Children can benefit from early physical therapy to treat a variety of conditions including infant torticollis, developmental delay, and idiopathic toe walking.
Infant Torticollis
Torticollis, or head tilting or turning, is the result of tight muscles in the neck. Babies may show signs of torticollis at age 2 weeks to 3 months,1 and it is during this time that early physical therapy is most effective. Yet the early signs of infant torticollis are often subtle and may be missed. The child may resist lying face down (“tummy time”), have difficulty rotating their neck, and prefer certain positions for gazing and interacting. As the condition progresses, the distinctive torticollis posture develops with restricted range of motion in the neck, neck weakness, and altered ways of moving. This alteration in movement is associated with reduced strength overall, and developmental delays in rolling, reaching, independent sitting, and crawling. Additional problems that develop with prolonged torticollis include the development of flat spots on the head (plagiocephaly) and changes in facial structure due to changes in the bones from prolonged neck postures, which requires further corrective treatment.1
However, if infant torticollis is recognized early, it can be successfully treated. Early physical therapy treatment for torticollis includes educating the child’s family on posturing and holding techniques, gentle neck range of motion and stretches, and gross motor strengthening. Early treatment with physical therapy is important to for correcting the infant’s posture, preventing further complications, and addressing gross motor developmental delay.
Developmental Delay
Early physical therapy is important to reverse or reduce the progression of developmental delays. In addition to infants with torticollis, children who have had had other medical conditions, birth trauma, or premature delivery are also at risk for developmental delay.2 Early physical therapy treatment for developmental delay focuses on helping the child meet motor milestones. This includes educating the child’s family on functional strengthening, positioning, and supported mobility through play. As they continue to grow and develop, children with developmental delays may need assistance to make progress with more challenging mobility needs, including walking and negotiating stairs. Early physical therapy can help address these concerns.
Idiopathic Toe Walking
Although many children may occasionally walk on their toes as they are learning to walk, if the child does so frequently and for prolonged durations, especially beyond three years of age, the condition is called idiopathic toe walking and the child may benefit from physical therapy treatment.3 Physical therapy treatment for toe walking includes stretching, strengthening, and improving balancing ability. If left untreated, toe walking can lead to shortening of the Achilles tendon, altered walking and posture, pain, and reduced ability to walk, run, and jump. These impairments can persist well into childhood and even as an adult. Chronic toe walking treatment in later childhood includes casting and surgery, but such treatment can be avoided with early physical therapy.
Overall, the benefits of early physical therapy treatment are significant. Early physical therapy is an opportunity to help children and their families correct progressive impairments, prevent further complications, and improve function. Physical therapy is an important part of treatment for children with impairments and disabilities, and early treatment is essential to provide the most effective care and achieve the most successful outcomes.
References
1. Karmel-Ross K. Chapter 12: Congenital muscular torticollis. In: Campbell SK, Vander Linden DW, Palisano RJ. Physical therapy for children. 3rd ed. St Louis, MO: Saunders Elsevier; 2006: 359-380.
2. Kahn-D’ Angel L, Unanue Rose R. Chapter 35: The special care nursery. In: Campbell SK, Vander Linder DW, Palisano RJ. Physical therapy for children. 3rd ed. St Louis, MO: Saunders Elsevier; 2006: 1053-1090.
3. Leach J. Chapter 17: Orthopedic conditions. In: Campbell SK, Vander Linden DW, Palisano RJ. Physical therapy for children. 3rd ed. St Louis, MO: Saunders Elsevier; 2006: 481-515.