How to Check Infant Neck Strength | Torticollis Explained
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In this blog post we are going to go over how to check for infant neck strength, in infants 3 months+, as well as the best markers for infants < 3 months for neck strength. We are also going to go over torticollis and plagiocephaly (head shape/head flatness) because these both can influence neck strength in infants significantly and all parents need to screen their infants for Torticollis and Plagiocephaly from day one.
Torticollis: A Quick Overview
First things first, let's talk about torticollis. This condition involves a tilt to one side and a rotation to the other, often due to tightness in the sternocleidomastoid muscle. But it's not just a neck issue; it can involve the whole body – from the arms and shoulders down to the pelvis.
Right vs. Left Torticollis: The side of the torticollis is named after the side of the TILT. The sternocleidomastoid muscle tilts to the same side as the muscle, but rotates to the opposite side, which makes it kind of confusing to parents.
Right Torticollis: If your baby has a tilt to the right and rotates more easily to the left, it's the right sternocleidomastoid that's tight.
Left Torticollis: If your baby has a tilt to the left and rotates more easily to the right, it's the left sternocleidomastoid that's tight.
Why Early Intervention Matters
The earlier we catch and address any signs of torticollis or neck weakness, the better. Ideally, babies should be seen by a pediatric physical therapist before they turn one month old. Truthfully though, we are a LONG WAY OFF from this being the norm in the United States (hopefully it’s more common in other countries!).
Most of the time at one month old, parents are barely able to get in to the pediatrician, let alone in to see a Pediatric Physical Therapist or know that this is something that could be beneficial for them.
Luckily, a lot of Pediatric Physical Therapists like myself are sick of parents getting frustrated that they didn’t know they could’ve done something earlier and we are here, hanging out on the internet, trying to get our knowledge in YOUR hands, if you need it.
Early intervention can significantly reduce the amount of therapy needed compared to starting after one month of age.
The national data for Pediatric Physical Therapy results with Torticollis is as follows:
0-1 month: 1.5 months average time of treatment
1-3 months: 5.9 month average time of treatment
3-6 months: 7.9 month average time of treatment
6-12 months: 8.9 month average time of treatment
The good news, though, is that Pediatric Physical Therapists who specialize in infants can often see quicker results in infants who are within the 0-5 month range closer to 3 months average length of weekly Pediatric Physical Therapy with sometimes needed but much less frequent visits up to six months, especially if a child is also receiving craniosacral therapy, chiropractic care, or infant massage.
The take home message is this: the earlier the better, not just because it doesn’t take as long, but also because the baby’s experience is so much easier when they are younger. Tightness in the body does not feel good and older babies can be cranky trying to help them resolve Torticollis and the movement struggles that are caused by unresolved Torticollis.
Plagiocephaly: Linked to Torticollis
Plagiocephaly, or flat head syndrome, often goes hand-in-hand with torticollis. A baby with a rotation preference might develop flatness on one side of their head (the side of the rotation preference), emphasizing the importance of early and proactive physical therapy.
This both make the Torticollis AND the Plagiocephaly worse. They’re like the worst kind of frenemies of new parents.
However, Plagiocephaly can also occur in utero, so monitoring head shape from birth is vitally important, especially because treating head shape without a helmet is only effective if the baby is seen by 3 months (some change possible 4-5 months but much less time to complete program, which results in decreased results and often a referral for a head shape scan/helmet after 5 months).
Testing Head and Neck Strength
Now, let's get into the nitty-gritty – how you can test your baby's head and neck strength at home. This simple check can help you spot any imbalances and take action. I recommend only doing this after the age of 3 months.
Prior to the age of three months, the best test of neck strength is whether a baby can tolerate tummy time and lift their head off the ground to 90 degrees and push through their elbows to lift their chest.
Age-Appropriate Expectations:
At 3 months: babies should keep their head horizontal
3 to 4 months: they should lift it slightly above horizontal
4 to 6 months and beyond: they should lift it significantly above horizontal, increasing in height as they age.
