Parents may start to worry if your baby’s head starts tilting to one side or if they prefer to look one direction — and your doctor may have even noticed it at your baby’s last check-up. Infant torticollis (tor-ti-col-lis) is easily diagnosable by tightened muscles on one side of the neck, which leaves your baby’s head at a tilt or rotation.
Torticollis in infants is common —some studies report that it affects 3 in every 100 babies. Fortunately, in most cases infant torticollis is easily treatable.
When your baby has torticollis, they were probably born with it (congenital torticollis). If that’s the case, it’s usually due to the way your baby was positioned in utero. In some cases, infants develop torticollis after birth (acquired torticollis, which is normally caused by some kind of trauma or infection), but most cases can be traced back to birth. Understanding the symptoms of torticollis, congenital or acquired, will help you understand how to help your baby.
Although your baby may have been born with torticollis, you may not notice any signs or symptoms until your baby’s between 6-8 weeks old. Around this age most infants begin to gain more control over their head and neck. At this point you may begin to notice the following symptoms:
- Head tilts or rotates to one side
- Limited range of motion in head and neck
- Asymmetry in your baby’s head and face (flattening on one side of the head)
- Breastfed babies may prefer one side over the other
- Musculoskeletal problems may be present (hip dysplasia)
- A small, soft lump in your infant’s neck
- The most commonly noticed symptom is plagiocephaly, or a flat spot appearing behind one ear and on the side the child likes to look toward
Symptoms of acquired torticollis are:
- Head tilts to one side
- Limited range of motion in the head and neck
- Recurrent episodes of head tilting. During these episodes, your child may also experience drowsiness, irritability, or vomiting
Causes of Torticollis
Infant torticollis happens when the muscles that connect the breastbone and collarbone to the skull (sternocleidomastoid muscle) are shortened. Because your baby’s neck muscle is shortened on one side of the neck, it pulls their head into a tilt or rotation, and often both. Often this muscle is shortened or tightened by abnormal fetal positions, injury during birth, abnormalities or bone problems in the neck portion of the spine, and in rare cases by inherited diseases that can cause damage to the nervous system or muscles.
Treatment for Infant Torticollis
The best way to treat torticollis is to encourage your baby to turn his or her head in both directions. This helps loosen tense neck muscles and tighten the loose ones. Rest assured that babies won’t likely hurt themselves by turning their heads on their own.
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 or chest for tummy time
- Position your baby so 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 several times a day
- Once your baby lays their head down for 10-15 seconds, they’re tired and need a rest.
Stretching exercises to treat torticollis are most likely to work well if they start when a baby is between 2 to 6 months of age. If you find your baby's torticollis isn’t improving with stretching, talk to your doctor or physical therapist.
In addition to tummy time, do what you can to encourage your baby to move to their affected side. For example, if your infant normally turns his head to the left, stand to his right when you’re changing him. Do the same when you place him in his crib. For breastfeeding mothers, encourage your baby to feed from the side he doesn’t normally enjoy. All of these movements can strengthen your baby’s neck.
Here are some other 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 while facing the direction they like to look. Since babies prefer to look out into the room, your baby will actively turn away from the wall, which will stretch the tightened muscles of the neck. Remember to always put your baby to sleep on his or her back, which reduces the risk of SIDS
- During play, draw your baby's attention with toys and sounds to make him or her turn in both directions
Physical therapy for infant torticollis
In certain cases, the doctor may suggest taking a baby to a physical therapist for more intensive treatment. After treatment has started, the therapist may examine your baby every 2 to 4 weeks to see how treatment is going. At these follow-up visits, the physical therapist will measure how many degrees the baby can turn their head, then help strengthen the muscles in their neck so they can increase range of motion. They will also track any head shape issues and make recommendations about how to decrease any flatness that may be present. Some children will require a helmet, but most will not.
When physical therapy and home exercises don’t correct your child’s head tilt, surgery may be required. Thankfully, this happens only rarely with babies who have persistent torticollis that doesn’t respond to conservative treatment. Very few children with congenital torticollis will require surgery. The surgery lengthens the sternocleidomastoid muscle and corrects the torticollis. Typically, your doctor will wait until your child reaches preschool years before recommending surgery.
When to see your doctor
Make an appointment with your doctor if your baby’s treatment for torticollis doesn’t seem to be helping, or if they develop new symptoms. Additionally, if your child’s torticollis develops after an injury or illness, see you doctor right away.