Torticollis: Symptoms, Treatment and Diagnosis

Some babies are born with or develop a head tilt known as torticollis or wry neck. It’s not usually permanent or painful for your little one, but an early diagnosis and treatment is important so it can be remedied as quickly and effectively as possible. Find out what infant torticollis is, what causes it, the signs and symptoms to look out for, and what treatment your doctor may recommend.

What Is Torticollis?

Torticollis is the Latin word for ‘twisted neck’. A stiff neck that is hard to turn and sometimes painful is referred to as torticollis or wry neck. The muscle that is affected by torticollis is the sternocleidomastoid muscle, which connects the base of the skull to the collarbone. When this muscle is contracted, it causes the head to tilt to one side. This condition can occur in adults, as well as in infants, babies and small children. When torticollis is present in newborn babies, it’s called infant torticollis or congenital muscular torticollis. Torticollis is relatively common in newborns. It’s sometimes present at birth but can also appear up to three months later. Although acute torticollis can be painful in adults, you’ll be relieved to know that infant torticollis doesn’t usually hurt your baby, and it can be treated.

What Causes Infant Torticollis?

Experts aren’t quite sure why some babies are affected by torticollis, but some possible contributing factors or causes of infant torticollis include:

• The uterus was too cramped for the baby, causing his or her head to be stuck in one position for a long time

• The baby was in an unusual position at birth, such as being in a ‘breech position’ (when the baby is positioned with the feet or bottom towards the birth canal, instead of being head-down)

• Forceps or vacuum devices were used during delivery

• The baby constantly looking to one side, for example to look at a favourite toy or picture that is always in the same position relative to the baby’s cot or pram.

What Are the Signs and Symptoms of Torticollis?

If your baby has torticollis, you may notice the following symptoms:

• Your baby’s head tilts to one side

• At the same time, his or her chin points in the opposite direction to the head tilt

• Your baby may have difficulty holding his or her head in a forward-facing position

• When breastfeeding, your baby may find it harder to turn his or head towards one of your breasts

• Your baby spends more time looking in one direction than the other

• In some cases, you may also notice a small lump – like a knot – in your baby’s neck on the side of the contracted muscle

• There may be a little flattening of the head on the affected side. This doesn’t affect your little one’s brain and there’s a good chance the head will regain its original shape as long as the torticollis is corrected early enough.

Does Your Baby Have Left or Right Torticollis?

Whether your baby has ‘left’ or ‘right’ torticollis depends on which side the head is tilted towards. Keep in mind that the chin will point in the other direction.

• Right torticollis. The head is tilted to the right, while the chin points to the left.

• Left torticollis. The head tilts left and the chin points right.

How Is a Torticollis Diagnosis Made?

If you think your baby might have torticollis, make an appointment to see the doctor, who can make a diagnosis and rule out any underlying conditions. If torticollis is diagnosed the doctor will refer you to a physiotherapist, who can teach you exercises and techniques for stretching your baby’s tight neck muscles. The physiotherapist will monitor your baby’s progress over about three months, and if there’s no improvement you may be referred to an orthopaedic clinic for further assessment and treatment.

Treatment and Remedies for Torticollis

• When it’s time for bed or a nap, put your baby to sleep on his or her back (as recommended for safe sleep) in a cot positioned so that – when you walk into the room – your infant has to look the opposite direction to the way his or her head is tilted. You can also place interesting toys or a mobile on that side of the cot to encourage head-turning in the appropriate direction.

• Gently turn your baby’s head to the left (in the case of right torticollis) or right (for left torticollis) while he or she is asleep. It might not stay that way for long – especially if your child is a restless sleeper – but even small amounts of time with the head turned the other way can help.

• Keep time in a car seat or baby carrier to a minimum – only use the car seat or carrier for travelling in the car, not for resting or as a place to sit during other activities’

• When your baby is in the car seat or pushchair, use a small rolled up towel on one side of his or her head to support it in a more central position

• Make sure your little one gets tummy time on a daily basis. During tummy time, position your baby in a way that encourages looking and turning his or her head in the opposite direction to the side of the head tilt. Try dangling toys or attracting your baby with fun sounds or funny faces to try to get him or her to look your way.

• If you bottle-feed your baby, hold him or her in your arm on the side that the head is turned to, and hold the bottle in our other hand. This way you can encourage your child to turn his or her head to the non-torticollis side to reach the bottle and look at your face

• When your baby breastfeeds from the breast on the non-torticollis side (that is, the right breast if your child has left torticollis, or vice versa), position him or her so it’s a stretch to bring your infant’s non-torticollis-side ear closer to his or her shoulder on that side. If this feels awkward, you could try experimenting with different breastfeeding positions.

• Carry your baby in a sling instead of a pushchair whenever you can, so you can vary your baby’s position to avoid constant pressure on one side of his or her head

• In some cases (for example, if other forms of treatment haven’t worked), surgery may be recommended to correct the torticollis.

How Long Torticollis Lasts

How long torticollis lasts depends mainly on how early you start treatment. In most cases, as long as the torticollis is treated promptly and consistently your baby will get back his or her full range of neck movement in about four to six months. The earlier torticollis treatment is started, the more successful it’s likely to be, so it’s important to see your child’s doctor as soon as possible. If the condition isn’t corrected, the soft bones on one side of your baby’s face can be flattened, making your child’s features asymmetric. The good news is that this can usually be reversed if the torticollis is corrected before your baby is around 1 year old.

The Big Picture

Torticollis is a treatable condition. If you suspect your baby has it, see the doctor for a diagnosis as soon as possible so treatment can begin sooner rather than later. In time and with the right treatment, the condition will improve and your little one will have no trouble looking around at all the exciting new things to see as he or she continues to explore the world with your help and guidance.