How to Test Neck Strength:
Start facing a mirror or set up your camera (I like the front facing view so you can see if you’re in the frame!).
Right Side Test: Place your right arm through your baby's legs, fingers on their abdomen. Your left arm goes between their bottom arm and chest, supporting them horizontally. Check how far the baby can lift their right ear towards their shoulder, holding for 5 seconds.
Left Side Test: Switch arms for testing the left side. Place your left arm through your baby's legs, fingers on their abdomen. Your right arm goes between their bottom arm and chest, supporting them horizontally. Check how far your baby can lift their left ear towards their shoulder against gravity.
Note if there is any difference side to side, if not, and your baby is consistent with the age recommendations, then your baby likely has equal strength side to side, if there is no rotation preference and no head tilt you are good to go!
If there is a difference side to side, your baby has a head tilt, rotation preference, or flatness in the back of their head a consultation with a Pediatric Physical Therapy is recommended.
Strengthening Exercises
If you find your baby struggles with maintaining head strength in the horizontal position, start in a more vertical position where gravity is less of an enemy. Gradually increase the challenge by tilting them more horizontally as they build strength. This gentle progression helps them develop neck muscle strength comfortably and effectively.
Recommendations for How Long
Start with 5 seconds, then increase to 15-30 seconds at a time for a total of 1-2 minutes split between sides. Always do both sides to make sure that neck strength stays equal.
Resources for Further Help
If you're eager for more detailed guidance or if you've noticed any concerns with your baby's neck strength or symmetry, my latest book, "Tummy Time and Learning to Roll," is a treasure trove of information.
It covers everything from the basics of torticollis and plagiocephaly to comprehensive exercises and strategies for ensuring your baby's development is on the right track.
for the most comprehensive information, including demonstration of how to do the check and exercises please watch the video below.
TIMESTAMPS:
0:47 Torticollis explained: What is torticollis? What does Torticollis look like? What causes Torticollis? Does my baby have right or left Torticollis?
2:03 which side is most common in babies for Torticollis or Plagiocephaly
2:20 when to see a Pediatric Physical Therapist and why you need to be seen by this age for quickest results
3:29 Plagiocephaly explained: why plagiocephaly (flat head in infants) is often associated with Torticollis, what plagiocephaly looks like
6:20 what normal neck strength in infants looks like based on age
8:39 how to check neck strength in infants on the right side
9:25 how to check neck strength in infants on the left side
10:00 how to use this position to increase neck strength in infants
LINKS IN VIDEO:
Physical Therapy Tshirt
Baby Begin for head shape consultations
TOY IDEAS:
Best Toys for Babies Learning to Roll
Best Toys for Babies
PT Approved Equipment/Containers for Babies
Tummy Time Toys
Curious About Learning More on Tummy Time, Rolling, or Both?
The absolute best book for parents on tummy time and rolling is: Tummy Time and Learning to Roll: A Baby Development Book for Ambitious Parents and Pediatric Healthcare Providers to Help Babies Learn to Roll Independently. The book comes with a free online video course to help parents fully understand how to complete the different exercises, printable checklists to know exactly where your baby is at, and when to reach out for additional help.
This book was written by Dr. Lauren Baker, PT, DPT, ATC, MTC, who is a Pediatric Physical Therapist in Boise, Idaho, trained in helping parents learn how to help their babies move and master their milestones. She loves teaching parents how to see how their babies are moving as well as how to influence those movements though play positions and exercises to help babies move with confidence and ease.
Tummy Time and Learning to Roll is the first book in the Proactive Play series written by Pediatric Physical Therapist Dr. Lauren Baker in order to help Ambitious Parents and Pediatric Healthcare Providers learn how to help babies master tummy time and learn to roll. It is meant to help ambitious parents understand baby development from birth to six months (tummy time to rolling).
This book is a mix of easy-to-follow and more in-depth information than is typically found in baby development books because Dr. Baker believes parents deserve to have all the information at their fingertips.
