before birth, which can restrict natural head movement and cause the fetus to be in one position for long periods of time. If the fetus is in an awkward position where the head is tilted (ear to shoulder) or the head is turned (chin to shoulder)for a long period of time during the last trimester, this prolonged positioning can affect the neck muscles differently on each side of the neck. The muscles on one side of the neck is positioned in a lengthened position (essentially positioned in a prolonged ‘stretch’) whereas the muscles on the opposite side of neck is positioned in a shortened position (essentially in a ‘cramped’ position, causing the muscle to tighten and lose flexibility).
Can my Doctor tell when my baby is born if his/ her neck muscles were affected?
These intra-uterine changes to the neck muscles are not easily detected right at birth so it is very easy for OBGYN doctors as well as Pediatricians to miss. The most common sign that there is neck muscle asymmetry is a developing flat spot in the back of the head. It takes about 2 to 3 months for the skull to flatten, which is about the time most parents and Pediatricians notice something may be wrong.
Is there anything I can do to prevent my newborn’s head from flattening during the first 2-3 months of life?
Yes. If you suspect that your newborn may be at risk for neck muscle tightness or asymmetry, it is recommended to schedule an early detection physical therapy screen, by a Pediatric Physical Therapist that specialized in Head & Neck conditions. By doing so, you gain awareness and are able to look for habitual patterns of preferred positioning when sleeping or feeding and you are essentially empowered with knowledge to be able to prevent your infant’s head from flattening, whether your infant was determined to be at risk or not.
Here is an inspiring success story from a first time Mom who had twins. If you have any questions about our Early Detection & Intervention Evaluations as well as Programs for Multiples, call us today! 800-507-2634.
Happy Mom shares Success Story of Twins with Torticollis