As concerned parents with young children, we watch our babies’ growth and development very closely and often find ourselves wondering which changes are normal and which require our attention. In this post, we discuss torticollis–a twisted neck position–and what you should do to identify and resolve it.

What is torticollis?

Torticollis, also called twisted neck or wryneck, is a muscular and postural condition in which the neck muscles are shortened, causing the head to tilt or rotate to one side. Additional symptoms include swollen or stiff neck muscles. Torticollis can be congenital (present at birth) or acquired later in life due to an injury.

How do I identify torticollis in my baby?

If your baby’s neck looks like it rotates at an odd or unnatural angle, he or she may have torticollis. You may notice your infant’s head tilted to one side at a diagonal angle, with the chin pointing the opposite direction.

What is the difference between congenital and acquired torticollis in babies?

Congenital torticollis is the most common type of this condition, and it typically appears when babies are a few weeks old and begin gaining control of their head and neck movements. It may occur as a result of a breech birth or due to the baby’s position in the womb. Babies with congenital torticollis may also display asymmetrical facial features. Luckily, torticollis is not painful at this early life stage.

Acquired torticollis in infants is usually detected between ages four and six months, though it can also appear later. It can be benign or can indicate a more serious health issue. Acquired torticollis can appear gradually or rapidly, and facial asymmetry is typically not an issue.

Both congenital and acquired torticollis can cause the following symptoms:

• head constantly tilted on a diagonal, with the chin tilted in the opposite direction

• unbalanced shoulders

• asymmetrical facial features (most common with congenital torticollis)

• neck muscle tightness

• neck muscle stiffness

• fibrosis/scar tissue, which presents as a lump on the neck muscle

• preference for one hand over the other when reaching

• limited head and neck mobility

• difficulty feeding in some positions

Additionally, acquired torticollis can cause:

• headaches

• swollen neck muscles

• severe neck pain

• head tremors

• limited head movement

• limited neck movement

How is torticollis diagnosed?

If you suspect that your infant has torticollis, make an appointment with your pediatrician. The doctor will observe the severity of your baby’s head and neck tilt, examine the neck, and check for stiff or swollen muscles. There is a chance that the pediatrician will order an x-ray, ultrasound, CT scan, or MRI.

How is torticollis treated?

Treatment for congenital torticollis will likely begin with a gentle stretching regimen to help you move your baby’s head to the other side. These movements are performed throughout the day.

Having your baby sleep (always on his or her back!) with the head positioned on the opposite/less favored  side will also help alleviate torticollis, as will placing toys on the weaker side during play time–this gives your baby an opportunity to practice turning in the opposite direction.

Practicing tummy time while your baby is awake is a great way to strengthen the neck muscles, shoulder muscles, and prepare to push up onto all fours and crawl. This strengthening exercise will also help your baby overcome torticollis.

Your pediatrician may also recommend physical therapy to treat your baby’s torticollis. In rare instances, surgery is an option for severe torticollis cases.

What can torticollis be mistaken for?

Torticollis can sometimes be mistaken for other illnesses which involve muscle stiffness. As a result, torticollis and cerebral palsy can sometimes be mistaken for each other. 

Some children with low muscle tone or muscle weakness due to prematurity, Down Syndrome or other conditions may have difficulty holding their heads up and their heads may flop or tilt. Although this condition is not torticollis, these children should also be evaluated and may benefit from physical therapy.

Some children who have vision problems may tilt their head to see better creating what is known as ocular torticollis where the issue stems from the child attempting to compensate for visual difficulties rather than a muscle imbalance. A visual screening by the child’s pediatrician or an ophthalmological evaluation may be indicated to rule out a vison issue.

How long does torticollis last?

Most infants with torticollis develop a normal range of motion within a month and a half of physical therapy treatment, if treatment starts within a few weeks of the condition becoming evident.

What causes torticollis?

Congenital torticollis can be caused by in-utero positioning or a breech birth.

The reasons for acquired torticollis can be a bit more complicated. Causes can include:

• neck muscle injury

• extensive scarring to skin on the neck

• infections: viral or bacterial

• neck muscle spasms

• awkward sleeping positions

 Why Does Early Treatment Matter?

Torticollis is much easier to treat during infancy. Without early treatment, a child may develop lasting neck tightness, head and neck facial asymmetry, posture and balance problems and is some cases, difficulties with eye-hand coordination and visual-motor skills that will impact their performance when they enter school. Early intervention helps promote normal movement, vision, and overall development while reducing the need for more intensive treatment later and preventing acquired learning difficulties.

To learn more about our torticollis PT offerings, please contact us.