Condition: Congenital (infant) torticollis is a disorder in which a neck muscle is abnormally shortened, causing the head to tilt to one side of the body. It is seen at birth or the first few weeks of life.
Background: The muscle involved is the sternocleidomastoid, or SCM muscle. There are 2 SCM muscles, one on each side of the neck, running from the back of the ear to the collarbone. The job of the SCM is to rotate the head to the opposite side. In congenital torticollis, this muscle shortens and forces the head to tilt towards one side of the body.
Risk Factors: Congenital torticollis occurs in up to 2% of births and is more common in males, first-borns, and breech deliveries. Other risk factors include:
• Abnormal head positioning in the womb
• Difficult or complicated labor and delivery
Symptoms: Torticollis causes the baby’s head to tilt to one side, with the chin turned to the opposite side. The baby will have trouble moving their head out of this position. The baby may also have a small mass on the side of their neck. This is due to inflammation or blood collecting near the injured muscle. The baby may also have a flat spot on the back of their head. Symptoms of congenital torticollis are seen by six weeks of age. If they show up after this age, it is considered “acquired” torticollis.
History and Physical Exam: A physician will ask questions about the pregnancy and delivery as well as the baby’s medical problems. They will also look at the baby’s head and neck position, flexibility, muscles, reflexes, and strength. They may refer the patient to a physical medicine and rehabilitation (PM&R)
physician who specializes in diagnosing and treating musculoskeletal disorders.
Diagnostic Process: Usually congenital torticollis is diagnosed from the baby’s history and physical exam. Sometimes, an ultrasound can help with diagnosis. If there is concern for issues with the bones, injury, or tumors, the PM&R physician may order an x-ray, MRI, or CT scan.
Rehab Management: To improve neck rotation, the PM&R physician may recommend physical therapy (PT). The PM&R physician and PT will teach parents how to stretch the neck safely. They will also teach parents how to feed, hold, and position the baby to improve neck rotation. They may suggest:
• Feeding: place food or bottles on the opposite side so the baby turns to that side
• Play time: put a mirror or interesting toy on the opposite side so the baby looks that way
• Tummy time: place the baby on their tummy to strengthen the back and neck
The PM&R physician or PT will teach parents which exercises are best for their baby. Most babies will get better by 6 months of age with these exercises. They may recommend a special tape or collar to help with stretching if needed. If the muscles remain tight, medications such as botulinum toxin injections, can help.
Other Resources for Patients and Families: Recognizing symptoms and getting an early appointment helps the baby recover faster.