Infant Torticollis: What Parents Need to Know

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Torticollis — Latin for “twisted neck” — is a head tilt caused by a shortened neck muscle typically on one side of the head. This causes a child or infant to tip the head to one side, while keeping the chin rotated to the opposite side. You may notice that baby keeps her head turned always to one side, or you may notice a flattening of the skull on one side of the head. These changes can cause her face or jaw to look uneven, and can cause permanent damage if left untreated.

Some researchers believe that fewer than 1% of babies have symptoms of infant torticollis at birth. Others have placed this number as high as 16%. Recent studies suggest the rate of torticollis is between 0.3% and 3.92% of live births. Twenty percent of babies with torticollis also present with hip dysplasia, a misalignment between the thighbone and the hip socket.

This post will discuss the causes of infant torticollis, types, diagnosis, treatment, and how to get help if your baby’s condition was caused by a birth injury.

What causes infant torticollis?

Researchers have theories about what might cause torticollis, but there is no known prevention strategy. Starting treatment early, however, can prevent the condition from worsening.

Torticollis may develop before birth (congenital torticollis) or after birth (acquired torticollis), and can even occur in adults. While in some cases no known cause can be found, torticollis may be caused by:

• heredity;
• problems with the nervous or muscular systems;
• baby’s head or spine was malpositioned before birth (such as with breech or transverse presentation, or in the cases of multiple babies in utero);
• birth trauma (especially if delivery is assisted by vacuum or forceps); or
• injury or illness (such as tonsillitis, reflux, tumors, accidents, drug side effects, etc.).

See also: Vacuum Extraction, Forceps Delivery, and Birth Trauma Risks

Types of torticollis

Congenital muscular torticollis is the most common form of head tilt in infants and children. It is caused by an injury to the sternocleidomastoid muscle (which connects the chest, head, and neck). It is typically diagnosed in the first two months after birth; Klippel-Feil syndrome is diagnosed when two or more of the neck vertebrae are fused before birth.

This type of head tilt responds well to physical therapy. It’s also possible for the vertebrae to become fractured or rotated, causing torticollis. These conditions are sometimes referred to as osseous torticollis.

Acquired torticollis occurs in the first year of baby’s life or later, starting slowly due to inflammation or coming on quickly due to injury. Conditions such as a sore throat or an upper respiratory infection can cause swelling and damage to the tissues of the upper spine and neck.

Sandifer syndrome is a head tilt associated with a hiatal hernia, causing the sufferer to keep her head in an abnormal position for comfort related to GI symptoms.

Occular torticollis happens when a heal-tilt occurs due to compensation for weakness of the eye muscles.

How is torticollis diagnosed?

Your doctor may suspect torticollis if your baby’s …

• Head is always tilted to one side (most often the right side) or chin is always tilted in one direction;
• Head movement is limited, or your baby doesn’t have full range of motion (such as when following a moving object from side to side or up and down);
• One shoulder is higher than the other;
• Neck muscles are swollen, occasionally with a hard lump in the muscle on one side of the neck.

Your child may experience headaches, head tremors, neck pain, and stiffness of the neck muscles, though these may not be obvious in an infant or not-yet-verbal child. See also: Baby Language: Communication Milestones for Ages 0-3

Infants with torticollis often have problems breastfeeding. When the neck is required to stretch to latching, it may be uncomfortable for baby. She may prefer one breast to the other, or may resist being held in certain positions.

A common side effect of torticollis in infants is plagiocephaly, or the flattening of one side of the head or face. Because torticollis keeps the neck turned in a particular direction, when baby is lying down in a crib or infant seat, the pressure is always applied to the same place on baby’s skull. This causes flat areas and is sometimes called positional plagiocephaly.

How do I treat my baby’s torticollis?

After taking a thorough physical exam, your child’s healthcare provider may suggest further diagnostic tests. These might include:

• X-ray or CT scan of baby’s neck
• MRI of the brain
• Electromyogram (EMG) to study the muscles involved
• Blood tests to rule out medical conditions that may cause head tilt

For congenital muscular torticollis, your baby’s doctor will likely have you begin stretching exercises to help loosen the tight muscles. You may need to take your baby to physical therapy, or the therapist or doctor may teach you how to do the exercises at home. Exercises need to be done several times per day, and work best when you can engage your baby playfully in the activity. In addition to the stretching, the doctor or physical therapist may recommend applying heat to or massaging the affected area. These stretches are typically successful when started early in life.

If the torticollis is triggered by inflammation or injury, treating the root cause will alleviate the head tilt symptoms. Researchers also are investigating the use of botulinum toxin (Botox®) injections to improve head tilt symptoms. Certain types of torticollis benefit from wearing a neck brace or from medications. Though rare, surgery may be recommended if other treatments do not help or if vertebrae are dislocated or fused.

Torticollis is easiest to treat in infants and children. The earlier the treatment starts, the more likely your child is to recover function without additional complications.

How can I get help?

Learning the correct way to perform the exercises and stretches with your baby — and doing them consistently at home — is the best way that parents can help their child with torticollis. Other ways parents can help include:

• Place interesting objects baby will want to gaze at on the side opposite baby’s injury — the window, toys with lights and sounds, etc. Or when the family is gathered, be sure to orient baby so she has to turn away from her injured side, thus stretching the muscle.
• Practice babywearing. Carrying your baby allows her to look in all directions at the interesting things you are seeing and doing, and it keeps from putting pressure on only one side of her head.
• When breastfeeding or bottle feeding, hold your baby in a way that requires her to turn to his less-favored side.
• Use tummy time as a way for baby to strengthen her torso and neck muscles. This also helps avoid positional plagiocephaly.
• Though doctors recommend always placing your baby on his back to sleep, be sure you position her head in the direction opposite the injury. Your doctor may recommend placing baby on her stomach if that helps to keep the neck stretched to the correct side.

If you know the cause of your baby’s torticollis was due to a birth injury, we may be able to help you recover costs for diagnosis, treatment, and more. Contact us today for a free case review.