What is congenital torticollis?

When you become a parent, you receive a lot of information about your baby's health. Congenital torticollis is a fairly common problem in infants, but what exactly is it?


Is congenital torticollis the same condition as torticollis in adults?

Congenital torticollis is different from the "torticollis" that adults may experience after sleeping in an awkward position. In infants, it is usually caused by a shortening or stiffening of a neck muscle, called the sternocleidomastoid muscle. This tighter muscle causes the baby's head to tilt to one side, while their face turns to the other side.

The most common cause is the baby's position in the uterus during pregnancy, especially when space is more restricted (for example, during a first pregnancy). More rarely, other abnormalities can also be responsible for torticollis.


Is congenital torticollis common?

Yes, nearly 4% to 16% of newborns are affected. It is one of the most common congenital musculoskeletal abnormalities.

Several factors can increase the risk of developing torticollis, including a first pregnancy, limited space in the uterus during pregnancy, certain difficult deliveries, the presence of plagiocephaly (flattening of the head), which is closely related to torticollis, and the baby's body length. Additionally, since infants move very little, they can spend a lot of time in the same position, which can also promote its occurrence.


How can I recognize torticollis in my baby?

You might notice that your baby almost always prefers to look to the same side, both when awake and asleep, often tilts their head to the same side, turns their head less easily to one side than the other, or has a flattened head (plagiocephaly).

In some cases, a healthcare professional may feel a small lump in the neck muscle. Depending on the severity of the torticollis, the baby may also develop compensatory postures, for example, in the shoulders, trunk, or the rest of the body.


When should I seek help for congenital torticollis?

It is recommended to seek help as soon as you notice that your baby has one or more of the signs described above, and it's never too early—a physiotherapist can intervene from the first days of life!

To obtain services in the public network, a medical prescription is usually required. Additionally, you can consult a pediatric physiotherapist directly in a private clinic without a medical prescription. Early intervention is important because the earlier treatment begins, the shorter and more effective it generally is. Current studies show that:

  • Treatment started before 1 month: 98.6% of infants with congenital muscular torticollis (CMT) achieve good results after an average of 1.5 months of treatment.
  • Started between 3 and 6 months: average duration 7.2 months, with 62% achieving good results.

The goal of treatment is to allow the baby to regain good neck mobility and promote symmetrical development of the head, face, and neck.


Can torticollis in babies be prevented?

A few simple habits can help reduce the risk:

  • Encourage tummy time every day, starting from the first 2 to 3 days of life when the infant is awake, with supervision.
    • 3-5 minutes each time up to 15-30 minutes/day by 7 weeks of life
    • Minimum 30 minutes per day by 6 months
  • Encourage your baby to turn their head to both sides during awake periods;
  • Alternate the side where you place your baby on the changing table;
  • Vary play positions;
  • Carry your baby sometimes on one side, sometimes on the other, so they naturally turn their head to both sides;
  • Limit time spent in car seats, swings,
    "babybjorn," various seats, or other equipment where the head remains in the same position for a long time.

Sources:

  • Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical therapy management of congenital muscular torticollis: a 2024 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2024;36(4):370-421. doi:10.1097/PEP.0000000000001114
  • Han MH, Kang JY, Do HJ, et al. Comparison of clinical findings of congenital muscular torticollis between patients with and without sternocleidomastoid lesions as determined by ultrasonography. J Pediatr Orthop. 2019;39(5):226-231. doi:10.1097/BPO.0000000000001297
  • Do TT. Congenital muscular torticollis: current concepts and review of treatment. Curr Opin Pediatr. 2006;18(1):26-29. doi:10.1097/01.mop.0000192520.48473.44
  • Van Vlimmeren LA, Helders PJM, van Adrichem LNA, Engelbert RHH. Torticollis and plagiocephaly in infancy: therapeutic strategies. Pediatr Rehabil. 2006;9(1):40-46. doi:10.1080/13638490500235660
  • Aarnivala HE, Valkama AM, Pirttiniemi PM. Cranial shape, size, and cervical motion in normal newborns. Early Hum Dev. 2014;90(8):425-430. doi:10.1016/j.earlhumdev.2014.05.009