Torticollis is a condition that many of us may have experienced the morning after an uncomfortable night of sleep. It develops in newborns after a difficult childbirth or improper positioning in the womb, a condition known as congenital muscular torticollis or infant torticollis.

Most babies do not experience any pain with torticollis, but they may have a lopsided head or problems turning their neck. Fortunately, with simple exercises and proper position changes, the child gets better with time.

What Is Torticollis?

Torticollis, “twisted neck” or sometimes called wry neck is a condition in which a child has his head tilted to one side and his chin tilted in the opposite direction. It is termed “congenital torticollis” if the child is born with this condition and studies have shown that about 1 in 250 babies suffer this condition at childbirth. In some cases, acquired torticollis can occur at a later time with the head and chin twisted in this same direction. Torticollis baby may look painful, but it usually is not.

What Are Symptoms of Torticollis Baby?

Torticollis baby may show symptoms relating to turning of the head such as:

• Head tilted in one direction
• Looking over one shoulder instead of turning the head fully to follow movement
• Prefer breastfeeding on one breast as he may have difficulty on the other side
• Have difficulty tuning fully in a particular direction and gets frustrated when unable to do so

Other conditions developed from having torticollis include:

• Positional plagiocephaly (development of flat head) on one or both sides as a result of always lying in a particular direction
• Development of a tiny bump or lump in the neck, resembling a knot in a tense muscle.

What Causes Torticollis in Babies?

1. Tightness in Sternocleidomastoid Muscle

Congenital torticollis usually develops when the muscle connecting the breastbone and collarbone to the skull (sternocleidomastoid muscle) becomes tight. This tightness may be due to abnormal positioning in the womb (head tilted in one direction) or the muscle could have been damaged during childbirth. The condition is termed “congenital muscular torticollis.”

2. Abnormalities in Cervical Vertebrae

Less commonly abnormalities in the formation of the cervical vertebrae may be the cause of congenital torticollis, a condition known as “klippel-Feil syndrome.” In such a case, the neck bones may be stuck together, abnormally formed, or a combination of both.

3. Inherited Disease

Congenital torticollis in rare cases may occur as a result of serious medical conditions that cause damages to the nervous system or muscles such as brain and spinal cord tumor. The condition is also hereditary.

Treatment for Torticollis Baby

An orthopedic surgeon or a physical therapist is the expert your pediatrician will refer you to. Stretching and positioning exercises performed on your baby are the most likely treatment for congenital muscular torticollis. You should learn them and be comfortable with performing them before leaving the physiotherapists office.

It is also advisable to engage your child in movements to the side that they don’t normally turn. For instance, if he has difficulty in turning his head to the left, you should always try to lay him on the changing table so you stand on his left. Placing him in his crib, so he always has to turn left to see people will also help in this case. It is important to note that neck muscles usually develop faster when babies spend much time lying on their tummy.

1. Non-Surgical Treatment

There are many simple ways to stretch out and develop the weak muscles in a child with torticollis which your pediatrician or child physiotherapist will show you. For example, proper ways to hold him while feeding and specific ways to place him in his crib in order to encourage movement to his weaker direction will be recommended. If instructions are followed properly, recovery could be in two months or between 6 to 12 months in severe cases.

• Physical therapy: Physical therapy for the treatment of congenital muscle torticollis involves taking stock of your baby’s motor skills and assessing movements of his neck, arms and leg. Your physiotherapist will teach you different bending and stretching exercises to help strengthen his neck muscles. A home exercise program usually involves active and passive bending and stretching motions during play and sleep to promote symmetrical movement. The success of the exercise program depends on how early treatment commences, the commitment of the parents and severity of muscle damage or presence of a tight muscle knot. Very high success rates have been recorded (90-99%) and it is important to follow strict instructions of the physiotherapist.

• Tummy time: This involves placing the baby on his stomach upon a blanket or soft surface and putting toys in front of him. You may also play with the toys and try to catch his attention. The aim is to encourage him to lift his head up and see all the action which helps strengthen his neck muscle.

A mom shares her successful story of improvements in her baby daughter with torticollis in this video. This is very encouraging to see:

2. Surgical Treatment

In some cases, physical therapy alone for the treatment of torticollis may not be enough to provide full recovery. Your pediatrician may refer you to an orthopedic surgeon if by 18 months the baby still has weak neck muscles. It is always preferable to exhaust all efforts at recovery through physical therapy before opting for surgery. Surgical operations can help lengthen the muscles for full recovery to occur.

When to see a doctor:

If symptoms do not get better with treatment or new symptoms develop, it is advisable to book an appointment with your doctor. Torticollis that develops due to illness or injury can be quite serious. If this occurs, seek medical help immediately.