Luke 18:16 – But Jesus called the children to him and said, “Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these.”

General speaking, torticollis is an abnormal position of the head and neck.  The word “torticollis” comes from the Latin words tortus, meaning “twisted” and collum meaning “neck”.  An infant who has torticollis will persistently hold their head tilted to one side and rotated.  

What causes torticollis? 

Torticollis is often caused by a tightness or shortening in the sternocleidomastoid (SCM) muscle on one side of the neck.  The SCM affects the positioning of the head and neck.  Torticollis can be congenital, acquired, or positional.  

Congenital muscular torticollis is the most common type of torticollis.  It is present at birth and can occur due to the positioning of the baby in the womb,  trauma to the SCM during birth, or atypical development of the SCM muscle.   There can be a thickening or a lump in the affected muscle as well as the neck or shoulder muscles as well.  

Acquired torticollis can occur due to trauma, visual deficits, soft tissue or bony irregularities.  This typically occurs in the first 4-6 months of life or later, and it may develop quickly or slowly.  

Positional torticollis can sometimes occur as a result of the baby’s position when sleeping on their back. 

If there are concerns that your baby may have torticollis, it is important to work with your doctor to find out the cause of your baby’s torticollis.  Your doctor will look at your baby’s head movements and may recommend further testing, if warranted.  Physical therapy can be a very effective treatment for torticollis, if it is recognized promptly.   

What are the signs of torticollis?

In congenital torticollis, the child has this at birth, however it may take several weeks for parents or providers to notice. This is because the infant is gaining more control of their head.  Babies who have torticollis may consistently tilt their head in one direction, prefer looking at you over one shoulder instead of turning their head to the other side, or become irritable when unable to turn their head to look at you from the other side. If breastfed, they may strongly prefer one side and have difficulty feeding on the opposite breast.  

As the baby gets older, they may be able to look straight ahead, but will have problems turning their head to the other side.  Parents often notice the persistent head tilt when looking at photos or at their child positioned in a car seat. 

Some babies with torticollis develop a flattening of their head on one or both sides from lying with their head in the same position all the time. This is called positional plagiocephaly and typically responds very well to physical therapy, especially when started early. 

Plagiocephaly can cause an asymmetry in the shape of the head and face.   You may notice one ear is forward compared to the other ear or that your baby may open their mouth unevenly.  Sometimes, one eye may appear “more open” compared to the other.  Another fairly common attribute is that one cheek may appear fuller compared to the other.  This is because the muscular tightness on one side of the face can make the facial features asymmetrical.  

How is Torticollis treated?

While the affected muscle (SCM) on one side of the neck may be tight and strong, it is common that the muscles on the other side of the neck are weak and stretched out.  One goal is to facilitate positioning your baby in a neutral, midline position so that the tight muscles are stretched and the weaker muscles are strengthened.  

If you suspect your child has torticollis, it is important to seek early care.  Outcomes for successful treatment and management of torticollis are influenced by how severe the torticollis is, how old your baby is when treatment is started, and how well you are able to follow through on your home exercise program.

 If your child has a significant flattening (plageocephaly) of the head, it is sometimes treated with the use of a helmet orthosis.  Your physician will determine if that is a necessary treatment step based on the child’s presentation.

How long will it take for muscular torticollis to improve?

In general, the majority of children with congenital muscular torticollis will demonstrate improvements in one to two months of physical therapy.  The earlier the intervention, the quicker and better the outcome.  Every child is different, so please discuss any concerns you may have with your doctor or physical therapist.  

How can this be treated by telehealth care?

With the help of your medical team, there is plenty that you can do to help treat your baby’s torticollis.  After a primary care provider (MD, DO, NP, PA) has diagnosed your infant with torticollis, a physical therapist referral is instrumental in treating this condition.  A physical therapist (virtual or in person) can direct you in positioning, stretching, strengthening, and motor development tasks to effectively treat most cases of muscular torticollis.  This can be successfully done virtually, allowing you the comfort and convenience of being seen in your own home environment.  

If there are any concerns that cannot be addressed in the virtual setting, your physical therapist or other medical provider would refer you to be seen in the clinic or office setting.  

Mark 9:37 – “Whoever welcomes one of these little children in my name welcomes me; and whoever welcomes me does not welcome me but the one who sent me.”

Author: Kelsey Goraczkowski, PT, DPT, Physical Therapist with MyCatholicDoctor

Editor: Samantha Wright, Director of Education and Online Resources with MyCatholicDoctor

Make an appointment or send Dr. Goraczkowski a message: 

Kelsey Goraczkowski, PT, DPT

Leave a reply