This book breaks down each piece of movement in checklists so that parents know what their babies need for tummy time and rolling. It also covers what areas might limit a child with rolling, why it is so important, and when to seek help from a pediatric PT.
This book comes with colored photos and easy-to-follow demonstration videos that can help parents implement safe, strategic play-based exercises with their babies in 20 minutes per day.
A Great Resource For:
Parents and Pediatric Healthcare Providers of babies 0-6 months
Parents of babies who are struggling with tummy time, rolling back to belly, belly to back, or only to one side
Access to simple, easy-to-follow videos of play positions and exercises
Learning the four pillars of movement needed in order to master rolling
240+ Color Photo Examples of:
Tummy Time, Sidelying, and Back Play
Developmental Toys and Equipment
Hand Placement and Strategic Play Positions
Common Areas of Restriction or Weakness
When To Reach Out For Help
What If You Want Extra Help?
If you have concerns about their movement, remember, you can always reach out to a pediatric physical therapist. It's your right as a parent to advocate for your child's development.
Sometimes, a few tips and tricks are all you need to get your baby moving better. We're here to support you and release those mama worries. If you are looking for in home pediatric physical therapy, check our listing of therapists.
For those eager to learn more or seeking personalized guidance, I offer online video parent consultations internationally which can be scheduled by clicking here. I am dedicated to answering questions and providing tailored play activities for each unique developmental journey.
When Should Babies Receive Pediatric Physical Therapy?
Parents can call and schedule with a Pediatric Physical Therapist at any time, for any concern in all fifty states without a referral from their Pediatrician.
Pediatric Physical Therapy is medically indicated in all babies who are not rolling in all four directions by six months (back to belly over their right arm AND left arm + belly to back over their right arm AND left arm).
Pediatric Physical Therapy is medically indicated if you notice a flat spot on the back of an infants head (possible plagiocephaly), a tilt of their head consistently to one side (ear to shoulder - possible torticollis), or a rotation preference of their neck (consistently look only to the right or left - possible torticollis).
Many Pediatric Physical Therapists including Dr. Baker, can successfully treat flat spots (Plagiocephaly) without a helmet with a combination of therapy and positioning strategies if seen prior to 4 months (0-3 months is ideal). Dr. Baker uses the Baby Begin Method of repositioning.
Flat spots can be due to in-utero positioning, rotational preference (right sided flatness most common) and babies are at an increased risk for flatness if they are male, were breech, multiple birth, premature, have difficulty with tummy time, or are in containers > 2 hr/day.
Final Thoughts
Watching your baby grow and develop is one of life's most beautiful journeys, and being proactive about their physical development can make all the difference. Whether you're testing neck strength, working on exercises, or just seeking more information, remember: you're doing an incredible job. Your baby is so lucky to have you.
For any questions or if you need personalized advice, don't hesitate to reach out. I'm here to support you every step of the way in this amazing adventure of parenthood. Let's ensure our little ones have the strongest start possible, together.
6 Warning Signs of Torticollis And What To Do If It Returns
Torticollis can resurface as a baby grows from an infant to pre-school age, due to the muscles growing faster than the bones. This blog post will cover torticollis warning signs from birth to 3 years old. The blog post is by Dr. Lauren Baker, PT, DPT, ATC, MTC a pediatric in home physical therapist in Boise, ID
Early treatment for Torticollis is necessary to decrease asymmetrical movement (one side moves different than the other, or better than the other) and in order to reach gross motor milestones, avoid complications such as positional plagiocephaly (flat head), and improve gross motor skills, which are essential to academic skills such as reading, writing, and coordination.
Torticollis can resurface as a child gets older, even after Physical Therapy direct services (1:1 with a child) have been stopped due to achievement of goals. It’s important for families to know the warning signs of a reoccurrence of torticollis. These warning signs of asymmetrical movement patterns can also be used as a guide to know when to call your PT if a child was seen for delayed milestones, tightness, or other concerns.
