It’s alarming to see your baby’s head tilt to one side. Torticollis — Latin for “twisted neck” — can develop in boys or girls from birth through 3 months of age. “Torticollis can be frightening for parents. But most kids do very well, especially when torticollis is identified early and treated quickly,” says pediatrician David Burke, DO.
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The condition, also called wry neck, can follow crowding in the womb (as seen with twins and breech births). If a baby doesn’t have much room to move around, the head may get stuck in one position for days or weeks.
This tightens and shortens one of the “strap muscles” that turn the head. These sternocleidomastoid muscles (SCMs) run from the collarbone to behind the ear.
The tighter SCM pulls the baby’s head to one side, tilting it — typically to the left, reflecting the position babies find most comfy in the womb.
Birth trauma can also cause torticollis.
What are the signs of torticollis?
The most common sign is a constant head tilt to one side, with the chin pointing to the opposite shoulder — and a reluctance to turn the other way.
Another sign can be a flat or misshapen head, called plagiocephaly. This can accompany torticollis because the baby’s skull bones have not yet fused. The tight neck muscle promotes lying on one side of the head, changing its shape.
Preemies are at greater risk of plagiocephaly because their skull bones are even less developed, and they are often tied in one position to a ventilator.
“Many kids have more flattened head shapes today because we want them sleeping on their backs to reduce the risk of sudden infant death syndrome (SIDS),” says Dr. Burke. “Although the head shape may be more flattened, it’s much safer than allowing kids to sleep on their bellies.”
How is torticollis treated?
Torticollis will often self-correct when treated early — ideally, within the first month or two, says Dr. Burke. If parents wait until babies are 3 months of age or older, treatment can take longer.
“Your pediatrician will explain how to reposition the baby, and do infant massage and stretches, or refer you to physical therapy (PT). Parents can begin home exercises immediately,” he says.
What kind of stretches can help the baby?
Parents massage the baby’s neck and back muscles, then do gentle stretching exercises several times a day.
“Osteopathic physicians can also do manipulative therapy, using a gentle hands-on techniques to guide tissues into a more relaxed position,” says Dr. Burke. “This allows the neck to straighten by restoring alignment and releasing tissue tightness.”
When the head tilt is significant or the muscle is really tight, more aggressive physical therapy is quite helpful in the first three months.
What does repositioning involve?
Repositioning essentially helps babies do their own PT. “You turn the babies so they’re facing the opposite direction from which they want to turn,” explains Dr. Burke.
“For example, if you place babies so they’re facing the wall in their crib, they’ll have to stretch their neck muscles to see you at the bedside.”
Siblings help when they play with the baby on the floor, encouraging the baby to follow them with his head in the restricted direction.
Appropriate tummy time is also important. Several times a day, when babies are awake, put them on their bellies for 20 minutes, Dr. Burke advises. This encourages them to turn their heads from side to side, push up on their arms and increase their muscle tone.
“We recommend doing this for all babies, but tummy time can correct mild cases of plagiocephaly and make babies’ heads nice and round,” he says.
What if treatment doesn’t work?
A frequency-specific microcurrent (FSM) device can deliver low-level electric current to kids who are at least 3 to 4 months of age to further relax the tight neck muscle.
For older kids with more severe torticollis, botulinum toxin (Botox®) can be injected to keep the tight neck from contracting too much, says Dr. Burke.
If kids still don’t respond to treatment, pediatricians refer them to the eye doctor for a visual exam. Some babies may tilt their heads to see better because their eyes are crossed, a condition called strabismus.
Further intervention will be needed for plagiocephaly if a baby’s ears are uneven, if one eye opens more than the other or if it causes vision problems.
Does torticollis also affect older kids?
Torticollis can occur in older children when a neck lymph node gets infected after a fever. “A big, painful, swollen lymph node may call for a round of antibiotics,” says Dr. Burke. Older kids can also develop torticollis after a neck injury or from sleeping “wrong.”
But when it comes to your newborn, his message is clear: “If you have concerns, talk to your pediatrician sooner rather than later.”
This will give your baby plenty of time for treatment and timely referrals, if needed.
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Adult torticollis, also known as cervical dystonia or “wryneck,” is a condition where your neck muscles go into spasm and pull your head to one side. Torticollis is often painful and can provoke twitching, twisting, and other uncomfortable neck posture problems.
