What Is Torticollis? Signs, Causes, and Treatment for Babies
Quick Summary: Torticollis is tightness in neck muscles that causes babies to tilt or turn their head to one side. It's very treatable with early physical therapy intervention, typically resolving in 2-6 months when treatment starts before 6 months of age. Look for consistent head tilting, difficulty turning to one side, or flat spots on the head.
If you've noticed your baby consistently tilting their head to one side, having difficulty turning their head in one direction, or developing a flat spot, your baby may have torticollis. This condition is more common than many parents realize and is highly treatable with early intervention.
What Is Torticollis in Babies?
Torticollis is a condition where tightness or shortening in the neck muscles causes the head to tilt to one side and often turn to the opposite side. The primary muscle involved is the sternocleidomastoid, which runs from behind the ear down to the collarbone.
When this muscle is tight on one side, it creates the characteristic head positioning that parents notice. The condition can be present from birth (congenital) or develop in the first few months of life (acquired). While it may look concerning, torticollis is very treatable, especially when addressed early.
What Causes Torticollis in Babies?
Several factors can contribute to torticollis development. Positioning in the womb, particularly in breech presentations or when space is limited (as with twins), can cause muscle tightening. Birth trauma or difficult deliveries may result in muscle injury within the muscle.
Positional factors after birth also play a role. Consistently placing babies in the same position, excessive time in car seats or carriers, and limited tummy time can all contribute to muscle tightness. Some babies also develop torticollis from preferring to look in one direction, which then leads to muscle shortening over time.
Understanding the cause helps guide treatment, but regardless of the origin, early physical therapy intervention is the most effective approach.
How Do I Know if My Baby Has Torticollis?
The most obvious sign is a consistent head tilt to one side, often with the chin pointing toward the opposite shoulder. You may notice your baby has difficulty turning their head fully to one side or consistently looks in one direction.
Other signs include a preference for nursing on one side or difficulty feeding on one side, a flat spot developing on one side of the head (plagiocephaly), one shoulder appearing higher than the other, and resistance or crying when you try to move their head to the non-preferred position.
Some babies also show asymmetrical movement patterns, such as always reaching with one arm more than the other or rolling preferentially to one side. These signs often become more noticeable as babies become more active around 2-4 months of age.
What's the Connection Between Torticollis and Flat Head?
Torticollis and plagiocephaly (flat head syndrome) commonly occur together, with studies showing up to 90% of babies with torticollis also developing some degree of head flattening. This happens because the head positioning preference created by tight neck muscles leads to consistent pressure on one area of the skull.
The relationship works both ways. Sometimes torticollis develops first and causes head flattening, while other times positional preferences lead to both muscle tightening and skull flattening simultaneously. This is why both conditions are often treated together in physical therapy.
Addressing torticollis early can prevent the development of significant plagiocephaly, while treating existing flat head concerns requires addressing any underlying torticollis for optimal results.
When Should I Seek Help for My Baby's Torticollis?
Current guidelines recommend seeking evaluation as soon as you notice signs of torticollis, ideally before 3 months of age. Early intervention leads to faster resolution and prevents secondary complications like severe plagiocephaly or developmental delays.
Contact your pediatrician or request a pediatric physical therapy evaluation if you notice consistent head tilting or turning preferences, difficulty with head movement in one direction, developing flat spots on the head, feeding difficulties on one side, or any asymmetrical movement patterns.
Don't wait to see if it improves on its own. While some mild cases may resolve naturally, moderate to severe torticollis typically requires professional intervention, and starting treatment early significantly improves outcomes.
How Is Torticollis Treated?
Physical therapy is the primary treatment for infant torticollis. As a pediatric physical therapist, I use specific techniques tailored to your baby's individual needs and severity.
Treatment includes gentle stretching exercises to lengthen the tight sternocleidomastoid muscle, strengthening exercises for the weaker muscles on the opposite side, and positioning strategies to encourage movement in the restricted direction. I also teach parents home exercises and environmental modifications to support treatment between sessions.
The treatment approach is always gentle and appropriate for your baby's age and tolerance. Sessions typically involve play-based activities that encourage natural movement while addressing the muscle imbalances. Most babies tolerate treatment well, and many even enjoy the gentle movements.
How Long Does Torticollis Treatment Take?
