Torticollis in Babies

In brief: Torticollis (wry neck) is a condition in babies in which the sternocleidomastoid (SCM) muscle is shortened or tightened, causing the head to tilt to one side. It is frequently related to the birth process or intrauterine positioning; the vast majority resolves with early physiotherapy.

• Physiotherapy: Physiotherapy started within the first 3–6 months is the most effective treatment.
• Head shape: If torticollis is left untreated, plagiocephaly (asymmetric head) may develop; both conditions may need to be treated together.
• Delay risk: If the baby is older than 6 months and not responding to treatment, consult an orthopaedist or neurologist.

What is torticollis?

Torticollis means "twisted neck" in Latin. The most common type seen in babies is congenital muscular torticollis: because the sternocleidomastoid (SCM) muscle is short or tight, the head tilts to the opposite side while the chin turns towards the same side. The baby consistently turning the head to the same direction and having difficulty tracking are among the early signs.

What causes torticollis?

Main causes:

• Birth trauma: Stretching of the SCM muscle with the use of forceps/vacuum or during a prolonged labour.
• Intrauterine positioning: The baby remaining in a restricted space in the same position for a prolonged period may affect muscle development.
• Multiple pregnancy: Space restriction in twin or triplet pregnancies creates a risk.
• Premature birth: Muscle tone and control may not be fully developed.

What are the signs of torticollis?

• Head consistently tilted to one side
• Face turned towards the opposite side
• A firm or knotted SCM muscle in the neck
• The baby having difficulty turning to one side
• Asymmetric responses to stimuli (sound, face)

Does torticollis affect head shape?

Yes. If torticollis is not treated, the baby's head will consistently turn to the same side, placing pressure on that side of the head. Over time, positional plagiocephaly (asymmetric head) may develop. This is why torticollis and plagiocephaly are frequently assessed together.

If both torticollis and head shape deformity are present, treatment of the torticollis is started first; head shape treatment (helmet) is then planned in parallel or once the torticollis is under control.

How is torticollis treated?

• Physiotherapy: This is the most effective treatment. Neck-stretching exercises are generally also taught to parents and practised at home. Starting within the first 3–6 months significantly improves outcomes.
• Positional change: Presenting stimuli (toys, light) from the side of the shortened muscle encourages the baby to turn towards that side.
• Helmet therapy: Once the torticollis has resolved or is under control, a cranial reshaping helmet may be considered if the head shape deformity is significant.
• Surgery (rare): Surgery may be required after the age of one year in severe cases that do not respond to intensive physiotherapy.

When should a doctor be consulted?

• If the head is noticed to be consistently tilted to one side from birth
• If a firm mass or firmness is felt in the neck at 2–3 months of age
• If no progress is made despite 6 months of physiotherapy
• If significant head shape asymmetry accompanies the condition

Consult your paediatrician for an assessment. If you have concerns about head shape, you can also apply through our pre-assessment page.

Frequently Asked Questions

Does torticollis resolve on its own?

Mild cases may resolve within a few months with positional work. However, if there is muscle tightness, physiotherapy is essential; if left untreated, head shape deformity may become permanent.

How many months does it take for torticollis in babies to resolve?

Physiotherapy started in the first 3 months typically shows significant improvement within 4–8 weeks. In cases where treatment has been delayed, the treatment period is longer.

Are torticollis and plagiocephaly treated together?

Yes. Torticollis is one of the most common causes of plagiocephaly. Treatment of torticollis generally starts first; head shape assessment runs in parallel.