Purpose: To investigate potential risk factors associated with torticollis in infants diagnosed less than 24 months of age. The potential risk factors included: 1) infant positional preferences, 2) sleep position factors, 3) infant factors, 4) obstetrical and birt factors, 5) family factors, and 6) torticollis diagnostic factors. Methods: Case control design with a convenience sample of 100 children diagnosed with torticollis and 200 controls without a diagnosis of torticollis. Data collected included chart review of case subects and caregiver interview of both case and control groups. Results: Infants with torticollis were significantly more likely to have a diagnosis of reflux, delayed development, and/or a congenital anomaly than infants in the non-torticollis control group. Infants with torticollis demonstrated positiional perference during the first few months, aversion to prone, and a preference for feeding to one side. Eighty seven percent of both infants with torticollis and non-torticollis slept in supine. Infants with torticollis were significantly more likely to have spent greater than 30 minutes per day in supine and sitting devices and have spent less than 15 min per day in prone than infants without torticollis. Parents of infants with torticollis were significantly more likely than parents of infants without torticollis to have reported they did not receive instructions from their physicians to place their infant in prone during non-sleep time. Cranial and fascial asymmetries were significantly higher among infants with torticollis compared to infants without torticollis. Conclusions: This study revealed a combination of obstetric and infant positioning factors that were significantly associated with the diagnosis of torticollis. When considering a 24-hour period, infants with torticollis were significantly were more likely than mothers of infants without torticollis to have reported pain during the last few week of their pregnancy. The findings of this study warrant that more research is needed to discern the amount of time infants spend in non-prone positions and risk of torticollis.
