Question
What are the primary risk factors associated with the development of congenital muscular torticollis in infants?
Answer
Congenital muscular torticollis (CMT) is influenced by a combination of prenatal, perinatal, and postnatal (environmental) risk factors. Prenatal factors often relate to the intrauterine environment, such as limited space due to a large fetus, first pregnancies, or multiple births (e.g., twins), which can result in the fetus being positioned in a way that promotes muscle shortening on one side of the neck. Breech positioning is another significant prenatal risk, as it can lead to the infant’s head being compressed or misaligned, increasing the likelihood of CMT.
Perinatal risk factors include complications during the birthing process, such as prolonged labor or the use of forceps, which can cause injury to the sternocleidomastoid (SCM) muscle. Postnatal or environmental factors have become more prominent with the widespread adoption of the "Back to Sleep" program, which encourages supine sleeping to reduce the risk of SIDS. This position, combined with poor head control in neonates, can lead to a postural preference and subsequent muscle shortening. Additional postnatal risks include poor tolerance to tummy time, excessive use of containment devices (like car seats and swings), and gastroesophageal reflux disease (GERD), which can cause infants to adopt compensatory head postures that mimic or contribute to torticollis.
This Ask the Expert is an edited excerpt from the course, 'Torticollis Evaluation and Treatment', presented by Kimber Kurr, PT, DPT, PCS.
