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BVHS Weekend Column: Torticollis

Is your infant only looking to one side? Do they constantly tilt their head to one direction? Torticollis is a condition where the muscles on the side of your child’s neck are tight, which prevents them from turning their head to both sides equally, or they tilt their head to one side more than the other. There are two types of torticollis. The first being congenital torticollis, which means present at birth. The second is called acquired torticollis, which means occurred later in infancy or even childhood.


Congenital muscular torticollis is a common condition in infants when they are born with weak neck muscles, leading them to have difficulty moving their heads. This condition affects up to two percent of newborns but might not be noticed until the baby is a few weeks old, and they are starting to gain more head control. It is very important to start treatment at or before three months of age for improved response to this condition. This type of torticollis is also associated with plagiocephaly, or an asymmetry of head and face shape.

Acquired torticollis often appears at four to six months old or later and might gradually arise or suddenly appear. Commonly, no facial asymmetry is noted with acquired torticollis. Acquired torticollis is often benign but it can also be a sign of a more serious health issue. Your health care provider needs to be notified of any new changes in neck positioning.

Often, parents and family members are the first to notice the following signs of possible torticollis. The following are things to watch out for: consistently holding head tilted or turned to one side, difficulty turning head to one side vs the other, difficulty nursing or taking a bottle from one side versus the other, a pea-sized, firm bump that can be felt on side of neck, skin irritation or redness on side of neck, difficulty cleaning one side of the neck versus the other, asymmetrical head shape with one side flatter than the other and facial or ear asymmetry.

If parents and/or family members notice any of these signs, it is important to discuss with their physician as soon as possible so that treatment can be started early. Commonly, physicians will refer the infant to a pediatric physical therapist to improve neck movement and strength. At physical therapy, the pediatric physical therapist will use toys to engage your child in age appropriate play to improve their neck range of motion and strength. The therapist will also educate the parents/family on activities and exercises to work on at home to improve neck movement and prevent any abnormal head molding or abnormal head flattening.

Activities to prevent these issues include tummy time, supported sitting, changing positions/sides while changing diapers, engaging the child from both sides, alternating feeding/nursing from both sides, alternate carrying the infant in both arms and limiting time in “container toys,” swings, bouncers or car seats.

Ask your provider today if physical therapy is right for your child.

Lisa Stewart, Physical Therapist
Julie A. Cole Rehab and Sports Medicine Clinic

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