Recognizing Congenital Muscular Torticollis in Your Newborn

Written by Catie Christensen, DPT and Allison Rish, MPT, Physical Therapy Team

All children are born with weak neck muscles making it difficult for them to control their head. As a result, they frequently rest with their head tilted or turned to one side. This is expected and is not a concern. If an infant consistently holds his or her head turned or tilted to one side more than the other, however it could be a sign of a condition called congenital muscular torticollis. This condition affects up to 2 percent of the newborns and is caused by a tight muscle on one side of the neck.

Research indicates that beginning treatment for torticollis at or before 3 months of age is vital to reducing recovery time and regaining full neck motion.  Parents are often the first to recognize torticollis making it important for them to understand the signs. Here’s what you should watch for:

• An infant consistently holding his or her head tilted or turned to one side
• More difficulty turning his or her head to one side as compared to the other
• More difficulty breastfeeding or taking a bottle from one side as compared to the other
• A pea size, firm bump that can be felt on the side of the neck
• Skin irritation or redness on one side of the neck
• More difficulty cleaning one side of the neck

If a parent is concerned that their child may be displaying signs of torticollis it is important to discuss it with the pediatrician as soon as possible to be sure treatment can begin at an early age. Pediatricians often refer infants to physical therapy. Early research indicates that attending physical therapy allows children to recover more quickly than when exercises are completed only by a parent.

At physical therapy, children with torticollis go through an evaluation to identify which muscle is tight and the degree of tightness present. The infant’s neck strength, head shape, and gross motor skills are also evaluated. The therapist will recommend how often the child will need to attend treatment which generally ranges from every other week to weekly. The family is taught gentle neck stretching and strengthening exercises which are completed at least four times per day. In addition, the physical therapist will provide education on how to encourage neck turning in the direction the child is having a hard time looking and will review positioning techniques. Recommendations may include:

• Increasing tummy time when the child is awake. Never place a child on his or her tummy when sleeping.
• Reducing time in a reclined position such as a swing, bouncy chair, or car seat. It is always important to have your child in a car seat when in a car.
• Positioning toys on the side of the child to encourage him or her to turn their head in the direction that is more difficult.

In most children, torticollis can be corrected through consistent physical therapy and parent adherence to a home exercise program. It is important however to begin treatment as early as possible to achieve optimal results.