What is Torticollis?

Torticollis is a problem involving the muscles of the neck that causes the head to tilt down. The term comes from two Latin words: tortus, which means twisted, and collum, which means neck. Sometimes it’s called “wryneck.”

If your baby has the condition at birth, it’s called congenital muscular torticollis. That’s the most common type.

Babies can also develop the condition after birth. Then it’s called “acquired,” rather than congenital. Acquired torticollis may be linked to other, more serious medical issues.

What Causes It?

You have a long muscle on each side of your neck that runs from the back of your ear to your collarbone. It is called the sternocleidomastoid, or SCM.

When your baby has torticollis, this ropy muscle is shortened on one side. Why does the muscle become shortened? Your baby might have been cramped in the womb or may have been in an abnormal position, such as a breech position. That can put extra pressure on one side of your infant’s head, which can cause the SCM to tighten.

If your doctor used forceps or a vacuum device during delivery, those also might have put pressure on your baby’s SCM.

Symptoms

You may not notice anything unusual about your baby for the first 6 or 8 weeks. It’s common for torticollis symptoms to become obvious once an infant gains more control of the head and neck.

Some of the symptoms you might see:

• Your child’s head tilts to one side with their chin pointed to the opposite shoulder. In about 75% of babies with torticollis, the right side is affected.
• Their head doesn’t turn side to side or up and down easily.
• You feel a soft lump in your baby’s neck muscle. This isn’t dangerous, and goes away within 6 months, usually.
• Your baby prefers to look over the shoulder at you. Their eyes don’t follow you because that would require turning their head.
• They have trouble breastfeeding on one side or prefers to feed on one side only.
• Your baby works hard to turn toward you, struggles to turn their head all the way, and becomes upset because the movement is hard.
• They might start getting a flat head on one side -- or both sides -- from lying in one position all the time. This is called “positional plagiocephaly.”

When Should I Call My Doctor?

If you notice signs that look like your baby might have torticollis, set up an exam with your doctor.

The doctor will start by checking how far your baby’s head will turn. They also may order imaging scans, such as X-rays and ultrasound, to check for other conditions. About 1 in 5 babies with torticollis will also have a hip problem.

Most babies with torticollis don’t have other medical problems. But it is sometimes linked to infections, broken bones, allergic reactions to medicines, or genetic conditions such as Down syndrome or Klippel-Feil syndrome (a rare bone disorder of the neck).

Why Treatment Matters

If you act early, you can help prevent any long-term problems for your baby. Without treatment, your baby might get complications, including:

• Less control of their head
• Limited reach on the affected side and less tracking with the eyes
• Delays in sitting and walking
• A problem feeding
• Poor balance
• Crooked crawling
• Rolling onto one side only

What You Can Do at Home

Try to get your baby to stretch those neck muscles. It’s the best treatment for torticollis, and it’s safe.

The doctor may teach you some specific exercises to do with your little one. These moves will help lengthen the tighter, short muscle and also strengthen the muscle on the opposite side.

Here are some other things you can do at home:

• Use your baby’s appetite as an incentive. Offer the bottle or your breast in a way that gets them to turn away from the favored side.
• Place toys so that your baby is forced to look both ways. Those with sounds and lights are really good at drawing their attention.
• Get them to play with their hands and feet. Babies like to bring their hands together and their feet up to their hands. When your baby does this, it builds up muscles they will need to crawl.
• Give them plenty of time on your tummy. Holding your baby this way will strengthen back and neck muscles and keep the back of their head from flattening. Ideally, they should have 15 minutes of tummy time 4 times a day. You can support them on your chest, across your lap, or on a pillow if that makes it easier.

Other Treatments

In addition to home treatment, your doctor may want your baby to see a physical therapist.

Once torticollis is diagnosed and stretching exercises start, most babies improve within 6 months. Two things can speed recovery: an early diagnosis and sticking to the treatment plan.

Very rarely, children with torticollis will need surgery to lengthen the sternocleidomastoid muscle. Doctors will usually wait until your child is a preschooler to consider this option.

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