Research Review: Breastfeeding Infants with Congenital Torticollis

Citation: Genna CW. Breastfeeding Infants with Congenital Torticollis. Journal of Human Lactation. 2015;31(2):216-220.

Link: doi:10.1177/0890334414568315

Abstract:

Infants with unilateral sternocleidomastoid tension and associated craniofacial, spinal, and hip asymmetries may feed poorly. Anatomic and muscular asymmetry stress both biomechanics and state control, increasing the potential for difficulty latching and sucking. A combination of positioning modifications to allow the infant to maintain his or her comfortable head tilt and turn, supportive techniques to restore alignment of oral structures, and handling techniques to help activate the weak contralateral muscles have been effective in the author's practice. Lactation consultants can promote positioning and muscle activation strategies and encourage physical therapy referrals for infants who do not respond promptly to reduce the risk of craniofacial deformity and developmental problems.

Takeaways:

This is a helpful review of breastfeeding infants with torticollis, and as expected, Catherine Watson Genna offers practical advice for supporting the dyad. Here are some key points:

Congenital Muscular Torticollis (CMT) is a twisting of the neck caused by a sternocleidomastoid (SCM) muscle lesion and/or shortening of the SCM. Microscopic finings support that the SCM may be affected due to a loss of normal movement-associated stresses on the muscle.

Half the infants with torticollis have a history of constrained intrauterine position in the last weeks of pregnancy due to fetal length and malposition including breech. They often have facial and hip asymmetries as well.

Look for torticollis in:

• Large, long babies

• Babies with facial asymmetry

• Babies with hip asymmetry

• Unfavorable presentations with difficult labor and birth

Related Feeding Difficulties:

• Unilateral breast refusal

• Weak suck

• Depressed reflexes

• Sensory integration challenges (fussy, irritable, low tolerance for position changes)

Ways to Help:

*POSITIONS:

• Laid Back Position - Place baby prone on reclining mother

• “Torticollis Tummy Twist” – Turn the infant’s lower body so the abdomen rests against the mothers thighs which rolls the infant’s head and trunk toward the mother

• “Spiderman” (hip straddle) – Sit baby against mother’s hip and allow the head to rotate toward mother’s center

• “Belly Sit” – Straddle the infant’s legs around mother’s abdomen and baby is sitting up to feed

• “Arm Lie” – Side lying position with baby’s head on mother’s arm

(*see article for some great photos of these positions)

OTHER:

• Keep environment calm, decrease environmental stimuli during feeding

• Help mother to identify and maintain a good seal

• Jaw support

• Light finger pressure in front of the ear

• Counseling Parents:

• Hear mother’s birth story

• Discuss and connect her birth history with current feeding challenges

• Encourage calming practices

• Encourage interactive play, tummy time and frequent carrying

• Focus on potential for improved feeding

Physical therapy is most effective before 3-4 months and often begins prior to 1 month of age. Parents will also be given stretching exercises to do with baby at home, including frequent prone play.

“Although lactation consultants may recommend bodywork for infants with torticollis, research on modalities other than physical or occupational therapy is limited.”