There are several exercises that you can try to reduce torticollis symptoms and prevent them from recurring as frequently.
Adult torticollis can have a wide variety of causes, from strokes to medication to injuries. Regardless of the cause, it is important to be careful when performing exercises for torticollis to avoid injuring your neck muscles.
Exercises to Help Adult Torticollis
Torticollis can make it difficult to perform everyday tasks or even turn your neck. In most cases, exercises and physical therapy for torticollis focus on relieving muscle tension and strengthening the muscles that help with posture. These exercises can help reduce pain and discomfort as well as help your head return to a neutral position.
Sensory Trick Training
The first exercise is a mental exercise to help relax stiff neck muscles. A unique aspect of any type of dystonia is how your muscles react to “sensory tricks.” These tricks involve using your senses to signal your muscles to release. With torticollis, many people find that touching their faces in a certain place helps the seized neck muscles release. While the exact reason this relaxes the neck is unknown, early studies suggest that it helps your brain focus on a different input than the seized muscles. The location of the touch is different for every person with torticollis.
For many people, simply imagining their sensory trick’s sensation is enough to help release their muscles. If you have identified a sensory trick, you can practice imagining that sensation to help relieve your torticollis without having to touch your face.
Forward Head Pulls
This stretch can help release the muscles running up the back and sides of your neck. It is helpful if your torticollis pulls your head back or to the side.
Step 1: While standing next to a counter, place your right hand on the back of your head. Hold the edge of the counter with your left hand.
Step 2: Slowly turn your head about 45 degrees to the right and then look down. You should feel a stretch in your neck and shoulders.
Step 3: If you can, use your right arm to gently press down on your head to deepen the stretch. Hold for up to 40 seconds.
You can flip this exercise to stretch muscles on the other side of your neck.
If your torticollis primarily involves a twist to one side, this exercise can help stretch and strengthen the muscles that oppose your seized muscles.
Step 1: Stand straight and lace your fingers together behind your head. Extend your elbows outward.
Step 2: Slowly turn your head in the direction opposite your torticollis. Keep your shoulders and arms still.
Step 3: When you feel a stretch in your neck, hold your position for thirty seconds, then release back to a neutral position.
Repeat this three to five times a day.
Once you feel comfortable doing this exercise on its own, you can add resistance to it. Lie on your side with your head on a pillow, with your torticollis causing you to look up. Gently turn your head towards the pillow and push your face into it, then hold this position for thirty seconds.
Sideways Head Pulls
If your torticollis pulls your ear towards your shoulder, this exercise can help those muscles release.
Step 1: Stand next to a counter so that your torticollis causes you to lean your head towards it. Hold the counter with your nearest hand.
Step 2: Place your other hand on top of your head.
Step 3: Lean your head away from the counter, aiming your other ear towards your shoulder. You should feel a gentle stretch. Use the hand on your head to deepen the stretch. Hold this position for up to forty seconds.
Repeat this three to five times a day.
The goal of torticollis exercises is to relieve pain, not cause it. If any torticollis exercise hurts or seems to make the condition worse, stop that exercise immediately.
If your torticollis lasts more than a few days or seems to get worse, you should talk to your physician. Chronic torticollis may be the result of a serious injury or brain condition.
Duncan Foundation: “Cervical Dystonia.”
Journal of Neurology: “Sensory trick phenomenon in cervical dystonia: a functional MRI study.”
Pathak, M., Frei, K., & Truong, D. The Spasmodic Torticollis Handbook, Demos Medical Publishing, 2003.
Physical Therapy: “Cervical Dystonia: Disease Profile and Clinical Management.”
Torticollis is an involuntary contraction of the neck muscles that can be caused by poor posture when sleeping or when using the computer. It usually causes pain on one side of the neck which may result in difficulty in rotating your head.
It is common to wake up with torticollis and have difficulty moving the neck. In some cases, the muscles get so tight that the person cannot move the neck to either side and needs to remain stiff or facing one way.
In order to cure torticollis and eliminate neck pain, the contraction happening in the muscles needs to be relieved. Mild torticollis can be treated only by using warm compresses and gentle neck massage, but when the torticollis is more severe, a more specific approach is needed.
