Home Page

Date issued: December 2022

Review date: December 2024

Ref: A-452/LB/Physiotherapy/Torticollis v2

PDF:  Torticollis final December 2022 v2.pdf [pdf] 366KB

What is Torticollis?

Torticollis is a term used to describe tightness in a muscle of your child’s neck. The muscle affected is called the sternocleidomastoid and joins the base of the skull to the collarbone. In babies with torticollis, this muscle is shorter on one side, so they lie with their head tilted to one side and rotated to the other. You may notice that your baby tends to look more in one direction than the other.

 There are different types of torticollis. The most common form is a tightening of the neck muscles on one side (known as muscular torticollis), which is responsible for approximately 80% of cases. Other causes include problems in the formation of the neck bones or muscles, inflammation, neurological problems, tumours and trauma.

What causes muscular Torticollis?

This isn’t known although it is thought that it could be due to the limitation of space inside the mother’s uterus, causing the baby’s head to be stuck in one position for a period of time so that the baby is not able to move its neck.

Sometimes, a lump of fibrous tissue may be felt in the affected muscle, known as a ‘sternocleidomastoid tumour’ which appears during the first three months and usually disappears by five to six months.

What are the signs of Torticollis?

• Your baby will prefer to turn their head to one side. They will have problems turning their head fully from side to side and will often keep their head turned only to one preferred side.

• Your baby may tilt their head to one side with one ear closer to their shoulder.

•  Your baby’s head may be misshaped with a flattening or bulging on the back or side of the head. This is called plagiocephaly. You may also notice one ear is forward of the other ear or there may be some facial asymmetry

• The behaviour of your baby may be affected with them being fussy when you try to change the position of their head or when they are put on their tummy because they are not able to lift or turn their head.

• Some breastfed babies may struggle to latch on to one side due to the muscular tightness, but this should improve with time.

How is it treated?

Treatment is most successful if the condition is detected early and involves education to parents as well as stretching techniques for the tight muscles of the neck and shoulder.

There is an increased risk of hip dysplasia in children with muscular torticollis, so your baby may have also been referred for an ultrasound examination of the hips to rule this out.

What can I do to help my child?

Encourage your baby to turn their head towards the side they normally avoid.

The examples throughout this booklet are for a right head turning preference. If your baby prefers to look to the left, reverse the instructions.

• Turn your baby’s cot so he has to look to the left to see you approach.

• Put interesting cot toys or a mobile on your baby’s left side.

• During floor play position your child so all the visual stimuli is on their left side.

• During play encourage the child to lie on either side to gain the midline position of the head.

• Try turning your baby’s head to the left when he is asleep.

• Little and often tummy time, encourage him to look up and especially to the left. If he is struggling, you can put a rolled-up towel under his chest to help.

Tummy time should always be supervised, and you should not put your child on their tummy to sleep!

• When holding your baby against your shoulder put him on your right as he will turn to his left to look around and your cheek will prevent him turning to the right.

• Consider the use of a baby sling as an alternative to a buggy to avoid constant pressure on one side of your baby’s head.

• If your baby is bottle fed, hold him with his head on your right arm and encourage him to look round to his left for his bottle, and to see you.

Stretching Exercises

Exercises can be carried out with your child lying on their back, sitting on your lap or propped on your legs like in the picture. Your physiotherapist will demonstrate these positions for you.

Neck rotation stretches

With one hand, gently hold their right shoulder against the surface. Place your open palm gently on your baby’s cheek. Slowly help your baby turn their head to their left side.

You can also work on this by rolling your baby’s body to their right, gently holding their cheek with one hand and allowing their shoulder to roll back to the surface.

Lateral head tilt stretches

Use one hand to gently hold your baby’s left shoulder against the surface. Place your other hand under your baby’s head. Slowly bring their right ear towards their right shoulder.

Side Superman Stretch

Place your baby across your body in side lying with tight side down, use one arm to come through your baby’s legs so the inside of your elbow is on their nappy. Use your hand to hold your baby’s shoulder. Using your other arm, come across the chest and use the inside of the elbow to lift their left ear towards their shoulder.

General Stretching Advice

• Work gently within your baby’s tolerance.

• Slowly increase the motion over time.

• Find the position and time of day that works best for your baby.

• Hold these gentle stretches for as long as tolerated.

• Stop the stretch sooner if your baby starts to resist the motion or becomes fussy.

• You should never feel like you are forcing the motion.

• Use your voice or favourite toys to distract and soothe your baby.