Patient Guide: Torticollis in Infants

Torticollis is a condition of the neck that arises when a major muscle called the sternocleidomastoid “SCM” becomes physically shortened or excessively contracted. This shortening creates tension that pulls the head and holds it in a fixed tilted position. In newborns, it is thought that torticollis occurs because of trauma during delivery, or because of a malpositioned head while in the womb. Insufficient ‘tummy time’ can also contribute to the development of torticollis in babies. Importantly, there are additional causes of torticollis that should be ruled out by a physician or paediatrician before pursuing physiotherapy for your newborn.

Symptoms of Torticollis in Infants:

• The head will appear to be bent toward one shoulder and tilted to the opposite side, due to the tension in the SCM muscle on one side of the neck.
• The back of the head may appear more flattened on one side, due to the baby primarily sleeping on one area of the skull as a result of the tilted neck position.
• It may be more difficult to breastfeed on one side, as your baby’s head is preferentially tilted to one side.
• You may feel a nodule or mass within the SCM muscle on one side of the neck (a form of benign tumour), which typically appears at the age of 2-4 weeks, then disappears gradually and is gone by age 5-8 months.

Self-Help Treatment Tips for Torticollis in Infants:

• Re-create symmetry in your baby’s head position by using a soft bolster placed next to tilt side of the head, whenever possible.
•  Retrain your baby’s head position by stimulating the baby near their mouth or on their face on the side opposite to the tilt.
•  Follow the daily stretching exercises demonstrated to you by your physiotherapist.
•  Consider initiating more ‘tummy time’ for your baby which further strengthens the neck muscles.
•  It is important to ensure that other causes of torticollis have been ruled out by your physician or paediatrician.  If the stretching and bolstering protocol does not resolve the torticollis, surgical release of the SCM muscle may be required in rare cases.

Physiotherapy Treatment for Torticollis in Infants:

• Gentle manual stretching of the affected SCM muscle.
• Education to parents and caregivers focusing on proper head bolster positioning, stimulation cues to use with your baby to retrain symmetry in the head position, and at-home stretches for parents to perform on their newborn.
•  Strengthening exercises for the opposing muscle groups which become weaker due to the tilted head position.