To treat torticollis there are 5 simples steps that can be followed:
1. Tilt your body forward with your head hanging
Simply stand with your legs apart and lean your body forward, leaving your head hanging down. Allow your head and shoulders to be loose, and stay in this position for about 2 minutes. This will cause the weight of your head to act as a pendulum, which may increase the space between the cervical vertebrae and decrease the spasm of the neck muscles.
While hanging you head, you can rotate it, as if saying “no”, to further relax the neck and shoulder muscles.
2. Apply pressure to the neck muscles
This technique consists of using your thumb to apply pressure for 30 seconds to the middle of the muscle. Then, press the part where the muscles begin, in the nape of the neck, for another 30 seconds. While applying pressure, you can be standing or sitting, and your head should be facing forward.
Physiotherapy is important because it can help you stretch your neck using a technique called muscular energy. This involves placing a hand on the head (on the side of the torticollis) and exerting force by pushing the head against the hand. Hold this position for 5 seconds and then relax, resting for another 5 seconds. Repeat this exercise 4 more times. Little by little your range of motion will improve.
If your movement is still limited after you finish this exercise, you can repeat this technique on the opposite side.
4. Massage and compresses
Massaging the neck using sweet almond oil or some other moisturizer is also a good way to decrease pain and discomfort. The massage should be performed on the shoulders, neck, back of the neck and head. You should only perform a massage as the final part of treatment, after using the techniques above.
This type of massage should not be performed with a lot of force, but you can press your palm a little on the muscles of the neck, from the shoulders towards the ears. Cupping techniques can also be used with low pressure to increase blood flow and help loosen the muscle fibers.
To finish off, a warm compress can be placed on the neck for about 20 minutes.
5. Medication use
Medications for torticollis should only be used as recommended by a doctor. This condition can be treated with anti-inflammatory creams like Voltaren, muscle relaxants, or anti-spasmodics. Applying a medicated compress is also a good strategy to cure the torticollis more quickly.
These remedies are also recommended for individuals with spasmodic torticollis that is characterized by persistent twitching of the neck muscles, causing your head to move in different positions. It is also known as cervical dystonia.
When to go to the doctor
Usually the torticollis improves after the first 24 hours, but it can last for up to 5 days. If the torticollis takes more than 1 week to heal, or if you have symptoms like tingling, loss of arm strength, difficulty breathing or swallowing, fever or incontinence, you should seek medical help.
How long does torticollis last
Torticollis can last for up to 5 days. It can cause a lot of pain and discomfort, making activities of daily living very difficult. Applying warm compresses on the neck and using the strategies indicated above can help to treat the torticollis faster.
What causes torticollis
It is very common for a person to wake up with torticollis, but it can also happen due to:
- Congenital problems, like when a baby is born with congenital torticollis, requiring treatment, sometimes surgical;
- Injuries involving the head and neck;
- Spinal changes, such as disc herniation, scoliosis, alteration of the C1 & C2 vertebrae in the neck;
- Respiratory infections, which cause torticollis and fever, or others such as meningitis;
- An abscess in the mouth, head or neck;
- Diseases like Parkinson’s, where the muscles are more prone to spasms;
- Certain medications, such as traditional dopamine receptor blockers (e.g. metoclopramide, phenytoin or carbamazepine)
The most common type of torticollis usually lasts 48 hours and is easy to fix. But, when it occurs with other symptoms like fever, you should go to a doctor for assessment.
Torticollis (wry neck, or loxia) is one of a broader category of disorders that exhibit flexion, extension, or twisting of muscles of the neck beyond their normal position. The Latin definition of torticollis means "twisted neck." In torticollis, the neck tends to twist to one side, causing head tilt. The condition can either develop slowly if you have a family history of the disorder, or acutely from trauma, or as an adverse reaction to medications.
When the disorder occurs in people with a family history, medical professionals refer to it as spasmodic torticollis (also called cervical dystonia). The characteristic twisting of the neck is initially spasmodic (involuntary contractions of the neck muscles that lead to abnormal movements and awkward posture of the head and neck) and begins between 31-50 years of age. If the condition goes untreated, it likely will become permanent.
