Does My Baby Have Torticollis? Signs, Symptoms, and Treatment Options
Noticing that your baby’s head tilts to one side, or that they seem to prefer looking in one direction, can bring up a lot of questions. During infancy, one possible cause could be torticollis. The good news is that torticollis is very treatable, and early support can make treatment easier.
This blog was written by Kaitlyn Kelly, DPT and Mikaela Magee, DPT, pediatric physical therapists at Cheshire Fitness Zone.
What is torticollis?
Torticollis is the medical term for a tight muscle in the neck, most commonly the sternocleidomastoid (also known as the SCM). Just like any other muscle in the body, this neck muscle can get tight, causing decreased range of motion of the neck and potential discomfort. If your child has torticollis, they might prefer to look one direction or their head may appear tilted.
Signs and symptoms of torticollis may include:
• Appearance of a “tilted” or “rotated” head
• Aversion to looking one direction
• Poor tummy time tolerance
• Difficulty latching on one side
• Asymmetrical head shape (torticollis is commonly seen along with plagiocephaly, or flatness on part of the head)
• One ear higher than the other
• The cheek or forehead on one side of the face more forward than the other side
• One eye appearing larger than the other
What do I do if I suspect my child has torticollis?
If you suspect your child may have torticollis, talk to your pediatrician and ask for a referral to physical therapy. The earlier you are able to schedule a physical therapy evaluation, the easier torticollis is to treat.
What can I do while I wait for a referral to physical therapy?
See below for a list of positioning techniques that can be incorporated at the suspicion of torticollis. Work to frequently change the child’s positioning, and incorporate positioning into all routines if possible, including playing, feeding, carrying, and sleep.
The goal is to encourage movement and symmetry throughout the day, not just during “exercise time.”
- Alternate end of crib
- Alternate end of changing table
- Be aware of toy placement
- Have baby turn their head to look over their tight side
- Alternate carrying routines
- Change arms for feeding
- Encourage baby to turn toward their tight side or feed midline facing forward
- Adapt all areas of home to provide visual stimulation
- Change toys, mobile, and crib positions
- Provide midline play opportunities
- Limit use of ALL containers: car seat, infant swing, and infant carriers
- Use cushioned head support
- Prevent pressure on the same side
How is torticollis treated?
Torticollis is treated through a series of positioning techniques, gentle stretching, and strengthening techniques. You will first need to contact your pediatrician and obtain a referral for a Physical Therapy evaluation. Following a physical therapy evaluation, the therapist will teach the caregiver stretches and techniques most beneficial for use with the child.
A pediatric physical therapist will guide you through several strategies, stretches, and techniques that are specific to your child.
Once full range of motion is restored, it is important to also incorporate strengthening exercises to ensure symmetrical strength. If symmetrical strength is not achieved following restoration of full range of motion, we may see a return of the torticollis, or development of asymmetrical gross motor skills.
This is why therapy often includes more than stretching. Strength and symmetry matter just as much as range of motion.
At your physical therapy evaluation the therapist will set a series of goals for your child. After 3-4 months, the therapist will reassess goals, and determine if continued monitoring and/ or treatment is needed. Typically your child will be monitored through restoration of full neck range of motion, attainment of symmetrical strength, and development of symmetrical gross motor skills. The duration of physical therapy looks different for every child and family.
Your PT will help you understand what goals are being worked on and what progress looks like over time.
What does physical therapy look like for an infant with torticollis?
Physical therapy for adults looks very different from physical therapy for infants. PT for infants is largely reliant on participation from caregivers and completion of a home exercise program. During PT, therapists work closely with parents to teach stretches, strengthening exercises, and facilitation techniques. For optimal progress and results from physical therapy, it is important to carry out the home exercise plan.
How long will my child be in physical therapy?
Physical therapy is different for every child. Typically your child will be monitored through restoration of full neck range of motion, attainment of symmetrical strength, and development of symmetrical gross motor skills. Even after torticollis seems to be resolved or is improving, a preference (tilt or rotation) can reappear if your child is upset, getting sick or even working on a new gross motor skill. It is important to monitor this preference and restart any stretches or exercises that your physical therapist provided in order to maintain mobility. Most of the time, the preference will subside once the skill or illness is finished.
What will happen at my child’s physical therapy evaluation?
At your child’s physical therapy evaluation, the evaluating therapist will take a thorough birth, medical, and social history and get to know your child. They will then take a series of measurements, assessing not only neck tightness but screening your child’s whole body for any of the frequently seen conditions that are associated with torticollis. They will assess your child’s movements and motor skills in different positions- on their back, on their belly, sitting and potentially standing. They may also measure your child’s head and look for facial asymmetries. Together, you will come up with an individualized plan for your child. The therapist may then teach you initial stretches or positioning techniques to complete at home.
How Cheshire Fitness Zone Can Help
If you have concerns about your baby’s head position, neck range of motion, or tolerance for tummy time, the pediatric physical therapy team at Cheshire Fitness Zone is here to help support your child’s development and guide you through the next steps.
Meet the Authors
Mikaela Magee, DPT
Mikaela graduated from Sacred Heart University. She is a physical therapist who supports children with developmental delays, Down syndrome, and cerebral palsy. She is trained in DMI Level A and B and the Universal Exercise Unit. Mikaela enjoys working with families, coworkers, and vendors to provide well-rounded and quality care for patients. Outside of work, she enjoys reading and spending time with friends and family.
Kaitlyn Kelly, DPT
Kaitlyn graduated from Quinnipiac University and joined Cheshire Fitness Zone in 2023.
Kaitlyn supports children across a variety of motor needs and especially enjoys supporting children with neurological differences and developmental delays. She enjoys helping children build strength, mobility, and confidence through individualized care. Kaitlyn is Dynamic Movement Intervention (DMI) Level C certified and trained in the Universal Exercise Unit. Outside of work, she enjoys working out, reading, spending time with family and friends, and going to the beach.
