Infantile torticollis is a common musculoskeletal condition where a baby develops a persistent head tilt or turn preference, usually noticed within the first few months of life. This asymmetry occurs because one of the large neck muscles, the sternocleidomastoid (SCM), is shortened or tightened, pulling the head out of alignment. While the condition can be concerning for parents, the most common form, congenital muscular torticollis, is highly treatable. Successful outcomes depend significantly on prompt identification and consistent follow-through with a prescribed treatment plan.
Recognizing the Condition and Seeking Professional Guidance
Parents often first observe torticollis as their baby’s head consistently rests tilted to one side, with the chin rotated toward the opposite shoulder. Other subtle signs include a preference for looking in only one direction, which might make tracking objects difficult on the non-preferred side. During feeding, babies may show frustration or difficulty latching when positioned on the side that requires turning the head toward the tightened muscle. In some instances, a small, non-tender lump or thickening, sometimes called a pseudotumor, can be felt within the tight SCM muscle.
Because the condition encourages prolonged resting on one side of the head, a common complication is positional plagiocephaly, or a flattening of the skull. Observing these signs requires an immediate consultation with a pediatrician for a definitive diagnosis. The pediatrician will assess the baby’s passive and active range of motion and typically refer the baby to a pediatric physical therapist (PT).
The Core Role of Targeted Stretching and Physical Therapy
Physical therapy forms the foundation of treatment, focusing on two primary goals: gently lengthening the restricted SCM muscle and strengthening the opposing, weaker neck muscles. The therapist will conduct passive range of motion exercises, which involve the practitioner or parent slowly moving the baby’s head to stretch the tight muscle. These stretches include lateral neck flexion, where the ear is moved toward the opposite shoulder, and rotation stretches, where the chin is gently turned toward the tight side.
Parents are taught a specific home exercise program to integrate these stretches multiple times a day, often during routine activities like diaper changes. Parents must receive hands-on instruction from the PT to ensure proper technique and safety before attempting any stretches. Active range of motion exercises are also incorporated, which encourage the baby to voluntarily move their head away from the preferred position. These exercises help build the necessary muscle control and strength to maintain the head in a neutral midline position.
The PT also introduces exercises designed to develop strength in the neck, shoulder, and trunk (postural control). These therapeutic activities are crucial for counteracting the muscle imbalance caused by the tight SCM. Consistency in performing the home exercise program is paramount, as frequent stretching drives the necessary structural changes in the muscle tissue.
Daily Positioning Techniques for Correction
Treatment extends beyond manual stretching and involves strategic environmental manipulation to encourage the baby to turn their head actively. Supervised Tummy Time is an important technique, as it forces the baby to lift and rotate their head against gravity, strengthening both the neck and trunk muscles. Parents should place the baby on their stomach on a firm surface for multiple short sessions throughout the day.
During playtime, toys, lights, and other visual stimuli should be strategically placed to encourage the baby to turn their head toward the non-preferred side. Similarly, when parents interact with the baby, they should position themselves so the baby must rotate or tilt their head in the direction of the restricted movement to maintain eye contact.
Adjusting carrying and feeding positions further reinforces therapeutic goals by placing the head and neck in a corrective alignment. When holding the baby, positions like the “football hold” can be used to naturally side-bend the neck away from the tight muscle. During bottle or breastfeeding, switching sides forces the baby to turn their head fully in both directions, promoting bilateral neck flexibility. In the crib, positioning the baby so the light source or activity is on the non-preferred side encourages necessary head turning.
Treatment Timeline and Advanced Interventions
The prognosis for congenital muscular torticollis is excellent, especially when intervention begins early, ideally before six months of age. Most infants show significant improvement within six months of consistent physical therapy and home exercise implementation. The condition is often fully resolved by 12 months of age, with high success rates reported for early-treated cases.
The duration of therapy can vary based on the severity of the SCM muscle tightness and the baby’s response to the exercises. If the baby shows minimal progress after several months of diligent physical therapy, the pediatrician or physical therapist may discuss advanced interventions. This could include a referral to an orthopedic specialist for further evaluation. In rare cases where conservative treatment over 12 to 24 months fails to restore full neck range of motion, a surgical procedure, such as a sternocleidomastoid muscle release, may be considered.