Bending or twisting your neck too far can lead to acute torticollis. This condition appears with few symptoms, although often you will appear uncomfortable and will hold your head straight or rotated to one side. It will hurt to move your head to the opposite side, and you will have limited range of motion. Your neck muscles on the affected side that hurts often are tender to the touch. The doctor will check your nerve and motor function to rule out spinal cord injury.
Benign paroxysmal torticollis of infancy (BPTI) is a rare medical disorder in infants characterized by recurrent episodes (or attacks) of tilting of the head to one side.
What Are Torticollis Symptoms and Signs?
- Because spasmodic torticollis is an abnormal contraction of the muscle in one side of the neck, people will appear with their head turned to one side. Neck muscles and those between the neck and shoulder will be tense and tender, causing neck pain.
- People with acute torticollis will be unwilling to turn their head to one side or may have their head turned slightly away from the side of discomfort.
- Deviation of the eyes (oculogyric crisis) where the eyes involuntarily look upward and protrusion of the tongue (buccolingual crisis) where the tongue sticks out involuntarily may also occur.
- With spasmodic torticollis (cervical dystonia), there may be neck muscle spasms that are sustained (tonic) or jerky (clonic).
- Other symptoms may include shoulder pain, back pain, headache, neck cramps, muscle tightness, muscle pain, or burning sensations.
- Attacks of benign paroxysmal torticollis in infants mayaccompany symptoms such as vomiting, irritability, and drowsiness.
What Are Torticollis Causes and Risk Factors?
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In adults, many different conditions can cause acute torticollis. Occasionally, medical professionals find no specific cause.
Trauma to the neck or spine can lead to torticollis. Injuries to the cervical spine or neck muscles often result in spasm of the muscles, leading to the twisting of the head, characteristic of torticollis.
Other causes include infection of the head or neck. These infections can cause an inflammatory torticollis secondary to inflamed glands (adenitis) and lymph nodes in the neck. The muscles overlying these lymph nodes may contract. Torticollis may be associated with abscesses of the throat, the retropharyngeal space, and upper airway, and those situations can be life threatening. Other infections of the sinuses, ears, mastoids, jaw, teeth, or scalp also can lead to torticollis.
Rarely, tumors, scar tissue, arthritis of the cervical spine, or vascular abnormalities may also cause torticollis.
Certain drugs of abuse such as ketamine, amphetamines, and cocaine as well as commonly prescribed neuroleptic drugs such as prochlorperazine (Compazine), haloperidol (Haldol), and chlorpromazine (Thorazine) can cause acute dystonia or dystonic reaction (a lack of normal muscle control). This is a condition involving the sudden onset of involuntary contractions of the muscles of the face, neck, or back.
In addition to bending of the head to one side (acute torticollis), people may experience other symptoms such as deviation of the eyes (oculogyric crisis) and protrusion of the tongue (buccolingual crisis).
In addition to the causes above, children, infants, and newborns may also acquire torticollis from congenital causes or trauma due to childbirth. Congenital muscular torticollis (CMT) is the most common cause of infant torticollis. CMT is a postural physical deformity present at birth that results from a shortening and scarring (fibrosis) of the sternocleidomastoid muscle on one side of the neck. Infants often sleep with their heads in the same position against the mattress, which can lead to plagiocephaly (flat head syndrome), which is why it often accompanies muscular torticollis.
Risk factors for torticollis include a family history of the disorder, congenital abnormalities of the cervical spine, taking drugs that predispose to muscular spasm, and trauma.
Before we begin, please NOTE: The stretching techniques I describe here are all for RIGHT torticollis. You can modify them for LEFT torticollis simply by substituting LEFT for any RIGHT, and RIGHT for any LEFT in the instructions.
STRETCHING & POSITIONING FOR PLAY
Doing these stretching exercises, carrying your child properly, and correctly positioning the child for play can help to correct torticollis.
The best place for stretching exercises is a carpeted floor. Place your child on his back. If you’re sitting on the floor, you can place the child in your lap, with the child on his back and knees tucked.
SIDE BENDING [for RIGHT Torticollis]
Place your RIGHT hand on top of the RIGHT side of your child’s head. Hold your child’s RIGHT shoulder down with your LEFT hand. Slowly bend his LEFT ear towards his LEFT shoulder
Hold this position for 30 seconds, as tolerated by the baby. Repeat 2-4 times. Do this exercise 3-4 times a day.