Treatment duration depends on several factors, including the severity of tightness, age when treatment begins, and consistency with home exercises. Mild cases caught early (before 3 months) often resolve in 6-12 weeks, while moderate cases typically take 3-6 months of treatment.
More severe cases or those starting treatment after 6 months of age may require 6-12 months of intervention. However, most babies show noticeable improvement within the first 4-6 weeks of consistent treatment.
The key to success is early intervention and consistency with both therapy sessions and home exercises. Babies who receive regular PT and whose parents follow through with home programming consistently achieve the best outcomes.
What Happens if Torticollis Isn't Treated?
While torticollis itself isn't dangerous, leaving it untreated can lead to several complications. The most common is progressive plagiocephaly (head flattening), which can become severe enough to require helmet therapy if left unaddressed.
Untreated torticollis can also affect overall development. Babies may experience delays in rolling, sitting, and other motor milestones due to asymmetrical muscle patterns. Facial asymmetry can develop over time, and some children experience ongoing neck stiffness and movement limitations.
Early intervention prevents these complications and ensures your baby develops normal movement patterns and reaches developmental milestones appropriately.
Can I Do Anything at Home to Help?
While professional treatment is essential for torticollis, there are strategies you can use at home to support your baby's progress. Encourage tummy time on both sides, place toys and interesting objects on the restricted side to motivate head turning, and alternate which end of the crib your baby's head is positioned at during sleep.
During feeding, try to encourage nursing or bottle feeding on both sides, and when carrying your baby, vary your holding positions to promote balanced neck movement. However, these home strategies should complement, not replace, professional physical therapy for diagnosed torticollis.
Your physical therapist will teach you specific exercises and positioning techniques that are safe and appropriate for your baby's individual needs and severity level.
What Should I Expect During PT Sessions?
Physical therapy sessions for torticollis are designed to be gentle and engaging for your baby. My sessions typically last 60 minutes and may occur weekly or bi-weekly, tapering to a lower frequency as soon as appropriate, depending on your baby's needs and progress.
During sessions, I'll assess your baby's range of motion, strength, and movement patterns. Treatment includes gentle stretching and strengthening exercises, positioning activities, and play-based interventions that encourage natural movement in the restricted directions.
I'll also spend time teaching you home exercises, positioning strategies, and environmental modifications to support your baby's progress between sessions. Parent education and involvement are crucial components of successful torticollis treatment.
How Do I Know if Treatment Is Working?
Signs of improvement include increased ability to turn the head toward the previously restricted side, reduced head tilting during alert periods, improved symmetry in movement patterns, better tolerance of positioning on the affected side, and prevention or improvement of any head flattening.
Most parents notice changes within the first weeks of treatment, though complete resolution takes longer. Your physical therapist will regularly assess progress using standardized measurements and functional observations to ensure treatment is progressing appropriately.
The Bottom Line
Torticollis is a common and highly treatable condition when addressed early. The head tilting and turning preferences that parents notice are signs that professional evaluation is needed, not something to wait and see about.
Early physical therapy intervention is highly effective, with most babies achieving full resolution when treatment begins before 6 months of age. The key is recognizing the signs early and seeking professional help promptly rather than hoping it will resolve on its own.
If you notice any signs of torticollis in your baby, don't hesitate to seek evaluation. Early intervention prevents complications and ensures your baby develops normal movement patterns and reaches developmental milestones appropriately.
Frequently Asked Questions
Q: Is torticollis painful for my baby? A: Most babies with torticollis don't appear to be in pain, but they may show discomfort when their head is moved to the restricted position. The tightness is more limiting than painful.
Q: Can torticollis come back after treatment? A: While recurrence is uncommon when treatment is finished successfully, some babies may show mild torticollis symptoms when they're fatigued, sick, or stressed. This is usually temporary and resolves as they feel better. Maintaining good positioning habits and developmental activities helps prevent any significant regression.
Q: How often will my baby need physical therapy? A: Frequency depends on severity but typically ranges from weekly to bi-weekly sessions, tapering to a lower frequency as soon as appropriate. You and your physical therapist will determine the appropriate schedule based on your baby's individual needs and progress.
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P.S. This information is for educational purposes only. It is not medical advice and is not a substitute for skilled physical therapy intervention. While I am a physical therapist, I am not your child's physical therapist. If you have questions or concerns about your child's health and/or development, please contact your pediatrician.