4 Ways To Screen Your Baby For A Side Preference

Torticollis, a condition which results from tightness in the neck causing the head to rotate and/or tilt to one direction, now affects anywhere from 3.9% to 16% of newborns.   There is growing research that babies should be treated as soon as a side preference is noted, but unfortunately, screening for these asymmetries is inconsistent and often results in delays in referral to a pediatric therapist.

In this blog post, I will provide you with information on how to screen your child for any signs of a developing side preference and what to do.

What Is A Side Preference And Why Does It Matter?

A side preference is when your baby shows a strong desire to consistently use one side of their body over the other. It can be an indication that they have Torticollis. If left untreated, this can result in developing one side of the body more than the other and/or tightness/weakness through different portions of the arms, trunk and legs. Ultimately, children should not be developing a strong side until closer to 3-5 years of age, If you're seeing a preference, they're not developing the necessary symmetrical foundational strength that will help for later, higher functioning skills.

The American Physical Therapy Association strongly recommends that expectant or new parents/caregivers should be educated on signs of side preference in the first 2 or days of life to prevent further complications. As shown in the chart below, research supports starting treatment early in order to improve outcomes and decrease length of care.

High Risk Characteristics of Side Preference That May Be Present At Birth:

Babies go through a lot prior to even entering this world. Their entire body develops in an enclosed, tight space and then they experience what must be one of the most exhausting and sometimes traumatizing experience: labor. These experiences ultimately make certain children at a higher risk for torticollis right from the start. These include, but are not limited to:

• Birth Trauma: Infants who go through a traumatic birth are more likely to harm their musculoskeletal system in some manner resulting in a side preference.

• First Born Child: first born infants may be impacted by less space in the uterus and birth canal than subsequent children

• Body Length of >51.3 +/- 1.49 cm/Multilples: longer infants and multiples may be more cramped in the uterus resulting less movement and asymmetrical positioning while muscles develop.

• A Mass in the Sternocleidomastoid Muscle of the Neck: the sternocleidomastoid muscle in the neck is one of the main muscles impacted by torticollis. A small mass within this muscle commonly indicates some form of injury to the muscle making it not function properly.

• Decreased Neck Motion (particularly to one side): if an infant is immediately unable to move their neck fully, they are already showing signs of a preference.

• Asymmetries in the Facial Features/Flatness of the Head: infants with craniofacial asymmetries have as much as a 22-fold increase in torticollis symptoms. If the face and head have not developed symmetrically there is a high likelihood that the neck muscles have also not developed symmetrically.

If your infant is positive for these high risk signs, they should be referred to their pediatrician or a pediatric therapist.

If you're starting to feel a little like:

hold on for one more second. This last section should bring it all together and give you the necessary tools to be the proactive advocate that you're hoping to be for your child.

Signs Of A Side Preference That Develop Later On:

While the previous high risk characteristics are good to know, many babies who develop a side preference do so after birth. The exact age varies, although a side preference is most common within the first 3-4 months of life when an infant has not developed full head and neck control.

This fourth trimester is already overwhelming. You have a small human that you're trying to keep alive and a whole new life full of additional information, sleep deprivation, and constant changes.

It's hard to remember anything during this time, so if you can retain one thing, remember PATH.

This acronym will provide you with the four most important signs that your baby is developing a side preference. These include:

1. POSITIONING: if you notice your baby having a consistent head tilt or turn toward one direction, a curve of their whole trunk to one side and tightness through their body (shrugged shoulders, fisted hands and/or red crease marks in their necks) it is a high likelihood they have developed a side preference. One trick is to take a look at pictures. These will give you a good idea about how your baby positions their head at different times, in various environments, and over time how their positioning worsens or improves.

   
   

2. ASYMMETRIES: a preference to eat or be held on one side, only look one way, use one hand more than the other and/or rolling only one direction all are signs that your baby is developing a side preference.

   
   

3. TUMMY TIME CHALLENGES: inability to lift or turn their head is associated with tightness through the neck that may make an infant more inclined to have a side preference.

   
   

4. HEAD/FACE SHAPE CHANGES: if a baby is more inclined to look one way, they will also be more likely to have pressure placed through one side of the skull. This can result in flatness along one side of the head (view from above), a shift forward of one ear compared to the other (view from above) and one cheek or eye appearing smaller than the other.

If you notice any of the changes within the PATH acronym in your baby, please DO NOT WAIT AND SEE, speak to your pediatrician and reach out to a local pediatric therapist for an individualized therapy program today!

I hope you found this information helpful to keep a proactive eye on signs of side preferences in your baby!  For more information on torticollis feel free to reach out to Small Strides Physical Therapy, a pediatric Physical Therapy company specializing in early development, torticollis/side preferences and plagiocephaly/flat head.  Small Strides offers in person mobile treatment for Newburyport, MA and surrounding towns, and clinic appointments in Hamilton, MA.

Data taken from The 2024 APTA Torticollis Clinical Practice Guidelines

Sargent, Barbara PT, PhD, PCS; Coulter, Colleen PT, DPT, PhD, PCS; Cannoy, Jill PT, DPT, PCS; Kaplan, Sandra L. PT, DPT, PhD, FAPTA. Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatric Physical Therapy 36(4):p 370-421, October 2024. | DOI: 10.1097/PEP.0000000000001114