ROTATION (HEAD TURNING) [for RIGHT Torticollis]
Place your LEFT hand on your child’s LEFT shoulder. Cup your child’s head with the RIGHT hand. Use your LEFT hand to hold your child’s chin
Slowly turn your child’s nose to his RIGHT shoulder.
Hold this position for 30 seconds. Repeat 2-4 times. Do this exercise 3-4 times a day.
POSITIONING FOR PLAY
Playing while lying on his side (side-lying): Position your child so he can play while lying on his side
This position allows gravity to do some of the work of stretching the neck and bringing the hands to the middle of the body. Bringing hands to the middle is an important step for feeding, hand-eye coordination, and other areas of your child’s development.
PLAYING ON HIS STOMACH
When your child is awake, it’s important he be placed on his tummy for play. This helps him learn to control his head movements.
When your child is on his tummy on the floor, place all toys so he has to turn his face to the RIGHT
You can help him turn his face to the left while he plays on his tummy.
CARRYING YOUR CHILD
Hold the child facing away from you, in a side-lying position, with your child’s RIGHT ear resting against your RIGHT forearm
Get your forearm between the child’s ear and shoulder to help stretch the tight muscles. You can use your forearm to lift your child’s head away from the shoulder to get a side-bending stretch. Place your LEFT arm between your child’s legs and support your child’s body and grasp her right shoulder with your left hand.
Carry your child in this position as much as possible. You can use this position to stretch the tight muscles if your child doesn’t tolerate the side-bending stretch well on her back.
OTHER SUGGESTIONS [for RIGHT Torticollis]
- Hold toys so that your child has to look up and out to his RIGHT.
- Position your child in the crib so activities in the room encourage her to look RIGHT.
- While breastfeeding or bottle-feeding your child, position him to face RIGHT.
- While holding your child across your shoulder, position her to face RIGHT.
- When not in the car, don’t use the car seat as a place to put your child for playtime.
- Your pediatrician or therapist can show you ways to use rolled-up baby blankets and towels to help keep your child’s head in a neutral position.
- If your child is ready and it is indicated, a physical therapist can show you how to encourage him to actively move his head to strengthen and stretch the neck muscles.
If your child doesn’t improve with these exercises, consult your Kids Plus Provider.
healthdirect Australia is a free service where you can talk to a nurse or doctor who can help you know what to do.
What is torticollis?
Torticollis is when the muscles of the neck spasm and cause the neck to twist to one side.
Torticollis is a common cause of neck pain in young people and it’s not generally associated with a previous neck injury or neck pain.
What are the symptoms of torticollis?
Torticollis usually causes pain on one side of your neck. You may feel pain in the middle of the neck and in the shoulders and head. Your neck may be very tender and if you try to massage the area, to provide some relief, it’s possible your neck muscles will spasm. You may also find it difficult to straighten your neck or turn your head a particular way.
Symptoms of a twisted neck will usually disappear completely within a week, and they usually ease considerably within 1 or 2 days. Sometimes symptoms last longer, but this is not common.
CHECK YOUR SYMPTOMS — Use our neck pain and stiffness Symptom Checker and find out if you need to seek medical help.
What causes torticollis?
Sometimes babies are born with torticollis, for example if there was birth trauma or they have an abnormality in their spine. Children can develop torticollis after a minor injury or inflammation.
In adults, a sudden muscle spasm in the neck may be caused by:
- sitting or sleeping awkwardly, without sufficient support for your head , such as at a workstation that is not ergonomically suited to you
- carrying bags with unequal amounts of weight that cause your neck to strain, for example, a handbag on one side and heavy shopping bags on the other
- inflammation or infection in the neck
- a neck injury
Sometimes torticollis can happen due to a neurological problem called dystonia.
When should I see my doctor?
You should see a doctor if:
- the pain is getting worse
- the pain doesn’t ease up in a week or so
- you have numbness, tingling or pins and needles in your arms or legs
- you start having difficulties with your bladder or bowel, you have a fever as well as neck pain
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How is torticollis diagnosed?
Your doctor will examine you and possibly order an x-ray or CT scan.
How is torticollis treated?
Usually there is no treatment for torticollis other than a heat pack, pain relief and massaging the neck. If a baby has torticollis, you may be advised how to position them during feeding and sleeping and shown how to gently move their head to encourage the neck to stretch.