What is Torticollis?
Plagiocephaly is a medical diagnosis that describes a flattening of the skull of infants. There are three main types of plagiocephaly: plagiocephaly, brachiocephaly, and scaphocephaly.
Plagiocephaly is a flattening on one side of the head in the back, which became more common after the introduction of the back to sleep campaign (which has decreased infant SIDS, thank goodness) but unintentionally has increased skull flattening. Data tells us that 46% of babies will have a deformation of the skull at some point in their infant lives.
Brachiocephaly is a flattening of both sides of the back of the head resulting in an increased width of the skull. Scaphocephaly is least common with a long, narrow head shape.
Plagiocephaly is often associated with a diagnosis of torticollis (head tilting and limitations in neck rotation), the baby is often rotated toward the side that is flattened and limited in the opposite direction.
The American Physical Therapy Association recommends that healthcare providers and family members screen children for head/neck tilting and preference for one side rotation of the head/neck within 2 days of birth.
Physical Therapy evaluation and treatment are recommended for infants 2 weeks and older. Torticollis has optimal results when a child receives Physical Therapy prior to 2 months of age; however, can be treated at any age. Physical Therapy average treatment is 1.5 months at up to 2 months and up to 6+ months after six months of age.
Can Torticollis be associated with Plagiocephaly?
Yes. Plagiocephaly, or flattening of the skull (usually one side of the back of the skull), is associated with both Torticollis and inutero constraint or positioning. The first warning sign of torticollis is usually a head tilt or rotation preference (rotation to the right is most common in infants). When a child spends a majority of their time in rotation, the side they prefer is at higher risk of flattening due to the pressure of the mattress/ground on the head.
It is important to eliminate any head/neck rotation preference through Pediatric Physical Therapy consultations, direct service, Chiropractic care, or a combination of both services. Plagiocephaly is easier to treat conservatively earlier, specifically before the age of 3 months. After the age of 5-6 months, or a child begins to roll, if the plagiocephaly measures in the moderate to severe range, a helmet (cranial orthosis) is typically recommended.
Physical Therapy is still recommended when a child is referred for a helmet (cranial orthosis) due to higher success rates with combined therapy and the influence of the muscular pull on the bones/joints that can decrease the effectiveness of the helmet if not completed in combination.
Can Torticollis come back after my child has been discharged from Physical Therapy?
Torticollis is a full body musculoskeletal condition, which means that the neck, trunk, and pelvis are all connected and therefore all involved. A Physical Therapy treatment and plan of care should incorporate flexibility and mobility exercises or stretches to the whole body and not just the head/neck.
Without this, the head tilt or rotation preference may return quickly after discharge of Physical Therapy. If this occurs, request additional upper and lower trunk and pelvis evaluation in the following directions: upper trunk rotation to right and left, upper trunk side bend to right and left, lower trunk rotation to right and left, lower trunk side bend to right and left. If any direction is moderately to significantly limited, further treatment is recommended.
A highly effective form of full body torticollis treatment is called Total Motion Release (TMR). Dr. Lauren Baker, PT, DPT, ATC, MTC is level 1 TMR trained and can refer to other practitioners in your area if you are not in Idaho. She can additionally help screen your child online via an online parent consultation, which you can book here.
What if my baby has been discharged but not yet crawling?
For babies with a diagnosis of torticollis, I prefer to keep children on my caseload until they are progressing toward all fours (hands and knees) crawling. The reason for this, is that there are significant alternative crawling patterns that can present in a child with a history of torticollis.
If a child struggles with being on all fours (hands and knees) and is not yet rocking on all fours (the best precursor skill to crawling), there may still be significant trunk or pelvis limitations that are contributing.
Crawling is such an important gross motor skills because it sets a child up by strengthening their hips for walking, strengthening their hands for handwriting, alternate hand/leg coordination for reading and writing, and primitive reflex integration (SNTR specifically) which is important in copying words down from the board.
