Torticollis, a condition in which the neck muscles become so tight that an infant’s head has difficulty moving, can occur shortly after birth or months later. Torticollis is classified as either congenital (present at birth) or acquired (occurring later in infancy or childhood). The most common type is congenital muscular torticollis. Caregivers should be aware of the signs of torticollis and speak to their primary care provider as soon as they notice them to ensure timely and effective evaluation and intervention for torticollis. Torticollis can have consequences later on in an infant/ child’s development if left untreated. Parents should be aware of the signs of torticollis and speak to their primary care provider as soon as they notice them to ensure timely and effective evaluation and intervention for torticollis.
Signs and symptoms of Torticollis that you may notice:
- Your baby’s head tilts to one side and rotates to the opposite side
- Your baby has limited movement of their head and neck (i.e. trouble turning their head equally in both directions)
- Neck muscle tightness and stiffness
- Because torticollis and plagiocephaly often occur together, an early head shape evaluation can help determine whether your baby may benefit from repositioning, physical therapy, or additional treatment.
- Musculoskeletal problems, such as hip dysplasia, are sometimes present
Torticollis in Infants: What is it?
Infant torticollis, also known as wryneck, is a condition that affects the neck muscles in infants.Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Acquired torticollis develops later on after birth and its causes vary widely and range in severity from benign (not serious) to very serious. Some causes of acquired torticollis include:
- a mild (usually viral) infection
- minor trauma to the head and neck
- gastroesophageal reflux (GERD)
- respiratory and soft-tissue infections of the neck
- abnormalities in the cervical spine (such as atlantoaxial subluxation)
- vision problems (called ocular torticollis)
In this article, we’ll discuss the symptoms of infant torticollis, its causes, and effective treatment options.
Symptoms of Torticollis in Infants?
The most common symptom of torticollis in infants is typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side.
Limited neck movement can also contribute to flattening on one side of the skull. Early plagiocephaly evaluation helps identify these changes before they become more pronounced.
Causes Torticollis in Infants?
Torticollis can be congenital (present at birth) or acquired (developing after birth). Congenital torticollis is caused by a shortening of one of the sternocleidomastoid muscles found in the neck which results from abnormal tissue formation during fetal development. Babies with persistent torticollis are also at increased risk of developing positional plagiocephaly, making early plagiocephaly treatment important when head shape changes are present.
Torticollis Infant Treatment in New Jersey
Caregivers in New Jersey who have a child diagnosed with torticollis can take comfort in knowing there are treatments available to improve the condition. Consult with your child’s primary care physician to help find a pediatric physical therapist that specializes in infants. Physical therapy management of CMT is comprehensive, going beyond just stretching tight neck muscles. A comprehensive plan of care addresses the following 5 components as the first-choice intervention: neck PROM, neck and trunk active range of motion (AROM), development of symmetrical movement, environmental adaptations, and parent/caregiver education. If physical therapy alone does not improve associated skull flattening, specialists may recommend treatment for flat head syndrome based on your baby’s age and head growth.
Best Torticollis Exercises for Infants
Infants with torticollis need to do exercises that can help reduce their neck stiffness, improve range of motion, and strengthen the muscles in the neck. While physical therapy is usually recommended, there are some gentle exercises you can do at home with your baby. Here are a few best torticollis exercises for infants:
- Tummy time: Placing your infant on their stomach for short periods of time each day can help to strengthen the neck muscles and improve head control.
- Gentle stretches: A licensed pediatric physical therapist will show the caregiver strategies to gently stretch the affected side of the neck both actively and passively to help improve range of motion of the neck.
- Repositioning: Moving your infant’s head to different positions while they are lying down or being held can help to encourage them to use their neck muscles in different ways.
- Physical therapy: A licensed pediatric physical therapist can work with you and your infant to develop an individualized exercise plan that will target the specific needs of your child.
These simple exercises can provide great benefits for your baby’s neck muscles, but be sure to stop if you notice any discomfort or pain.
