Health Education

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What is torticollis?

Torticollis, also called “wry neck” is a condition where the child’s head is tilted to one side. It is usually detected at birth or up to 6 months of age.

What causes torticollis?

There may be more than one cause of torticollis. Perhaps the most common cause is intrauterine positioning of the head, causing shortening of the muscle. Many such children present at birth but it is not unusual to see 4-6 month olds beginning to tilt. Another cause of torticollis is bruising during the birthing process that may cause some bleeding into the muscles of the neck, specifically the sternocleidomastoid muscle. The hematoma (blood collection) within the muscle scars down over time, causing the muscle to shorten and then “pull” the head to the typical tilted position. Sometimes, there is an associated mass that can be seen or felt within the muscle, a hematoma that is in the process of forming scar tissue. This mass usually disappears by 3 months of age.

What are the symptoms of torticollis?

The condition does not cause pain, but over time, with increasing head tilt there can be some discomfort when the head is moved to the opposite side. The right side is involved in 75% of cases. In right torticollis, the child holds his head tilted to the right, with his face and chin rotated to the left. In a child with left torticollis, the head is tilted to the left and the face is rotated to the right. As mentioned earlier, some parents may notice a “lump” or knot on their child’s neck.

What if torticollis is not corrected?

In some mild cases, torticollis may resolve spontaneously. However, if torticollis remains uncorrected, the face on the side affected may stay "flattened" as the child grows and facial asymmetry may occur. This is reversible if the torticollis is corrected before age 6-9 months. Beyond that, some facial asymmetry may remain permanent. Often torticollis is associated with head plagiocephaly, or flattening, and both the torticollis and plagiocephaly worsen with time.

How is torticollis corrected?

Depending on the severity of the torticollis, we may refer you to a physical therapist. The mainstay of treatment includes stretching exercises to stretch the contracted sternocleidomastoid muscle 4-6 times a day.

What can be expected of the future?

When discovered early, and stretching exercises and positioning followed consistently, 80% recover completely with no long-term effects. In some cases that do not respond to exercises by age 1, more intense treatment may be warranted.

We may suggest you see a physical therapist to evaluate the severity of the torticollis and demonstrate stretching exercises. In addition to physical therapy, the following home exercises may be helpful. It may be easier for two people to do the exercises at first - one person can stabilize the shoulders while another does the stretching exercises with your child lying on his or her back. For best results, continue exercises daily until your child is one year of age or until we tell you to stop.

Stretching and Positioning

Instructions for stretching and positioning right torticollis is as follows (if your child has left torticollis, replace the word right with left and left with right):

  • First, sit with your back against the wall and knees bent. Place your child in your lap, with her back and knees tucked.
  • Hold her right shoulder down with your left hand.
  • Place your right hand on top of the right side of the child’s head, and slowly bend her head towards her left shoulder. Hold the position for 10 seconds. Repeat 15 times, 4 to 6 times a day.

Other recommendations that are helpful include:

  • Positioning: When your child is on her stomach, position all toys in the crib so that she has to turn her face to the opposite side of the torticollis.
  • Hold toys so that the child has to look up and out to the other side.
  • Reposition the child in crib so that activities in the room encourage her to look to the other.

Remember torticollis has nothing to do with what you as parents did or didn’t do. It can be almost always corrected with physical therapy and exercises.