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Congenital Torticollis: The Tilted Head And Neck

Have you ever seen an infant that seems to favor moving his/her head to one side or direction? It may be that the neck twists or that the head tilts, but there is definitely a preference to one side over the other. This is a phenomenon called torticollis or wryneck. Torticollis in Latin means “twisted neck.”

Why does it happen?

When you grow a whole human in a tiny sac, things are bound to get cramped. If the infant is positioned in the womb such that the head/neck is bent, then the child is likely to prefer that side when he/she is out of the womb. Difficult childbirths (like those that require forceps or vacuums) can also put strain or stress on neck muscles and cause torticollis. While congenital torticollis is usually noticeable at the time of birth, it can take a couple of months to develop.

Although rare, it is also worth mentioning that torticollis can happen as a result of the bones in the neck (called cervical vertebrae) having malformations. This can be seen in conditions like Klippel-Feil syndrome.

Think of the last time you slept funny and woke up with a tight, painful (“twisted”) neck. In essence, you experienced to a small degree what torticollis is like.

What exactly is torticollis?

In torticollis the neck muscles get tight, short, and pull the head to one side. The muscles involved are the sternocleidomastoids. These are the muscles that run along the side of the neck (from the collarbone to the skull).

How is it diagnosed?

The diagnosis is completely clinical. An experienced doctor will be able to do an exam on the infant and determine that the baby has torticollis. Fancy/expensive imaging is not necessary to make the diagnosis. If the torticollis has been present for a while, the child may develop a flat head (on the side that he/she favors). The medical term for this is plagiocephaly. See Babies with Flat Heads.

How is it treated?

The good news is that congenital torticollis is treatable. The treatment generally involves frequent, gentle stretching exercises. This will loosen the tight muscles and strengthen the weaker muscles. Sometimes infants will be referred to a physical therapist for more intensive, targeted therapy. A physical therapist will work on range of motion and stretching exercises.

What can I do at home?

In addition to any exercises suggested by your doctor or physical therapist, making a conscious effort to reposition your baby to optimize neck movement can make a huge difference.

  1. Feeds: Typically when babies feed, the neck is positioned toward the person feeding. If that happens to be the direction the child favors, try repositioning during feeds. Either flip the baby and feed bottles with the opposite hand or change holds (cross cradle vs. football) when breast feeding.
  2. Holding: Try holding your infant in the other arms if the direction you currently hold the infant aggravates the torticollis.
  3. Sleeping: Most babies will prefer to look into the room (rather than the wall). Position the baby so that the room direction makes the infant move the head in the unfavored direction. Your pediatrician may also have you position your infant slightly onto his/her side (again, forcing the infants head to the side that he/she doesn’t like). This should be done only under the guidance of your pediatrician as sleeping directly on the back without any sleep positioners is the safest sleep environment in terms of SIDS.
  4. Playing: Using visual and verbal cues to try and get your infant to move his/her head in all directions.
  5. Tummy time: Make sure your infant gets lots of tummy time to help strengthen shoulder and neck muscles. Aim for a short intervals (just a few minutes) multiple times a day. Your infants arms should be positioned at the shoulders (rather than down by his/her sides) during tummy time. This allows for the arms to help “push up.”

What’s the prognosis?

The prognosis for torticollis is great. Most kids will resolve with stretching, strengthening, and time.

What does the hips have to do with torticollis?

You may have heard mentioned something about hip issues with congenital torticollis. This is because 10-20% of kids with congenital torticollis also have hip dysplasia (malformed hip joints). I only mention this so you make sure your doctor does a hip exam at the same time he/she is checking out your child’s neck.

Are there other types of torticollis?

While I really only addressed congenital torticollis here, there are other types as well. “Acquired” torticollis develops later (that is, the child isn’t born with it) and may require various other interventions to address it.

If you think that your child has congenital torticollis, discuss it with your doctor. In the meantime, don’t freak out. It’s fixable.