What Is Torticollis?

Torticollis, also known as congenital muscular torticollis (CMT), wryneck, twisted neck, or simply head tilt, is when your newborn’s head seems permanently turned and rotated to one side due to tightness in their neck muscles. Torticollis affects up to 16% of infants and is usually noticeable shortly after birth, according to a report in the journal Pediatrics. (When torticollis develops later in infancy or childhood it’s called acquired torticollis.) Most of the time, infant torticollis is an isolated condition, which means there are no worrisome underlying issues causing your bub to tilt their head.

What are the symptoms of torticollis?

The signature torticollis head tilt is one obvious symptom, but it’s not the only one. Other signs include:

Head tilts to one side, chin tilts to the other
Always turns to the same side during tummy time
One shoulder is higher than the other
Limited range of motion in the head and neck
Firm but moveable pea-sized lump on the neck muscle occurs in about 50% of cases
Head and face asymmetries
Plagiocephaly (flat head syndrome)
Musculoskeletal problems, such as hip dysplasia

No matter which signs and symptoms of torticollis your baby displays, know that the condition is usually painless. And don’t beat yourself up if you didn’t spot your newborn’s symptoms at first! Torticollis often goes unnoticed until your little one is a few weeks old and starts to gain more head control.

What causes torticollis?

You know how you can get a stiff neck if you’re in a cockeyed position for too long watching a Bravo marathon? Same thing happens to babies in the womb. Doctors suspect that being in an unusual position—or being too cramped—in the womb is the cause of torticollis in babies. These two things can put undue pressure on your baby-to-be’s sternocleidomastoid muscle, which runs from the back of the ears to the collarbone and controls how the head moves.

On rare occasions, abnormal development of this muscle or trauma to the muscle during birth causes torticollis, too. Congenital muscular torticollis may be the result of an underlying condition such as dwarfism, skeletal anomalies, or Klippel-Feil syndrome where neck vertebrae are fused together.

Other Causes of Head Tilt

Hands down, congenital torticollis is the most common cause of head tilt in babies and young children, according to the American Academy of Pediatrics (AAP). However, in rare instances, an infant’s head tilt may be due to issues like hearing loss, eye misalignment, throat or lymph node infection, reflux, or very uncommonly, a brain tumor.

When an older child—up to about age 10—experiences head tilt, it’s often due to acquired torticollis. This painful condition comes on quickly and stems from throat inflammation, usually caused by an upper respiratory infection or an injury.

How is torticollis diagnosed?

Your baby can be easily screened for torticollis during their first postnatal examination. Here, the pediatrician should check your baby for full cervical (aka: neck) range of motion in both directions. If torticollis is missed during the initial screening, pediatricians usually spot and diagnose torticollis within your little one’s first six to eight weeks, according to the AAP, with half of all torticollis cases diagnosed before babies are 2 months old.

Most of the time, doctors diagnose torticollis based on appearance and a quick examination of your infant’s neck, including their range of motion. At times, however, your healthcare provider will order imaging to zero in on the cause of your baby’s head tilt—and to screen for hip dysplasia. About 15% of babies with congenital torticollis also have hip dysplasia.

How is torticollis treated?

Torticollis is not something that naturally corrects itself over time. Instead, infants with torticollis need prompt physical therapy (PT) that involves neck stretches, neck and trunk strengthening, activities to promote symmetrical movement, parent-tailored strategies to encourage Baby to turn their head in the desired direction, and more. Experts agree that properly treating torticollis requires the help of a trained physical therapist—as well as doing parent-lead exercises with your baby several times a day, gradually extending the movement as the muscle stretches. (The AAP advices against doing at-home neck-stretching without regular physical therapy.)

At times, torticollis may require frequency-specific microcurrent (FSM) treatment, which involves a low-level electrical current or Botox injections, which can relax the tight neck muscle. Approximately 10% of children with torticollis require surgery to lengthen the shortened neck muscle if other treatments fail to yield the desired results.

How to Treat Torticollis at Home

Your child’s physical therapist will give you plenty of tips and exercises to do at home to help treat torticollis, such as…

Sleep position: Place your baby on their back with their head positioned opposite to the direction of the tilt, facing the wall. Babies prefer to look away from the wall, so they’ll actively turn away which’ll help stretch their tight neck muscles.
Feeding: Offer the bottle or breast in a way that encourages your little one to turn away from their favored side.
Awake positioning: When your baby is awake, hold or place them so that visually interesting things (window, baby mobile, pictures, etc) are on the side away from the tilt to encourage them to stretch their shortened neck muscles to see.
Play time: When you’re playing with your baby, encourage them to turn their head in both directions with the help of toys and sounds.
Tummy time: Lay your baby on your lap and position them so that their head is turned away from you. Then, talk or sing to encourage your little one to turn and face you. (Learn pediatrician Dr. Harvey Karp’s tummy-time tips.)

How long does it take to fix torticollis?

The earlier torticollis treatment starts the better. Babies with torticollis shouldn’t have any long-term issues if treatment starts early. In fact, 98% of babies with torticollis who begin a comprehensive PT program before turning 1 month old achieve a normal range of motion in their neck within 1.5 months, according to a report in the journal Pediatrics. Unfortunately, about 66% of infants aren’t referred for torticollis treatment until they’re 3 to 4 months—and one-third of babies don’t see a PT for torticollis treatment until they’re 5 to 6 months old.

Delaying torticollis treatment until after a baby is 6 months old may require 9 to 10 months of PT or, worse, put your baby at risk for needing a more invasive torticollis intervention, such as surgery. That said, combining physical therapy and FSM has been shown to be an especially effective torticollis treatment for older infants or toddlers.

Does torticollis cause flat head syndrome?

Yes, it’s estimated that 85% of babies with torticollis have a positional skull deformity like flat head syndrome (plagiocephaly). That’s because tight neck muscles make it difficult for babies to turn their heads, so they often keep their heads in the same position when lying down. This can cause flattening.

What are the possible complications of torticollis?

Torticollis is a fairly common condition that—when treated properly—should not result in any lingering problems. However, when torticollis treatment is delayed, there are some of long- and short-term complications, including:

Flat head syndrome
Facial asymmetry
Facial deformity
Difficulty chewing
Difficulty swallowing
Restricted head movement

What is the outlook for infants with torticollis?

Torticollis in babies is a very treatable condition. Up to 95% of babies who receive early torticollis treatment experience great improvement during their first year. Just remember: Early treatment is key! If you suspect your baby has torticollis, do not hesitate to bring it up to your healthcare provider.

More Newborn Must-Reads:

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REFERENCES

Cleveland Clinic: Torticollis
Congenital Muscular Torticollis: Bridging the Gap Between Research and Clinical Practice. Pediatrics. August 2019
Congenital Torticollis. StatPearls. January 31, 2023.
American Academy of Pediatrics (AAP): Head Tilt (Torticollis)
Boston Children’s Hospital: What is torticollis?
The Nemours Foundation, KidsHealth: Torticollis in Infants
Yale Medicine: Torticollis
American Academy of Orthopaedic Surgeons, OrthoInfo: Congenital Muscular Torticollis (Twisted Neck)
The Nemours Foundation, KidsHealth: Flat Head Syndrome (Positional Plagiocephaly)
Neglected Torticollis: A Rare Pediatric Case Report. International Journal of Clinical Pediatric Dentistry. January - February 2020

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.

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