Torticollis

Congenital muscular torticollis happens when a muscle on the side of a baby’s neck, called the sternocleidomastoid, is shortened or tightened. This may result in a head tilt and/or limited ability to turn the head to one shoulder.

Torticollis is a common diagnosis, occurring in 3.9 to 16% of newborns.

There is a range of causes of torticollis including positioning in utero or trauma to a neck muscle during birth. There are other rare causes of torticollis that can be diagnosed by a specialty provider. For the best outcomes, early diagnosis and treatment are important.

Babies with torticollis may have trouble moving their neck because of muscle tightness, strength and/or length. They also may tilt their head noticeably in one direction, and they might also lean back to view objects. Their chin might point slightly upward.

More than half of babies who have torticollis symptoms also have a flat spot on the affected side of the head (deformational plagiocephaly) caused by lying consistently in one position. Without treatment, torticollis can affect the symmetry of gross motor skills like vision and balance and may cause facial asymmetry. 

Some babies who have torticollis also have developmental dysplasia of the hip (DDH) or brachial plexus injury. Like torticollis, DDH and brachial plexus injury can develop due to birth trauma or the baby’s position in the uterus. These associated conditions can get missed in routine exams.

Torticollis in babies usually becomes noticeable at birth or shortly after. If you or your pediatrician notice neck tightness, head tilt or preference to turn the head one way, schedule an evaluation with a specialist as soon as possible. Early intervention is recommended. The Gillette Children’s craniofacial team evaluates infants suspected to have torticollis.

If your child has torticollis, we begin torticollis treatment with physical therapy to stretch and strengthen the muscles of the neck. Physical therapy is most successful when it begins early in life.

Regular physical therapy exercises help babies move the affected side of their neck, creating balance. In most cases, torticollis in children can improve with a few weeks or months of therapy, when combined with daily exercises at home. The condition rarely returns as a baby grows.

Additional Treatment Options

If your child doesn’t respond to therapy after several months, or if improvement slows too much, additional assessments may be recommended, such as cervical spine films (X-rays) and an eye (ophthalmologic) exam.

These tests help rule out a cervical spine condition or an eye-related cause for torticollis. If other methods of treatment aren’t working, we might discuss surgery to lengthen the neck muscle.

Torticollis and Flat Head Syndrome (Deformational Plagiocephaly)

If your child has torticollis, you might notice an impact on the shape of the head. In this case, we offer the Gillette CranioCap® orthosis to gradually reshape your baby’s skull, rounding the head over a period of three to four months. Our Orthotics, Prosthetics and Seating staff works closely with our craniofacial team to custom-fit the orthosis and make adjustments as your child grows.

Limiting the time your child spends in equipment such as bouncy chairs and car seats as well as encouraging a variety of positions can help decrease the amount of flattening (plagiocephaly) that results from torticollis. Because deformational plagiocephaly has no known long-term medical effects, the decision to fit your child with a CranioCap® orthosis is up to you and your family.

If your child has torticollis, early diagnosis and treatment increase the chances for successful correction. Our multidisciplinary team of craniofacial experts, rehabilitation therapists and orthotists will work with you to create a treatment plan customized to your child’s unique needs.

Your child might receive treatment from specialists in the following areas:  

• Craniofacial and plastic surgery.
• Physical therapy.
• Child life.
• Social work.

Throughout your child’s treatment, our team of experts is here to offer support, answer your questions about torticollis causes and provide family-centered care.