My baby is making my boobs lopsided!

"My baby is making my boobs lopsided" said one of my Mother's group Mummies. Could Torticollis (a twisted stiff neck) be the reason why?

Our boobs change a lot during pregnancy and when breastfeeding. Now I actually have some stretch marks to match the overnight enormity of them. Like we often have one foot slightly bigger than the other or one leg longer than the other (very common) we often have one breast bigger than the other. But this is not what she was talking about. Her baby had a breast she preferred to drink from and through increased demand to that side, that breast became bigger and the other less popular breast became smaller.

About 1 in 200 babies have congenital (present at birth) torticollis (Nilesh and Mukherji, 2013). Torticollis is a ‘twisted neck’ caused by a tightness in the sternocleidomastoid muscle (a neck muscle) which causes the neck and head to be rotated or tilted to one side and looking up. Neck movement is restricted to the other side. The tight shortened muscle is on the opposite side to where they are looking. The muscle feels tight and raised.

Torticollis can cause the baby muscle tightness and pain and can lead to plagiocephaly (a flattening of the skull) due to the head being held in one position too long on the mattress/ floor. See our blog for more information on Plagiocephaly. It can also make it hard for your baby to turn their head to breastfeed so they could end up with a lot of painful wind with poor attachment and you could end up with sore cracked nipples or mastitis (see our blog on Mastitis). So because of these repercussions, it is important that it is treated promptly.

“torticollis... can lead to plagiocephaly (flattening of the skull)...”

The cause is unknown but thought to be caused by the baby’s head and neck being held for prolonged periods of time in a twisted position in the uterus, difficult deliveries, injuries to the blood vessels of the muscles or infection. If muscles are injured, as the muscle heals the scar tissue develops which tightens the muscle into a shortened position. A baby can also develop muscle shortening if they turn their head to the same side all the time. This is acquired torticollis but the management is the same. Sometimes but rarely joint stiffness in the neck can lead to the muscle tightness.

What can you do? Torticollis is easily treated in a few sessions by a physiotherapist. Recovery is quicker and less physio is required if the problem is picked up as early as possible. If you note your baby’s head is tilted or not moving freely get in touch with your physio. It can be hard to detect with an untrained eye so get it checked out if you are unsure.

No x-rays or other scans are generally required to confirm diagnosis. Limited range of movement and palpation assessment is sufficient.

“About 20% of babies with torticollis also have hip dysplasia and club foot...”

Treatment is gentle application of stretches and positional advice for carrying, playing, breastfeeding and sleeping to encourage your baby to look to the restricted side. Some physiotherapists are trained to apply the most gentle techniques to massage or mobilise stiff muscles or joints. The techniques are literally as firm as light touch because a baby is so malleable, so your baby will feel no pain or discomfort with treatment. I usually see recovery in 1-2 sessions with the manual therapy techniques.

Other references talk about improvements in 2-3 months and full neck movement within 12 months from stretches and positioning alone. If the condition does not improve by the time they are one, surgical correction may be considered.

If torticollis is not treated the muscle can become permanently tight and as mentioned before plagiocephally (flattened skull) and an asymmetrical face can result if the head is always tilted to one side.

Another important fact is that about 20% of babies with congenital torticollis also have hip dysplasia and club foot (or the milder metatarsus adductus) so this needs to be assessed by a Paediatric Physiotherapist or Paediatrician.

My baby, Misaki, had all four; Torticollis, Plagiocephaly, Hip Dysplasia and Metatarsus adductus! I treated the torticollis in one session in the first few days of her birth with gentle pressure on her tight neck muscles and this restored full range of movement. We went to a Paediatric Physiotherapist to treat the hip dysplasia and metatarsus adductus and the plagiocephaly resolved with management techniques above.

Please see our blogs on Hip Dysplasia and Metatarsus adductus for more details of these conditions.

Summary

1 in 200 babies have congenital torticollis.

It can lead to breastfeeding issues such as gas and torn and infected nipples.

Torticollis can be easily treated by physiotherapists with special training like our therapists.

Melli Tilbrook is a Physiotherapist based at Adelaide Physiotherapy and Pilates Studio, Beulah Park.