Torticollis is a condition where an infant has an imbalance with their cervical muscles which leads to a head tilt to one side, referred to as wry neck. Torticollis literally means “twisted neck” in Latin. It is a shortening of the sternocleidomastoid muscle which runs up the back of the neck. In newborns, torticollis occurs due to positioning in the womb or as a result of a difficult childbirth. This is commonly referred to as congenital muscular torticollis (CMT).

Congenital Muscular Torticollis is associated with deformational plagiocephaly, brachycephaly and scaphocephaly. It is prevalent in 70-95% of cases of deformational plagiocephaly and is still considered to be underreported.

Infants with torticollis will generally tilt their head to one side. Physically, this presents with the chin pointed to one shoulder and the head pointing to the opposite shoulder. For example:

If a baby has torticollis where the right side of the neck muscles are affected, their head will tilt to the right and their chin will tilt to the left.

You may notice the symptoms when your baby gets fussy when they are unable to turn their head to one side. Also, infants may prefer to breast feed on one side only as the other side is tight and thus difficult. In some cases, a small lump in the neck may appear.

Because they favor one side, some babies may develop a flat spot on their head (positional plagiocephaly) on one or both sides. While torticollis may be frustrating for your baby, most babies do not feel pain from it. Positioning and stretching exercises will improve torticollis. In more severe cases, therapy may be needed.

Most often, a doctor can make the diagnosis of positional plagiocephaly simply by examining the infant’s head. X-rays are usually not required, though an evaluation scan may be requested to determine the severity of the plagiocephaly. In some cases, a pediatrician my choose to consult with a specialist. This may be a pediatric cranial facial surgeon, neurosurgeon or plastic surgeon.

There are two types of torticollis most commonly associated with infants: congenital muscular torticollis and idiopathic torticollis. Congenital occurs at birth and is the most common form. The exact reason infants get Congenital Muscular Torticollis (CMT) is not known, though it is largely viewed as a result of intrauterine constraint and/or position. With multiples, such as twins, intrauterine space is limited and the fetus may be cramped or in an abnormal position. The sternocleidomastoid (SCM) muscle, the muscle which runs along the sides of the neck, somehow becomes shortened and contracted. This can occur from a difficult birth causing damage to the SCM muscle, incomplete development of the SCM muscle or simply the baby’s position in utero.

Idiopathic torticollis refers to torticollis that arises spontaneously and for which the cause is unknown.

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