Motor and cognitive development at one-year follow-up in infants with torticollis

Background: Clinical experience suggests infants with torticollis are at risk for developmental delay. Aims: To examine gross motor (GM) skills at presentation in infants with torticollis; report first-year GM and cognitive outcomes; examine relationship between types of torticollis and above outcomes. Study design: Prospective follow-up study. Subjects: Infants referred to 2 regional child development centers from April 2001-December 2002 with torticollis/head tilt and no perinatal complications syndromes were studied. Outcome measures: GM function was measured using the Alberta Infant Motor Scale and classified as normal (> 10%), suspect (5-10% inclusive), or abnormal (< 5%). Cognitive function was measured at follow-up using CAT-CLAMS-r Developmental Assessment. Follow-up data obtained between 8 and 15 months of age. Results: One hundred and one infants with torticollis were seen for initial assessment at mean age 2.9 (SD 1.5) months. Eighteen had sternomastoid tumor, 47 muscular torticollis and 36 postural torticollis. At presentation, 35 (35%) of the 101 infants had suspect or abnormal GM function. 19/66 children with normal GM and 17/35 with suspect or abnormal GM function had postural torticollis (p = 0.054). All children received physical theraphy. Follow-up assessment of 83 participants, mean age 12.8 (SD 3.6) months, showed 75 had normal GM function and 8 had suspect or abnormal GM function; 11/83 still had torticollis. Cognitive assessment on 66 infants, mean age 14.4 (SD 4.8) months, revealed 57 (87%) had normal cognitive function and 9 (13%) were either delayed or significantly delayed. Conclusions: Infants with torticollis are at increased risk for early GM delay but most normalize by one year. Torticollis is not associated with delays in early cognitive function.