What is torticollis?

You might be reading this title and wonder, what even is torticollis and how do I know if my baby may have it? In its most limited form, torticollis describes a condition of neck issues where a baby has a strong turning or tilting preference. However, a young infant is developing quickly and the neck issues are intertwined with the baby’s visual and postural systems. To put it simply, a baby whose eyes are more often turning in one direction is missing the opportunity for full visual development. A baby who learns to reach with one hand while using the other for stability or rolls only to the left, is missing out on developing the reverse patterns which at times has implications for development.It has become common for a number of reasons which we will discuss later in this post.

Torticollis specifically occurs when the sternocleidomastoid muscle in the neck becomes tight, and in return, actually shortens in length. This muscle runs on either side of the neck and when one side gets tightened and shortened, the baby typically hangs out in a position where the baby’s head is tilted due to tightness. Torticollis is a tricky condition because typically, the head tilt is paired with neck rotation, meaning that the baby’s head is tilted and turned slightly. As your baby spends more and more time in the same position due to tightness, the other muscles in the neck can become weak since they are unable to move against that tight muscle. Most often, the neck tightness also causes the ribs and hips on one side to be closer together than the other, giving the baby’s body a C-shape. If you are noticing these things, there are many ways to help your baby that are pain-free and result in full resolution. Getting started early (as soon as you or your pediatrician notice it) can be very helpful! 

What causes it? 

It can be hard to pinpoint what exactly causes torticollis but there are trends that may help us better understand why and how, and almost always it has nothing to do with anything you did as a parent or a caregiver! This condition is commonly caused due to circumstances that are out of our control. For a full discussion see this blog post 13 Factors that Can Contribute to Flattening of a Baby’s Head. 

For example, the way a baby may be positioned in utero may be a reason. Toward the end of the third trimester, babies are running out of space. This means that they may often stay situated in the same spot and have their head in the same position. Think about how you may wake up with a tight neck after sleeping in a funny position. You are fairly sore and it can be painful to stretch the neck out, but it resolves throughout the day. Now imagine sleeping in a funky position for weeks! That problem may become much more persistent and will take some work to get it resolved. 

Another trend we often see is torticollis being noticed following a vaginal birth where suction may have been necessary or if the baby had a harder time being delivered. Again, neither of these things are in your control as a parent or caregiver. When either of these occur, it is not uncommon for a baby to have experienced muscle damage due to abnormal pressure or stress on the muscle. Torticollis can also be common in babies of multiples due to positioning of themselves and the other babies in the womb. It is also not uncommon for births of multiples, babies who have experienced medical issues such as prematurity or surgery, or babies that spend a lot of time in containers. Additionally, first born babies are statistically more likely to have torticollis.

Why is it important to address? 

Let’s talk about head shape! For the first year of a baby’s life, especially as a newborn, babies’ heads are super malleable. The fontanels (their soft spots) in between the bones in the skulls are not fully fused which is important as it allows for vaginal delivery and growth! When a baby has torticollis and spends a majority of their time in a tilted, rotated position, it is typically followed by a flat spot on the back, side, or a combination of both, on the head. These conditions are called plagiocephaly and brachycephaly. Babies that have these head shape issues are often treated with repositioning or cranial band (baby helmet) if necessary. 

Torticollis not only can lead to asymmetry of your baby’s head, untreated, torticollis can also cause muscle tightening down through the body. For example, if a baby is tight on the right side of their neck, it can be common to see tightness through that right arm, right hip, and end down the leg to the right foot. This may lead to your baby preferring to reach with the arm that isn’t tight and even affect the way your baby will prefer to crawl.

Additionally and mentioned above, if a baby prefers to look one way over the other (due to neck tightness), this can also affect a baby’s visual development. Aside from creating difficulty tracking objects, torticollis can also cause the baby to “ignore” the side where they don’t look. When this occurs, it causes the baby to neglect that side of the body. Meaning that the baby may have difficulty using both hands when playing with toys at the midline of their body or may only reach and hold onto things with the one hand. When babies are only looking in one direction and are unable to properly track objects, muscles in the eyes can actually develop asymmetrically. Tracking is important for babies because they are working on steadying their gaze, increasing their ability to focus on objects closer and further away, and giving their eyes an opportunity to work together in order to follow an object. These are all important skills for children to develop and are required to be able to read, color, and simply play. 

Because torticollis can affect so many of the body’s systems, it is important to keep an eye out for signs of any tightness. Below is a list of common signs that torticollis might be present. 

First signs of torticollis:

  • Head tilted to the side
  • Often prefers to look in one direction (either mainly to right or left or straight in the center. A mix of all positions is ideal!)
  • Often tracks people or toys with just their eyes, rather than turning their head 
  • During bath time or throughout the day, you may notice dark red creases on one side of the neck more than the other 
  • Baby may relax into a “C-shape” when laying on their backs or bellies
  • Breast feeding preference—Only like to feed on either left or right 
  • Despite position put into, they always sleep with head in one direction 
  • Difficult to manually turn their head to other direction 

If you notice any of these, go ahead and begin tummy time (when awake and supervised) or do more of it and reach out to your pediatrician! Oftentimes an occupational or physical therapist who specialized training in this area is recommended. Again, the earlier a baby comes for help, the better because the patterns haven’t had as much time to be set into place; the head has had less time to become misshapen and it’s easier to resolve. 

Olivia Willis OTD Student

Susan Klemm MS, OTR/L