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Torticollis in Infants: Signs & Treatments Parents Should Know About

Posted on Aug 18, 2023

Medically Reviewed by: Carina Torres, PT, DPT, PCS
Pediatric Physical Therapy Specialist
Reviewed on: November 14, 2023

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 
  • Asymmetries of the head and face, indicating plagiocephaly, may also be present.
  • 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. The tightness of the muscle can make it difficult for the baby to move their head in any other direction. Other signs include difficulty turning their head to look at objects on either side or difficulty with breastfeeding or bottle-feeding due to not being able to turn their head properly. 

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. Acquired torticollis develops later on due to improper positioning and/or trauma from a difficult birth or from carrying an infant in an awkward position for too long. 

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. Earlier physical therapy intervention is more quickly effective than intervention started later.

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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. It can also help to improve the baby’s overall gross motor development. With early intervention and proper therapy, most babies with Torticollis can make a full recovery.

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. Your doctor will start by taking a medical history and performing a physical examination of the neck area. 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.

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