I find, as a Physical Therapist, it is essential to ensure that my babies are able to progress to this stage without complications as well as educate my mamas on what to look for if there is any gaps in service (due to no current concerns, scheduling conflicts, or budget concerns).
What should I look out for?
Asymmetrical Crawling
Army Crawling
After 4-6 weeks, army crawling should naturally progress to rocking back and forth on all fours. If a child is still army crawling (belly crawling) after 4-6 weeks, there could be some tightness or limitations in the upper or lower trunk or pelvis (or all three).
Army crawling is an example of sagittal plane movement, which is the same as moving the right and left sides of your body. It is an easier movement pattern than the front plane (moving side to side) or the transverse plane (rotating your trunk to the right or left).
Army crawling is a great precursor to hands and knees crawling, but it is not ideal for long term strengthening for hands, shoulders, elbows, hips, or progressing toward academic skills such as reading, writing, or copying down from the board.
Whenever possible, it is ideal to encourage hands and knees crawling with both hands on the ground, extended elbows, and both knees on the ground. If a child is not crawling on hands and knees by 11 months, direct Pediatric Physical Therapy services are recommended.
Hitch Crawl
A hitch crawl is a combination of all fours (hands and knees) but instead of both knees on the ground, one knee is off the ground and the foot is on the ground instead.
This position is more similiar and closer to hands and knees crawling, but is not quite there. What it typically means is that one hip or trunk is tighter, which is resulting in a compensation mechanism. When one foot is on the ground, that same side of the trunk is in a side bend (their shoulder is closer to their hip on that side), which could indicate that side of the trunk is tighter.
Additionally, the side of the foot that is on the ground is pulling both with the arm on that side, as well as the foot on that side. The mechanics of this movement are far different from pushing through the knees into the ground and shifting weight from side to side. It also uses the same side body parts (the arm of the foot on the ground pulls as does the foot on the ground) instead of the right arm and left leg working in conjunction and vice versa for the left arm and right leg.
A hitch crawl is often indicative of a combination of trunk/pelvis tightness and/or core/upper trunk weakness. The hitch crawl as the sole way of crawling is not ideal, and Pediatric Physical Therapy is recommended to enhance progress toward full hands and knees crawling as well as to decrease any future complications due to not having the gross motor experience of contralateral body movements (right hand/left leg), both knees on the ground for hip strengthening (decreases risk of falls or difficulty with stairs), and improved coordination (due to weight shifting instead of one sided pulling common with hitch crawl).
Booty Scooting
If I’m being honest, the booty scoot is my least favorite of the bunch. I will take a stubborn army crawler or a hitch crawl over a booty scoot any day of the week. That being said, if your child’s only form of movement is a booty scoot, don’t be scared — just know that it will likely take longer to transition to all fours crawling than the other asymmetrical crawling types.
The biggest reason that kiddos choose to booty scoot over other forms of crawling is that they do not like to be in tummy time or in supported all fours. If the kiddo hates tummy time and has not been able to learn how to tolerate being on their belly for up to 60 minutes per day, they have a higher risk of learning the booty scoot.A child who did not like rolling from belly to back or back to belly may also progress to booty scooting because rolling requires trunk rotation and moving the upper half of the trunk on a stabilized lower half of the trunk.
Booty scooting is also typical of kiddos with significant trunk rotation limitations in both the upper and lower trunks. Booty scooting is another sagittal plane movement (like walking or moving the right and left sides of your body, which is the easier plane). The difficulty with booty scooting is that you need trunk rotation in order to transition in/out of sitting, from lying on your back to sitting, and in order to have good hip strength.Booty scooting is a pulling motion, where a child uses both hands on the floor to pull their bottom forward. They often like this motion because they can do it fast, they are upright and can see their surroundings, and they simply prefer sitting to all other positions.
