You gently place your baby in the crib, only to notice they always tilt their head to one side. At first, it seems like a harmless habit—but could it be something more? Torticollis in babies is more common than many realize, yet its causes remain a mystery to many parents. Is it due to birth position, muscle tightness, or something unexpected? The answer might surprise you.
Find out how pediatric physical therapy torticollis supports baby health
How Does Torticollis Develop in Babies?
Torticollis occurs when the sternocleidomastoid muscle in a baby’s neck is tight and shortened. This causes the baby’s head to tilt to one side, restricting movement. Depending on when the condition appears, pediatric torticollis is classified into two main types: congenital and acquired.
- Congenital Torticollis: Present at birth, this is the most common form in babies. It develops when the neck muscle is unusually short or tight, leading to stiffness and difficulty moving the head.
- Acquired Torticollis: This develops after birth and can be caused by muscle inflammation, infections, or prolonged positioning in one direction.
Common Symptoms
Babies with torticollis may show the following signs:
- Head tilting to one side.
- Difficulty turning the head in both directions.
- Uneven head shape due to constant pressure on one side (plagiocephaly).
- Neck stiffness or discomfort when moving.
Early detection leads to successful treatment. Physical therapy and targeted exercises can improve mobility and prevent long-term complications.
1. Birth Trauma (such as the use of forceps)
Torticollis in babies can be linked to birth-related trauma. In such cases, the condition is classified as congenital torticollis and is often recognized by an abnormal head position, where the baby’s head tilts to one side while the chin points in the opposite direction.
The use of forceps or vacuum extraction during delivery may injure the sternocleidomastoid muscle, causing it to shorten and develop fibrosis. The severity can range from mild to severe, and it is more commonly observed on the right side of the neck.
Primary Causes of Birth-Related Trauma
- Improper use of forceps or vacuum extraction.
- Forced extraction during a difficult delivery.
- Excessive pressure on the baby’s neck during birth.
2. Position in the Womb During Pregnancy
Congenital torticollis can occur when a baby is born with an abnormal head position due to a tight and shortened neck muscle. While the exact cause is unknown, it has been linked to fetal positioning during pregnancy. This condition is more frequently observed on the right side of the neck and can vary in severity.
Healthcare providers typically detect congenital torticollis during a physical examination. In some cases, the issue is not immediately noticeable and becomes apparent weeks later. Additional tests may include:
| X-rays | Identify abnormalities in the bones of the neck and shoulders. |
| Ultrasound | Uses sound waves to assess the condition of the neck muscle. |
If left untreated, torticollis can lead to developmental complications, including:
- Limited head movement: Difficulty turning the head in both directions.
- Chronic muscle tightness: Persistent rigidity affecting posture and comfort.
- Uneven head and facial development: Asymmetry caused by prolonged pressure on one side.
Early intervention with stretching exercises and postural adjustments can prevent these issues.
3. Muscle Tension or neck Muscle Contracture
Muscle tension or contracture in the neck is another cause of torticollis in babies. It can result from various conditions that restrict movement and cause discomfort.
Common Causes of Neck Muscle Contracture
- Sleeping in an uncomfortable position: Staying in the same position for long periods can lead to stiffness.
Associated Symptoms
| Feature | Baby with Normal Muscle Tone | Baby with Torticollis |
| Sleeping posture | Bends elbows and knees | Keeps limbs extended |
| Response when held | Holds posture firmly | Feels floppy, like a “rag doll” |
| Neck mobility | Turns head easily | Limited movement |
Detecting early signs, such as reduced muscle tone or difficulty turning the head, allows for timely treatment, improving mobility and comfort.
4. Genetic and Hereditary Conditions
This condition progressively restricts neck mobility and can affect head growth and posture. In many cases, genetic mutations have been linked to an increased likelihood of developing torticollis.
While the exact causes of congenital muscular torticollis remain unclear, evidence suggests a genetic component in some cases. Hereditary mutations may predispose individuals to fibrosis in the sternocleidomastoid muscle.
| Evaluation | Purpose |
| Clinical Assessment | Identifies fibrous bands or muscular abnormalities. |
| Imaging Tests | Confirms diagnosis and assesses the severity of movement restriction. |
Early diagnosis and treatment can help avoid complications. In cases where conservative methods fail, surgery may be required to correct the condition.
5. Infections or Medical Issues Related to the Neck
Infections and other medical conditions can contribute to torticollis in babies. Additionally, certain disorders affecting the nervous system, spine, or muscles may also play a role.
Torticollis and Infections: Infections can cause neck muscle irritation, leading to temporary torticollis. Common infections associated with this condition include:
- Throat infections: Inflammation in the throat can spread to nearby muscles, causing stiffness.
- Common colds: Congestion and inflammation may contribute to neck tension.
- Swollen lymph nodes: When neck lymph nodes enlarge in response to infection, they can irritate surrounding muscles, leading to discomfort and restricted movement.
Symptoms of Infection-Related Torticollis
| Neck pain and stiffness | Difficulty turning or moving the head. |
| Discomfort in other areas | Possible pain in the head, shoulders, or arms. |
| Head tilting | Involuntary turning or tilting of the head. |
If torticollis persists or worsens, consulting a specialist is recommended.
Ready to Address Your Baby’s Torticollis?
If your baby has been diagnosed with torticollis, there are many ways to help improve neck mobility and strengthen muscles. One effective strategy is encouraging natural head movement in both directions, which helps relax tight muscles and strengthen weaker ones. Babies cannot hurt themselves by turning their heads naturally, making these exercises safe to incorporate into daily routines.
During feeding, position the baby so they turn their head toward the less favored side. Placing them to sleep facing the wall can also help, as they will instinctively turn their head to look at the room, stretching their neck muscles in the process. Engaging them with toys or sounds in different directions while playing further encourages movement.
Most babies with torticollis improve with exercises and postural adjustments, but the process can take months. Consistency is key for effective recovery. If the condition does not improve or worsens, seeking professional evaluation can help explore additional treatment options.
Sources:
- Reidie, S. (2023). Torticollis with Toddlers: A Guidebook for the Parents.
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