Understanding Baby Torticollis

You may have noticed your baby prefers to look in one direction, or that they tilt their head down to one side. Perhaps your baby’s head shape is looking a little asymmetrical or flat on one side. This could be due to a Torticollis, and if you know the early signs and ideas of what to do, it can be picked up and treated quickly.

Torticollis means ‘twisted neck’ in Latin. It is a condition characterized by a preferential head turn, i.e. baby only being able to turn their head fully in one direction, and can also cause an asymmetrical head tilt and flat spots on baby’s head.

Torticollis is one of the most common baby orthopaedic conditions I see both within the NHS and private settings, alongside Plagiocephaly and Positional Talipes. Seeking early assessment and intervention is vital for effective management.

With treatment, Torticollis will resolve, but if left untreated it can cause permanent changes to your baby’s head shape, effect gross motor development, restrict normal movement patterns and leave a permanent limitations to range of movement and even require surgery.

Causes of Torticollis in Babies

So why does it happen?

Torticollis is caused by shortening of the sternocleidomastoid muscle. The Sternocleidomastoid is a muscle that connects the base of your skull to your collar bone. Tightness in this muscle can cause your baby’s head to tilt and turn in one direction. It may be present at birth but can also develop in the first few months of life.

It is not always clear why a baby develops Torticollis, but some factors may include:

1) Foetal position in utero- this is thought to be the most common reason for a Torticollis. Lack of space in utero and positional preferences may lead to muscle imbalance of the sternocleidomastoid muscles on both sides of the neck. This can lead to a preferential head turn. Torticollis is more common in breech presentation babies.

2) Assisted delivery- traumatic or difficult births, especially those using ventouse or forceps have a higher incidence of Torticollis as a result of muscle or tissue damage in the neck.

3) Repetitive patterns of movement- if baby’s attention is constantly drawn to one side for a favourite toy for example, it may contribute to development of a preferential head turn.

4) Muscle abnormalities: in rare cases, babies may have muscle abnormalities such as shortened or tight neck muscles which cause a Torticollis. Torticollis can also be caused by a sternocleidomastoid tumour, which is a benign swelling in the muscle. This occurs on just one side of the neck.

5) Head flattening caused by caused by Plagiocephaly can also lead to Torticollis. A flattened area on the skull makes it hard for a baby to turn their head, but also lack of movement due to a Torticollis can cause a flat spot. Often one of the first symptoms parents notice, is their baby developing a flat spot on their head.

Symptoms of Torticollis in Babies

It is important for parents and caregivers to watch out for the following signs and symptoms that may indicate a Torticollis:

1) Limited range of movement- the inability of baby to turn their head fully in one direction and difficulty holding their head in the midline.

2) Resistance to passive movement- if you try to passively turn your baby’s head to the non-preferential side, you will likely feel some resistance to the movement. Baby may appear uncomfortable with the stretch.

3) Muscle tightness- the muscles on one side of your baby’s neck may feel tight on palpation, or you may feel a lump or swelling (sternomastoid tumour) in the muscle.

4) Feeding difficulties- babies with Torticollis may have difficulty feeding on one side (whether breast of bottle fed) due to the restricted neck movement.

5) Plagiocephaly- as mentioned, there is a strong link with Plagiocephaly and Torticollis, therefore if your baby has a flat spot on their head, they may develop a preferential head turn as a result.

6) Head tilt- due to muscle imbalances and tightness, a head tilt over to one side may be indicative of a Torticollis.

7) Developmental delay- in some cases, Torticollis may be associated with delays in meeting developmental milestones.

Treatment of Torticollis in Babies

Research shows that early intervention by a Paediatric or Baby Physiotherapist elicits the best outcomes.

Babies don’t usually feel any pain as a result of Torticollis, but need to learn how to turn their heads the opposite way. With treatment, the muscle will grow and stretch, but without intervention it may cause permanent limitation of the baby’s neck movement and require surgery when they are older.

*The following advice is provided as guidance only and is not a treatment plan for Torticollis. If you think your child has Torticollis or Plagiocephaly, it is recommended to seek a full assessment with a Paediatric Physiotherapist.

Treatments may include:

1) Stretches- prescribed passive stretches can help to improve range of movement in your baby’s neck. Parents and caregivers are taught how to perform the exercises at home.

2) Active movement exercises- Positioning toys to encourage your baby to turn to the non-preferential side can help to encourage range of movement.

3) Massage- massage techniques may also help to loosen the tight muscles in the neck.

4) Repositioning techniques and advice- changing your baby’s position can help to prevent the head turn progressing.

5) Tummy time- regular time on baby’s tummy can facilitate midline play, symmetrical development and thus aid head turning. It is also important to practice tummy time little and often to benefit overall gross motor development and prevent plagiocephaly.

Finding a Professional for Treatment

The NHS recommends Paediatric Physiotherapy as the first line treatment for Plagiocephaly and Torticollis.

If you think that your baby might have Torticollis, speak to your GP. They will be able to signpost or refer you to a local healthcare professional who can help. Depending on where you live, you may have local NHS services who are trained in treating baby Torticollis, but most localities do not have NHS Baby Orthopaedic Physiotherapy.

Unfortunately, in some cases, even if you have a local service, the waiting lists can be significant, therefore you may choose to seek private intervention. Bear in mind that children, especially babies, are not just small adults, they require a whole different skill set, so make sure that the professional has adequate training, experience and skills in paediatric therapy before you book.

Research shows that early intervention produces the best outcomes, therefore if you notice any of the symptoms above, try to seek intervention ASAP. Addressing the issues early will also decrease the risk of developing a secondary Plagiocephaly and longer-term issues such as developmental delay.

Prevention of Torticollis in Babies

To reduce the risk of torticollis developing or while you are waiting for an appointment, some things to try:

1) Avoid keeping your baby in the same position for too long, especially in ‘containers’ such as car seats, bouncer chairs etc.

2) Try turning baby round in the cot so that they have to look to the non-preferential side to see you.

3) Hold baby in positions where they have to look to the side they would normally avoid in order to see anything of interest.

4) Feed from both sides whether breast or bottle fed as this will encourage head turning in both directions.

5) Approach and play with your baby from both sides to encourage bilateral head turning.

6) Begin tummy time exercises as early as possible.

The Association of Paediatric Chartered Physiotherapists produces a leaflet on head turning preference and plagiocephaly which also has some useful things to try.

Conclusion

Torticollis in babies is a relatively common condition that can be effectively managed with early intervention by a Paediatric Physiotherapist.

It is important for parents and caregivers to be aware of the signs and symptoms and to consult a healthcare professional if they suspect any issues.

With treatment, most babies will regain full range of movement of their necks. Your baby’s movement should be monitored by a physiotherapist, and if there is no improvement with regular intervention over ~3 months, they may need a referral the Orthopaedic Department for further assessment.

For any further information, feel free to contact us.

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