Booty scooting is not ideal because it does not allow a child to increase their core strength (being on all fours is a much better core strengthening position), push through the palms of their hand into the ground (strengthening their inner hand muscles for hand writing), coordinate their alternating sides of the body together (which is the same motor plan as reading and writing), and does not all for hip strengthening (which is needed for progression to walking and decreasing difficulty with stairs, running, or jumping).
If a child is showing signs of consistent asymmetrical crawling in hitch crawling or booty scooting and/or has been army crawling for greater than 6 weeks without progression to hands/knees rocking on all fours, please call your Pediatric Physical Therapist for exercises or additional appointments. If your child has not yet seen a Pediatric Physical Therapist, it is ideal to be proactive and call on your child’s behalf in order to obtain optimal movement strategies for your child.
Difficulty with one direction of side sit
Side Sitting is one of the best types of sitting for children 7 months and older. It is a great core-strengthening position, functional to progress to getting from sitting to crawling, and helps improve both trunk rotation and crossing midline while playing.
Sometimes, one hip is tighter than the other or one side of the trunk is tighter or weaker than the other, which can influence which side sit is more comfortable for a child. Ideally, while a child may prefer one direction to use for transfers, a parent will want to make sure the child practices both directions equally during strategic play times (at least 20 minutes/day).
If a child with a history of torticollis, shows significant preference to only one side of side sit and/or they do not tolerate one direction when placed in a side sitting position, that is a sign of hip, pelvic, or trunk tightness that if not resolved with previously taught stretches, would benefit from a consultation from the child’s previous Pediatric Physical Therapist or consultation with a new Peds PT.
For examples of side sitting and modifications, please watch this video.
Pulling to Stand with only one leg
When pulling to stand, a child will lead with one leg in a half kneel “will you marry. me,” pose. At the beginning, this pose will look quite messy and they may need some assistance bringing their knee closer to the surface they are pulling up on. Sometimes, babies will even try to pull themselves up solely by their arms and use the tops of their feet, which is normal at first, but looks quite icky to most of us!
As a baby continues to pull to stand, they should progress to using the half kneeling “will you marry me” pose, with assistance or independently. A child will likely have a preferred side, but a torticollis recurrence warning sign would be if a child only used one leg forward and when prompted (you put the opposite leg forward) they collapse or aren’t able to push through it to stand.
This would be indicative of weakness in the hip, pelvis, or lateral trunk (or all three). A family can choose to practice this position by holding it statically while playing on a higher surface, by going to both knees on the ground in tall kneeling (which strengthens both hips at the same time and is less strenuous on the trunk), or by encouraging the child to pull to stand with the non-preferred leg leading.
If a family notices that progress is slow, or a child refuses to push through the non-preferred limb, or collapses when being placed in the half-kneeling “will you marry me” pose, a Pediatric Physical Therapy consultation or evaluation may be beneficial.
Cruising only to one side
If a child is only cruising to one side after practicing cruising for 4 weeks, then there may be core, pelvic, or hip strength difficulties that are limiting that child. Cruising requires more lateral trunk and hip muscular strength than sitting does, so a child with an asymmetrical crawl or a history of torticollis may be experiencing a recurrence of symptoms that are limiting their progress in this skill.
Core strength to keep a child upright, while then shifting their weight to one hip/side in order to lift the other leg off the ground and then place it, followed by shifting the weight onto that new limb, and then doing it all over again, is actually a fairly complex process! For kiddos who have hip or core tightness, they may try to avoid any unnecessary effort by simply avoiding the difficult side (this isn’t ideal, of course!).
A family who practices cruising to the non-preferred side but is struggling to motivate the child or they just plop to their bottom instead of attempting to cruise to that side, may benefit from a Pediatric Physical Therapy consultation or evaluation.
Increased falls while walking after walking independently for 6 months
Kiddos fall a lot as they learn to walk. Falling in itself is not a bad thing, in fact, families can help their kiddos learn to walk simply by cheering when they fall down instead of showing fear. Kiddos naturally fall to their bottom and get back up and try again often falling over 17 times per hour, which is normal.
