What is Torticollis in Infants?

Amy Yacoub, MS, CCC-SLP

Amy is a licensed Speech-Language Pathologist and a consultant within the field. She has been practicing for over 10 years. She has a Bachelor’s degree in Child Development and a Master’s degree in Speech Pathology from Columbia University.

May 6, 2023

Parents of newborns are likely to keep a close watch on their baby’s physical development, particularly during those first few months.

Some parents may notice that their baby’s head tilts more towards one side or that he or she prefers to look more to a certain side. This can be a sign of a condition called Torticollis.

Torticollis is fairly common and is estimated to affect about 1 in 300 babies. Parents can breathe a sigh of relief knowing that symptoms of Torticollis aren’t typically permanent.

With the appropriate treatment and exercises, infants with Torticollis can improve their physical development. First, parents should be familiar with some important details.

Let’s start by defining the condition.

Torticollis comes from the Latin words tortus (“twisted”) and column (“neck”). The condition is sometimes called wryneck. It happens when a shortened, tight neck muscle causes a baby’s head to be tilted downward and toward one side.

If you’ve ever had a “stiff neck”, think of the position your head and neck were in. That’s very similar to how Torticollis can appear.

Here’s a deeper look at the causes, signs and symptoms of Torticollis. We’ll also get into when and how it’s diagnosed, and what parents can do to help treat the condition.

What causes Torticollis?

First, it’s important to know that there are actually 2 types of Torticollis; congenital and acquired.

Congenital torticollis is present at birth. Acquired torticollis occurs later in childhood, and causes can range from a mild viral infection to an abnormality in the spine.

The most common form is Congenital Torticollis, which we’ll focus on.

Congenital Torticollis (also known as Congenital Muscular Torticollis or Infant Torticollis) occurs when the sternocleidomastoid muscle (SCM) is shortened and contracted on one side. This muscle connects the baby’s head and neck to their breastbone.

What makes this muscle shorten and contract?

Here are some possible causes:

The infant’s position in the womb (i.e., breech or the baby was cramped)
Use of forceps or vacuum during delivery
Fibrosis (atypical thickening of the infant’s muscle tissue)
Hematoma (collection of blood) in the baby’s neck muscles
The SCM developed abnormally

In some cases, the cause of a baby having Torticollis is unknown.

Congenital Torticollis is present at birth, but parents might not notice it until their baby is a few weeks old. That’s when infants typically start gaining more head control.

Signs & Symptoms

Parents should be aware of the signs of Congenital Torticollis so they can seek the appropriate treatment and follow up early on if they have concerns.

Possible signs of torticollis in infants include:

Head tilting to one side with chin tilting to the other.
Stiffened neck muscle.
Neck muscle appears swollen.
Reduced head and neck movement.
One shoulder appears higher than the other.
Facial features that appear uneven.
A small lump or “knot” in the neck muscle.

Torticollis can lead to several other issues. Here are some of the possible consequences that might result from the condition, according to research:

Changes in the shape of the head (ex: deformational plagiocephaly); flat head on one or both sides
Facial scoliosis
Infantile scoliosis
Hip problems
Unilateral breastfeeding difficulties (difficulty nursing on a certain side)
Asymmetrical use of hands
Other functional problems

Developmental delays and a domino effect of delayed motor milestones can occur as a result of congenital Torticollis.

Because babies with the condition have trouble maintaining midline, they typically spend less time in the prone position or participating in tummy time. That can lead to flat spots on the baby’s head.

Tummy time is important for strengthening the neck and shoulder muscles. These muscles help the baby to be able to sit up, crawl, and eventually walk. Tummy time also helps develop motor skills. By reducing tummy time, Torticollis can lead to delays in all of these areas.

Diagnosis

If you notice any of the above signs or symptoms of Congenital Torticollis in your baby, you should start by talking to your child’s pediatrician.

The doctor can do an assessment that includes looking at how far your baby turns his or her head and examining the baby’s SCM (sternocleidomastoid muscle).

He or she might order additional tests to check for other issues, like hip problems or other medical disorders. Medical problems, however, can be rare for most babies with Torticollis.

Treatment for Torticollis

Your child’s Pediatrician might recommend making an appointment for your baby to see a Physical Therapist if he or she is showing signs of Torticollis.

According to research, early intervention for infants with torticollis can lead to better outcomes. So to improve your child’s motor skills and keep development on track, it’s best to seek treatment early.

A Physical Therapist can start with an evaluation. Following this, the therapist will likely discuss some exercises to do with your baby at home to treat his or her Torticollis. These might include:

Encouraging your infant to turn his or her head to the other/”non-preferred” side by using fun toys and motivating sounds.
Specific stretching exercises that loosen the tighter side of the neck and strengthen the SCM muscle on the weaker side of the neck.
Discussing different positions for bottle feeding or breastfeeding to encourage your baby to use both sides of his or her head and neck more evenly.
Laying your baby on their back and with their head turned to the opposite side (weaker/non-preferred side) in their crib when sleeping.

The Physical Therapist might recommend that your baby receive weekly or monthly therapy to improve symptoms of their Torticollis. These sessions typically include demonstrating and teaching you the different stretching exercises and strategies to use at home.

Additional Resources

Torticollis is a common congenital condition that affects a baby’s physical and motor development, as well as that of other functional skills.

With Physical Therapy, home exercises, and a few modifications, a baby’s Torticollis can improve.

If you have concerns about your child’s speech and language, fine motor, or gross motor skills, he or she may benefit from specialized services from a Speech-Language Pathologist, Occupational Therapist, or Physical Therapist. An initial evaluation can help determine what difficulties your child is having. Ongoing individualized therapy can include techniques and activities to help improve these areas.

TherapyWorks offers Speech Therapy, Occupational and Physical Therapy both in person (in Illinois, Michigan, and Ohio) and through teletherapy (nationwide). If you would like to learn more, or discuss your child’s specific needs, please don’t hesitate to reach out to TherapyWorks!