Infant Torticollis

About Infant Torticollis

Torticollis is relatively common in newborns. Boys and girls are equally likely to develop the head tilt. It can be present at birth or take up to 3 months to develop.

No one knows why some babies get torticollis and others don't. Most doctors believe it could be related to the cramping of a fetus inside the uterus or abnormal positioning (such as being in the breech position, where the baby's buttocks face the birth canal). The use of forceps or vacuum devices to deliver a baby during childbirth also makes a baby more likely to develop torticollis.

These factors put pressure on a baby's sternocleidomastoid muscle (SCM) — the large, rope-like muscle that runs on both sides of the neck from the back of the ears to the collarbone. Extra pressure on one side of this muscle can cause it to tighten, making it difficult for a baby to turn his or her neck.

Some babies with torticollis also have developmental dysplasia of the hip, another condition caused by abnormal positioning in the womb or a difficult childbirth.

Signs & Symptoms

Babies with torticollis will act like most other babies except when it comes to activities that involve turning. A baby with torticollis might:

• tilt the head in one direction (this can be difficult to see in very young infants)
• prefer looking at you over one shoulder instead of turning to follow you with his or her eyes
• if breastfed, have difficulty breastfeeding on one side (or prefers one breast only)
• work hard to turn toward you and get frustrated when unable turn his or her head completely

Some babies with torticollis also will develop a flat head (positional plagiocephaly) on one or both sides, due to laying in one direction all the time. Or they might develop a small neck lump or bump, which is similar to a "knot" in a tense muscle. Both of these conditions tend to go away as the torticollis gets better.

Diagnosis

If you think your baby might have torticollis, ask your doctor to perform a physical examination on your baby, which involves seeing how far your baby can turn his or her head.

If a diagnosis is made, the doctor might teach you neck stretching exercises to practice with your baby at home. These exercises help loosen the tight SCM and strengthen the weaker one on the opposite side (which has weakened due to underuse). This will help to straighten out your baby's neck.

In certain cases, the doctor may suggest taking your baby to a physical therapist for more intensive treatment. After treatment has started, the doctor may examine your baby every 2 to 4 weeks to see how treatment is going.

If your baby is 6 weeks of age or younger and has an unstable hip, the doctor might order an ultrasound to determine if your baby also has developmental dysplasia of the hip.

Treatment at Home

The best way to treat torticollis is to encourage your baby to turn his or her head in both directions. This will help to loosen tense neck muscles and tighten the loose ones. Rest assured that babies cannot hurt themselves by turning their heads on their own.

Here are some exercises to try:

• When your baby wants to eat, offer the bottle or your breast in a way that encourages your baby to turn away from the favored side. (Use your child's desire to eat to encourage him or her along!)
• When putting your baby down to sleep, position him or her to face the wall. Since babies prefer to look out onto the room, your baby will actively turn away from the wall and this will stretch the tightened muscles of the neck. Remember to always put your baby to sleep on his or her back, as this helps reduce the risk of SIDS.
• During play, draw your baby's attention with toys and sounds to make him or her turn in both directions. 

Don't Forget "Tummy Time"

Laying your baby on the stomach for brief periods while awake (known as "tummy time") is an important exercise because it helps strengthen neck and shoulder muscles and prepares your baby for crawling.

This exercise is especially useful for a baby with torticollis and a flat head — and can actually help treat both problems at once. Here's how to do it:

• Lay your baby on your lap for tummy time. Position your baby so that his or her head is turned away from you. Then, talk or sing to your baby and encourage him or her to turn and face you. Practice this exercise for 10 to 15 minutes.

Outlook

Most babies with torticollis get better on their own through position changes and stretching exercises. The condition might take up to 6 months to go away completely, though in some cases it can take up to a year or longer.  

If you find that your baby's torticollis is not improving with stretching, talk to your doctor. Your baby may be a candidate for muscle-release surgery, a procedure that cures most cases of torticollis that don't improve with physical therapy alone.

Reviewed by: Jeremy Michel, MD
Date reviewed: May 2011