You should keep active and move your neck as normally as possible. Don’t make sudden movements for a day or so, but then try to carry on with your normal routines and move your head and neck to prevent it stiffening up.
Try gently moving your neck in circles and moving it backwards, forwards and to either side to loosen the muscles and keep your neck supple.
If the torticollis doesn’t improve or you’re worried, you may need to see a physiotherapist or doctor or have further investigations.
Can torticollis be prevented?
To reduce your chances of future episodes of neck pain, you can:
- improve your posture with gentle stretching exercises, such as those popular in activities such as yoga or Pilates
- arrange your workspace so that your desk and chair are suitable for your needs. Ask for a footrest if you find that your knees and hips are not level and your feet do not sit flat on the ground. You may also need to move items that you use regularly closer to you, so that you don’t twist or reach too far to find items you need
- support your neck while sleeping with a support pillow, and sleep with just one pillow
- make sure your neck is supported in the car by adjusting the headrest so that it is at least at eye level and as close to the back of your head as possible. Don’t drive if you can’t turn your head properly
Complications of torticollis
Very rarely, torticollis may be the sign of something more serious like an infection, an abscess in the head or neck or a neck injury.
Resources and support
These websites provide more detailed information about the causes and management of neck pain.
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Last reviewed: December 2019
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Cervical Dystonia – Brain Foundation
Cervical Dystonia often referred to as spasmodic torticollis, is a particular type of focal dystonia that affects the muscles of the neck. It presents in different forms as follows: torticollis, laterocollis, anterocollis and retrocollis.
Read more on Brain Foundation website
Cervical dystonia (spasmodic torticollis) | HealthEngine Blog
Cervical dystonia or neck dystonia is a movement disorder of the neck muscles. It causes spasms, tremors and pain in the neck, and abnormal head posture.
Read more on HealthEngine website
Neck pain: symptoms and causes – MyDr.com.au
Knowing the symptoms of your neck pain and when to see a doctor can help in finding the cause and getting a diagnosis.
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Neck pain – Better Health Channel
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It’s something that many parents overlook at first – you may notice it for the first time when checking on your sleeping baby at night or when looking through photos of your little one: baby’s head always seems to turn to one side.
While it can be easy to think that your baby favors one side over the other due to comfort reasons, the cause of this persistent head turn is often the result of a muscular condition called congenital muscular torticollis.
What is torticollis?
Torticollis is a common muscular condition caused by the tightening of one of the muscles on the side of the neck. It is often the result of crowding in the womb.
Torticollis is often very concerning to new parents; however, when identified early, it can be easily treated and resolved with no long-term effects.
What does torticollis look like?
Torticollis most often presents as a baby consistently turning his or her head to one side.
Other symptoms of torticollis can include a limited neck range of motion to one side, a preference to sleep with the head to one side, and a preference to breastfeed on one side.
Additionally, torticollis may also present with a small lump in your baby’s neck.
Torticollis and plagiocephaly
Plagiocephaly, which is flattening on one side of the head, can also be a sign of torticollis.
In the early months of a baby’s life, the skull bones are not yet fused; as a result, consistent pressure on a particular part of the head can cause its shape to change.
How can you help a baby with torticollis?
Because torticollis is often caused by issues with a muscle, you can help address torticollis in your baby through stretching, carrying your baby properly, and correctly positioning your baby for play and feeding.
Here are five simple things you can try at home to help improve your baby’s movement and development:
- Position your baby in the crib or changing table so that activities in the room encourage baby to look away from the preferred side.
- Hold toys or talk to your baby in a way that causes baby to look in the direction that neck mobility is limited.
- Limit the amount of time your baby spends in places where the head is likely to rest in the same spot, like a swing, bouncy seat, or car seat. Additionally, using a head support may help with aligning your baby’s head while in the car seat.
- Hold your baby at your shoulder or chest to encourage lifting and turning away from the preferred side.
- Tummy time! Tummy time will help develop your baby’s neck and upper body strength, along with developing adequate tone needed for rolling, reaching, sitting, and crawling.
Tummy time tips for babies
When your baby is awake and supervised, start by placing your baby on his or her belly — you can do short periods at the beginning to help your baby get used to tummy time.
