Torticollis

What Is Torticollis?

Torticollis is the medical term used to describe a tilting or twisted posture of the head and neck. In babies with torticollis, there is often a strong preference to look or turn the head in one direction. This position may be a result of muscular, skeletal, neurological, or visual conditions, however, the vast majority of cases are muscular, caused by a stiff neck muscle. Torticollis may be congenital (present at birth) or acquired (develops later on).

Congenital Muscular Torticollis (torticollis) is by far the most common type of torticollis in babies. It can be noted at birth or in early infancy. It is usually first identified when the baby has a persistent head tilt or turn toward one side. This is caused by a shortening of the sternocleidomastoid (SCM) muscle on one side of the neck. About 50% of infants with torticollis have a fibrous “knot" within the SCM muscle that can be felt. This “knot" feels like a pea, is harmless, and usually gets smaller over time. Gentle massage of the neck is helpful to address this.

Does My Baby Have Torticollis?

Talk with your pediatrician, physical therapist, or other health care provider if you notice the following:

  • Your baby has a strong preference of looking in one direction more so than the other.
  • Your baby always tilts her head to one side. One ear may appear closer to her shoulder than the other side.
  • Your baby has a flat spot on the back or one side of his head or a misshapen head (deformational plagiocephaly).

What Causes Torticollis?

The exact cause of torticollis is unknown. Current research theories include positioning in the womb and/or injury to one of the neck muscles (SCM) in the womb or during early infancy. How common is torticollis? Torticollis is one of the most common muscle issues seen in infants. Recent research has reported an incidence rate as high as 16% (1 out of every 6 babies born).

How Is Torticollis Diagnosed?

Torticollis is usually diagnosed by a health care provider or physical therapist based on clinical presentation of head/neck position and physical exam. Rarely, other diagnostic tests such as ultrasound or X-rays are used.

How Is Torticollis Treated?

Torticollis is treated with physical therapy (PT). PT treatment includes gentle stretches, range of motion exercises, strengthening, repositioning, gentle massage and developing strong, symmetrical gross motor skills. Treating torticollis with PT has an excellent success rate, ranging between 90-99%.

Why Does My Child Need PT?

Torticollis causes a lack of flexibility of the neck muscles, which creates an imbalance of strength and flexibility throughout the body, not just the neck. This can cause babies to perform their motor skills asymmetrically (not equal side to side), such as using one hand or leg more than other. Infants are not yet right- or left-handed and should use both sides of the body equally. If not treated, torticollis can be associated with a delay in achieving gross motor milestones, such as rolling, sitting, crawling, pulling to stand, and walking. PT works with your baby to improve all of this. Torticollis does not impact your baby's intelligence. The PT evaluation will include taking your baby's history, examining the flexibility and strength of the neck, arms, legs and trunk, and assessing your baby's gross motor skills. During the evaluation, the therapist will also teach you about torticollis, answer your questions, and teach you daily exercises to complete with your baby.

What Is a Home Exercise Program?

Exercises for torticollis include daily stretches, strengthening exercises, gentle massage, repositioning, and developmental play activities. Increasing regular supervised tummy time is also extremely important for strengthening the baby's neck, shoulders, and back. Tummy time should begin within the first few days of life. This helps your baby become strong and ready to roll, sit and crawl. Research* has shown that by 4 months of age, a baby should receive at least 80 minutes of tummy time added up throughout the day. Tummy time can be achieved in many ways, not just on the floor.

Please see our UPMC Children's Hospital of Pittsburgh Tummy Time brochure for more detailed information and ideas for tummy time.

Will the Exercises Hurt My Child?

Although your baby may fuss during the exercises, they will not harm your baby. Your trained physical therapist will teach you gentle neck stretches and massage for your baby and practice them with you to be sure you are performing them correctly and safely. The PT will teach you how to monitor your baby for any signs of discomfort or distress.

What is Repositioning and Why Is It Important?

Repositioning is an important part of treating torticollis. Many babies with torticollis also have deformational plagiocephaly (misshapen head) due to the strong preference for keeping the head turned or tilted to one side. Repositioning your baby and increasing tummy time helps to reduce pressure on the back of the head, prevent flattening and improves existing flat spots. It also helps your baby keep her head and neck in a midline position.

How Long Will My Baby Need PT?

The duration and frequency of PT will depend on the individual baby. The earlier a baby begins PT for torticollis, the better. Factors that can affect PT duration are severity of the torticollis, developmental progress, and whether the family is completing daily exercises and repositioning. A baby is typically followed by PT until around 12 months of age or until the child is walking independently to be sure the strength, flexibility, and motor skills are equal on both side. How often a baby receives PT typically decreases as the baby gets older. Talk with your PT about how long and how often your baby will need PT.

Does My Baby Need to Wear a Helmet for a Misshapen Head?

If you are concerned about your child's head shape, despite your efforts at repositioning, talk to your health care provider to initiate further evaluation to determine if helmet therapy is necessary. Helmet therapy is most effective if begun by 6 months of age.

Where Can I Get More Information?

  • UPMC Children's Department of Physical Therapy 412-692-5480
  • UPMC Children's Division of Plastic Surgery, Cleft-Craniofacial Center, Deformational Plagiocephaly and Torticollis Clinic 412-692-7964
  • UPMC Children's Tummy Time Brochure
  • UPMC Children's Deformational Plagiocephaly Brochure
  • American Physical Therapy Association
  • American Academy of Pediatrics