After six months, though, a child should be able to walk independently with much less falling. If you feel as though your child is falling more frequently than their peers, it may be due to a core/hip strength or mobility concern that is popping back up. Falling frequently does increase the risk of accidental self-injury but alone is a little bit of a tough area to differentiate between what is any okay number of falls (ages 1-4 years, frequent falls after age four is always a concern) and what is an age appropriate amount when “we’re learning about this gravity thing?”
The rule of thumb I give parents is that if your intuition tells you that your child is falling more than their peers, they likely are and could benefit from Physical Therapy. If your child is both falling more than their peers AND has one or more of the other signs and symptoms of asymmetrical movement or recurrence of torticollis, then you can confidently reach out for additional Physical Therapy support. The biggest one I’d see combined with falling is difficulty ascending/descending stairs. If a child is struggling with two areas, seeing a Pediatric Physical Therapist is recommended.
Difficulty with Climbing or Descending stairs
Stairs are super difficult. Let us first talk about at what ages should children be able to do stairs, because there is a systematic way of progressing to walking up/down stairs on your own.
18-22 months: walk up/down stairs while holding your hand and/or a railing/wall
24 months: walk up/down two steps independently while holding onto a wall/railing (not your hand)
30 months: walk up stairs using one foot on each step (R foot then L foot then R foot, with one foot on each step) with/without holding onto the wall/railing
Typically, if a child has difficulty (weakness or difficulty with balance) with one limb they are going to go up the stairs with the opposite limb with two feet at a time (R is stronger, R goes up the stair then L meets it on the stair, R goes up the next stair). If a child struggles with either balance or strength or both, they may insist on holding a parents hand, which after 24 months of age is not ideal. To help a child progress to independent stair climbing, a parent can support the child at the hips instead of holding their hand, walk behind them as the child goes up the stairs, and walk facing them but below them when going down the stairs.
When descending stairs, if a child has weakness or difficulty with balance, we often see them ask to be carried down the stairs, scoot on their bottom down the stairs, or refuse to walk down the stairs by becoming upset because it is too difficult. Walking down the stairs, children typically lead with the leg that is weakest. For example, if the R leg is strong and the L leg is weak, the child with go up the stairs with the R, but go down the stairs leading with the L (in both directions, the R leg does all the work).
If a child refuses to switch limbs or uses only one limb when prompted by an adult when descending stairs, even when the adult switches sides (uses the railing going down and uses the wall on the opposite side going down), there is likely an imbalance in one limb/side of the trunk, which could benefit from PT.
How can I have my baby or child work with Dr. Lauren?
If you would like Dr. Baker to come to your home to evaluate your baby (2 weeks+) or toddler you can schedule an evaluation online. Evaluations are 60 minutes in person in the Treasure Valley and Boise area. For pricing considerations please visit our pricing page. If your baby/toddler is not in Idaho, you may schedule an online parent consultation, where Dr. Baker, DPT, will answer any questions you may have and/or screen your child if appropriate.
Conservative Management of Plagiocephaly Without A Helmet Using The Baby Begin Method
Plagiocephaly can be conservatively treated with the baby begin method by Dr. Lauren Baker, PT, DPT, ATC, MTC in Milwaukee, WI
Dr. Lauren Baker In Home Pediatric Physical Therapy is excited to announce that Dr. Lauren Baker, DPT, is officially trained in the Baby Begin Method of conservative management of Plagiocephaly. We’re so excited to bring conservative management of plagiocephaly without a helmet to Boise, Idaho and the Treasure Valley.
What is Plagiocephaly?
Plagiocephaly is a medical diagnosis that describes a flattening of the skull of infants. There are three main types of plagiocephaly: plagiocephaly, brachiocephaly, and scaphocephaly.
Plagiocephaly is a flattening on one side of the head in the back, which became more common after the introduction of the back to sleep campaign (which has decreased infant SIDS, thank goodness) but unintentionally has increased skull flattening. Data tells us that 46% of babies will have a deformation of the skull at some point in their infant lives.