Infant Physical Therapy for Torticollis
Infant physical therapy for Torticollis is usually provided by a licensed physical therapist who has experience working with infants. The therapist will work with the baby and their caregivers to develop a treatment plan that may include development activities, strengthening, stretches, and positioning techniques to help improve the baby’s head and neck position. During therapy, specialists also monitor your baby’s head shape to determine whether additional plagiocephaly treatment may be beneficial.
Surgical options for Infant Torticollis
Surgical options are sometimes recommended for Infant Torticollis when the condition persists after months of conservative treatment such as physical therapy and positional exercises. The most common surgical procedure used to treat infant torticollis is called sternocleidomastoid release or SCM release. In this procedure, the surgeon partially removes part of the tight muscle. Another less common option involves cutting and relocating the tendon which attaches the sternocleidomastoid muscle to the clavicle. This procedure is called a tendon transfer. Both procedures are generally successful in relieving symptoms of infant torticollis, but they do come with some risks including infection or nerve injury.
When to See your Doctor
It is important to consult your doctor if you suspect that your child has torticollis. If your baby has both neck stiffness and an uneven head shape, your doctor may recommend a comprehensive head shape evaluation to rule out positional plagiocephaly or other craniofacial conditions. They may also order imaging tests, such as an X-ray or MRI scan, to detect any underlying problems in the bones or muscles of the neck. Depending on the underlying cause of your child’s torticollis, they may refer you to a specialist such as an orthopedist or physical therapist who can provide more targeted treatment. It is important to follow their instructions and attend regular follow-up appointments to ensure that your child’s torticollis is adequately managed. If you have any questions or concerns about your child’s condition you can immediately contact NJ Craniofacial for an appointment or you can visit our clinic.
Reference: A 2018 Evidence-based Clinical Practice Guideline
Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA academy of pediatric physical therapy. Pediatric Physical Therapy. 2018;30:240-290.
Reference: Boston Children’s Hospital (n.d.). Torticollis. Retrieved July 6, 2023, from https://www.childrenshospital.org/conditions/torticollis#:~:text=In%20contrast%20to%20congenital%20muscular,of%20more%20serious%20health%20issues.
FAQs About Infant Torticollis
Q1. What is torticollis in babies?
Torticollis, also known as wryneck, is a condition where a baby’s neck muscles tighten, causing the head to tilt to one side. It can affect movement, posture, and sometimes facial symmetry.
Q2. What causes infant torticollis?
Common causes include congenital muscular torticollis (tight neck muscles at birth), positioning in the womb, neck muscle injury during delivery, or limited movement in early months.
Q3. How can you tell if a baby has torticollis?
Signs include head tilt to one side, difficulty turning the head, preferring one side while sleeping, or uneven shoulders. A pediatrician can confirm diagnosis.
Q4. How is torticollis treated in babies?
Treatment usually includes repositioning techniques, physical therapy, and stretching exercises. In moderate cases, a specialist may recommend helmet therapy or other interventions.
Q5. Can torticollis cause developmental delays?
If left untreated, severe torticollis may affect motor development, posture, or cause asymmetry, but early detection and treatment usually prevent long-term issues.
Q6. Will babies grow out of torticollis?
Many babies improve naturally with proper tummy time, repositioning, and therapy, especially if diagnosed early. Mild cases often resolve within a few months.
Q7. What is congenital torticollis?
Congenital torticollis is present at birth, often due to tight neck muscles or positioning in the womb. Early stretching and therapy usually lead to full recovery.
Q8. Are there exercises for baby torticollis?
Yes, gentle neck stretches, supervised tummy time, and guided head-turning exercises are recommended by pediatricians or physical therapists.
Q9. What are the symptoms of torticollis in newborns?
Symptoms include head tilt, limited neck movement, neck stiffness, or a small lump in the neck muscle (sternocleidomastoid tumor). Early evaluation is important.