You can also use a nursing pillow or infant lounger if your baby needs additional support.
Use brightly colored toys, mirrors, or even siblings to get baby’s attention and encourage him or her to look up and away from the preferred side.
Your baby doesn’t need to lay on the floor or a blanket! Using your chest to prop your baby on his or her belly also counts as tummy time.
When does torticollis require professional treatment?
If you notice flattening of your baby’s head, it’s important to bring it to the attention of your pediatrician.
After talking with your pediatrician, he or she may suggest a referral for physical therapy for further evaluation and treatment.
If your baby requires physical therapy for torticollis, a licensed Pediatric Physical Therapist will evaluate your baby’s level of impairment and tolerance for neck stretches.
After that evaluation, the pediatric physical therapist will provide instruction on stretches and exercises specific to your baby’s needs.
Torticollis is a common condition and is often associated with plagiocephaly. It is characterized by an inability to turn the head fully in both directions, and there may also be a head tilt towards the affected muscle.
It can vary in severity, from mild where there is a slight restriction, to severe where the baby has real trouble turning fully in both directions. Depending on the symptoms that are present, an indication of the treatment needed to treat torticollis in infants. For example, some babies have developed a torticollis due to their position before birth in the womb during pregnancy; others may have developed the condition following a difficult birth.
Infantile torticollis, sometimes called congenital muscular torticollis (CMT), can be associated with infant fibrositis (a muscle inflammation) or a sternomastoid (SCM) tumour. This sounds scary but it’s just a little knot of muscle fibres in the muscle on one side of the neck. Tumour just means lump, it’s not cancer. While there are many potential causes of torticollis in young children, most cases will come from either neck positioning before or during birth leading to a continuation of positioning to give comfort.
Treatment for infantile torticollis will depend on the underlying cause of the condition, and may include Physiotherapy or Osteopathic therapy to gently stretch and extend the baby’s neck muscles to allow full range of movement in both directions.
To effectively treat your baby’s torticollis, there are a few steps you can take.
- Physiotherapy for torticollis can be effective in treating the condition, as gentle stretching and strengthening exercises will help to restore full range of motion. Early treatment and stretching exercises can reduce the incidence and severity of plagiocephaly.
- Changing the position of your baby’s head while feeding encourages them to use their full range of movement at other times. This is a simple and effective way to deal with infantile torticollis.
- Parents can encourage changes in position by moving toys across the baby’s line of sight to encourage head turning.
If you carry out stretching exercises regularly under the advice of a health professional, this can resolve the issue within a few months.
Baby’s Diagnosed with Plagiocephaly and Torticollis
If your infant has been diagnosed with plagiocephaly secondary to a torticollis, the types of repositioning techniques mentioned can help to reduce the severity of the head shape asymmetry if started early enough.
If the torticollis isn’t resolved within a month, or the condition becomes severe, we recommend further investigation.
Moderate to severe cases of torticollis which result in plagiocephaly can require treatment to correct the head shape in the form of a plagiocephaly helmet, which gently allows head to grow naturally towards the normal corrected head shape. We have almost 20 years’ experience providing this fast and pain-free treatment, and can provide you with all the information and support that you need.
Types of torticollis
- Congenital torticollis
- Acquired torticollis
Congenital torticollis refers to a condition that was present at birth and is the more common of the two classifications. Congenital torticollis can occur as a result of either difficult births or if the baby has maintained one specific position in utero during pregnancy. Although congenital torticollis is normally able to be identified soon after birth, many parents do not notice their child has this condition until they are about 2 months old and start to gain control over head movement.
Usually, congenital torticollis responds very well to repositioning techniques and the earlier the child is placed in an alternate position, the more successful treatments are. Congenital torticollis is often related to plagiocephaly as these babies spend a significant period of time in one spot leading them to have pressure on parts of their skull which can be asymmetrical making it difficult for them to grow properly resulting in an uneven shaped head.
Acquired torticollis is a medical condition which can develop after birth, often becoming noticeable within the first six months. The cause of acquired torticollis is typically the muscles in the neck not growing evenly in length resulting in a restriction to one side.
Treatment options include seeking professional diagnosis and pursuing necessary treatment as soon as possible.