Brachiocephaly is a flattening of both sides of the back of the head resulting in an increased width of the skull. Scaphocephaly is least common with a long, narrow head shape.
Plagiocephaly is often associated with a diagnosis of torticollis (head tilting and limitations in neck rotation), the baby is often rotated toward the side that is flattened and limited in the opposite direction.
What is the Baby Begin Method of Treatment for Plagiocephaly?
Baby Begin: The Helmet Alternative is a conservative method of treatment using strategic, safe placement of the head while a baby is sleeping on their back. It involves strategic, proprietary positioning using a velcro swaddle in order to allow the head to rotate to the opposite side. It uses gravity to assist positioning to maintain the pressure of the crib mattress on the fullest part of the skull. This allows for the restructuring of the skull without a helmet.
What ages are able to benefit from the Baby Begin Method?
Babies 2 weeks to 4 months see the quickest results with the Baby Begin repositioning method. Babies from 4 months to 6 months who are not yet rolling independently can also see changes.
What if my baby is older?
Babies older than 6 months who still have flattening of the skull will require a helmet for re-shaping of the head. If your baby is older than 6 months, it is recommended that you bring up your concerns with your pediatrician as well as reach out to either hanger clinics or cranial technologies. Their initial consultations are usually free, which often include imaging of the skull.
Changing in the skull shape is required before the age of two. If your baby is over six months and their head shape has not become fully round or they are now sleeping on their stomach; a helmet is the only option for skull reshaping. The reason the helmet is the only option for head reshaping is that in order to change skull shape you must have an external force.
What if my baby has torticollis?
Torticollis is often associated with a diagnosis of Plagiocephaly. Torticollis is typically demonstrated by a head tilt to one side with a preferred rotation to the opposite side.
Torticollis must be addressed for optimal results from both repositioning conservative plagiocephaly treatment with the Baby Begin Method as well as with utilization of helmet corrective treatment. Torticollis is associated with tightness of the neck muscles, which can put a force through the head/neck often resulting in asymmetrical positioning of the head/neck as well as being associated with facial asymmetries.
The American Physical Therapy Association recommends that healthcare providers and family members screen children for head/neck tilting and preference to one side rotation of the head/neck within 2 days of birth. Physical Therapy evaluation and treatment is recommended for infants 2 weeks and older. Torticollis has optimal results when a child receives Physical Therapy prior to 2 months of age; however, can be treated at any age. Physical Therapy average treatment is 1.5 months at up to 2 months and up to 6+ months after six months of age.
How can I have my baby work with Dr. Lauren?
If you would like Dr. Baker to come to your home to evaluate your baby (2 weeks+) you can schedule an evaluation online. Evaluations are 60 minutes in person in Treasure Valley and Boise, Idaho.
How do we explain this to our Pediatrician?
The best way to explain conservative management of plagiocephaly to your infant’s pediatrician is to ask if they have heard of the Baby Begin Method for conservatively treating plagiocephaly or show them Baby Begin’s website. You can also reach out to Dr. Baker, who would be happy to share the strategic positioning and conservative management she has been trained in directly with your pediatrician.
If your pediatrician would like you to both seek Physical Therapy for your child’s diagnosis of plagiocephaly and/or torticollis as well as have a consultation with either Cranial Technologies or Hanger Clinic; Dr. Baker would absolutely be in agreement with your pediatrician. While the Baby Begin Method of conservatively treating plagiocephaly is an option for babies younger than 6 months who are sleeping on their backs, it is not the only treatment and Dr. Baker is still a fan of helmets for reshaping skulls for babies (especially after 6 months of age).
Can I see Dr. Baker’s official completion certificate?
Of course! Dr. Baker loves wearing her heart on her sleeve and believes that transparency makes your experience with your baby and choosing Physical Therapy easier. She was officially certified with the Baby Begin Method in June of 2021. The online certification includes an online course and multiple exams.
