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Quick reference medical handouts used by Pediatric offices


My four month old daughter appears to favor her holding her head to the left most of the time. Her features appear symmetrical to me and I have seen her hold her head up straight. What is the reason for this? Is this a potential problem? Could this have long term implications? Should I have her seen by a specialist? Thanks for your help.
    
Infants holding their heads in one preferred position is now a fairly common problem we see. What you did not share with us is whether this has been something she has done since birth, or if it has been something she has gradually developed over the last few months. Some infants are born with what could be called congenital torticolis. These infants either suffer some mild injury to one of their anterior neck muscles (the sternocleidomastoid muscle) prior to birth or during the birth process. This can lead to a lump forming in the injured muscle, which is thickening or fibrosis in the injured area. This can cause the muscle to be tighter or shorter on the affected side, and can cause the baby to preferentially turn his head towards that side. This is usually noted within the first two weeks after birth, and the muscle thickening can be well visualized with an ultrasound of the neck muscle. Early physical therapy usually leads to good functioning and normal flexibility.

Some infants have preferential head positioning if they have certain underlying genetic problems. However, it sounds as though your infant is a lovely, normal healthy infant.

Perhaps the most common cause of some infants holding their heads preferrentially to one side comes from the recommendation to place all infants on their backs for sleep (which HAS led to a reduction in Sudden Infant Death Syndrome, or Crib Death). Infants placed exclusively on their backs for sleep often develop flattening of one part of the back of the head. This may make them want to hold their head turned towards one side, especially when placed on their back to play. By five months of age, your baby should have good head and neck control, and placing toys or mobiles on the side she does not prefer to look towards may make her turn towards the tight direction. You can do some passive range of motion exercises, which your pediatrician could show you how to do, to help the tighter side of her neck become more flexible; at five months she should be given plenty of time when awake to play down on a mat on the floor on her stomach and on her sides; she could be put to sleep on her sides some of the time too.

It is important for you to check with your pediatrician to make sure her head circumference is growing normally and to make sure your pediatrician is not concerned that any of the growth lines between the growing skull bones on your baby's skull are not fusing or growing together too fast.It is also important that an examination of her eyes shows that she is tracking and following well with both eyes and that a good "red reflex" from both retinas is seen on examination. A marked deficit in vision between the two eyes can lead to a head tilt in some children.

If you have not discussed this concern with your pediatrician, this is a good thing to put on your "list" when you go in with your baby for her next well child check up.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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