If you’re concerned about your baby’s head shape and are treating your child with torticollis, don’t hesitate to contact us. We have a team of clinicians ready and waiting to help you
As your baby develops head control, she’ll want to turn and look at the world all around her — at bright toys, towards silly sounds and into your adoring eyes. But sometimes, tight neck muscles can prevent baby from seeing the full picture.
Babies with torticollis have limited mobility in their necks, causing their heads to tilt to one side. Unlike some other health conditions that can crop up during those early months, torticollis is easy to spot. But with treatment — stretching and strengthening exercises, for example — most infants with torticollis regain full head and neck mobility within months, as well as the ability to look all around them.
What is torticollis?
The name “torticollis” comes from two words in Latin: “tortus” and “collum,” which translate to “twisted neck.”
When babies have torticollis, tight neck muscles cause them to tilt their heads to one side and their chins to the other. The most common type is congenital muscular torticollis, which affects up to 2 percent of all infants.
What causes torticollis?
There are two main types of torticollis, each with different causes:
Congenital muscular torticollis
This type of torticollis is present at birth, and it can happen if your baby experienced cramped conditions inside the womb, like in the breech position. It can also occur if your doctor used forceps or a vacuum device during delivery. Both of these put pressure on your baby’s sternocleidomastoid muscle (SCM), a large, rope-like muscle that runs on both sides of their neck, contributing to torticollis.
Congenital torticollis is often discovered when a baby is about 2 months old and has better control of head movements. You may also notice it sooner if your baby always rolls to one side while sleeping.
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Acquired torticollis usually shows up later in infancy (after 4 to 6 months) or in childhood.
An upper respiratory infection or an injury can cause throat inflammation. This swelling moves vertebral bones out of whack and causes neck muscles to spasm. It usually comes on quickly, and, unlike congenital muscular torticollis, feels painful.
Symptoms of torticollis
For the most part, a baby with torticollis will eat, sleep and play like any other baby, except when it comes to activities that involve turning. You may see:
- A constant head tilt in one direction.
- A limited range of motion in the head and neck.
- A preference to look at you over one shoulder, rather than to follow you with her eyes.
- Trouble breastfeeding on one side.
- A flat spot on the head (positional plagiocephaly) from lying in one direction all the time.
- A pea-sized neck lump or bump, like a knot in a tense muscle.
Treatments for torticollis
Babies with congenital torticollis usually get diagnosed by the time they’re 2 months old via a physical exam.
If your doctor determines your baby has torticollis, it’s important to start treatment right away to prevent permanent asymmetry, a flat spot on your baby’s head and restricted head movement. Treatment options may include:
Your baby will undergo an evaluation to identify which neck muscle is tight. The physical therapist will also evaluate your little one’s neck strength, head shape, gross motor skills and range of motion. They will perform some neck stretching and strengthening exercises and teach you how to do some with your baby at home.
They will also show you ways to encourage neck turning and make sure you are holding your baby the right way. Research suggests that attending physical therapy is more effective than solely doing exercises at home.
Your physical therapist will recommend that you do tummy time and stretching exercises with your baby every day, like neck rotation stretches and lateral head tilt stretches.
As your baby gains head control, you will also learn to place your baby in certain positions so that she uses her muscles to lift her head against gravity. This helps strengthen the neck muscles.
Continue building those all-important muscles by motivating your little one to turn her head to the side she normally doesn’t turn to: Place her in the crib on her back with her face to the wall, encouraging her to roll her head to see the the room (or the noisy, colorful toy you’re shaking).
You can also put her to sleep on her back with her head positioned in the opposite direction of the tilt.
About 10 percent of children with congenital muscular torticollis require surgery to lengthen their shortened neck muscles. This is done by an orthopedic surgeon, usually right around the time your child starts preschool.
Heat and massage
If your child develops acquired torticollis, the typical course of treatment is to apply heat and use massage and stretching to ease the pain. Botox injections are also an option for older children with severe torticollis. Your pediatrician can refer you to a neurologist or orthopedist for more treatment.
Most children with both forms of torticollis respond to treatment and recover. Babies with congenital torticollis in particular tend to respond very well to physical therapy programs, usually within a matter of months. The key is to get a prompt diagnosis, so your baby can begin treatment ASAP — and begin looking at you from any angle.
From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.