What to Do If Your Baby Has Torticollis

Quick answer: If you notice that your baby consistently turns their head to one side, has difficulty turning it to the other side, or you can feel a lump in the neck muscle, consult your paediatrician. Torticollis is treated with physiotherapy stretching exercises and has a high success rate when started early. If left untreated, it can lead to or worsen plagiocephaly (flat head syndrome).

What Is Torticollis?

Torticollis (also called "wry neck") is a condition in which the baby’s head is persistently tilted to one side due to tightness or shortening of the sternocleidomastoid (SCM) muscle in the neck. The most common type in babies is congenital muscular torticollis (CMT), which can develop during pregnancy or delivery.

It affects approximately 1 in 250 to 300 live births, making it one of the more common musculoskeletal conditions in newborns.

Signs of Torticollis in Babies

• Head consistently turned or tilted to one side (typically chin turns to one side, ear drops to the opposite shoulder)
• Difficulty or reluctance to turn the head to the opposite side
• A palpable lump or tightness in the sternocleidomastoid muscle on one side of the neck
• Uneven facial features (mild facial asymmetry)
• Preference to feed from one breast only
• Asymmetric movements during tummy time

How Does Torticollis Cause Flat Head?

Torticollis and plagiocephaly frequently occur together. When the baby consistently lies with the head rotated to one side, constant pressure is applied to one area of the still-soft skull. Over time, this leads to asymmetric flattening.

This is why treating torticollis and addressing head shape deformity must go hand in hand. Helmet therapy alone, without resolving the underlying torticollis, may deliver limited results.

Treatment: Physiotherapy

The primary treatment for congenital muscular torticollis is physiotherapy. A paediatric physiotherapist teaches parents specific stretching exercises and shows how to perform them correctly. Key points:

• Stretching exercises should be performed gently, regularly, and consistently — typically 3–4 times per day.
• The earlier treatment begins, the better the outcomes. Most mild–moderate cases resolve fully within 6 months of physiotherapy.
• Carrying and positioning strategies during daily activities (feeding, holding, playing) also support recovery.

Important: Do not attempt stretching exercises without guidance from a physiotherapist. Incorrect technique can injure the baby’s neck.

What to Do at Home (While Awaiting Your Appointment)

• Tummy time: Encourage your baby to spend supervised time on their tummy. This strengthens neck muscles and reduces pressure on the back of the head.
• Stimulate the opposite side: When playing, place interesting toys on the side that the baby tends to avoid turning toward, encouraging them to turn to that side.
• Vary feeding position: Alternate which arm you use to hold your baby during feeds.
• Side-of-crib stimulation: Position yourself or a mobile on the side the baby tends not to look toward, to encourage active rotation.

When to Seek Urgent Help

See your doctor promptly if:

• The head tilt is very pronounced or appears to be worsening rapidly.
• The baby seems to be in pain when the head is moved.
• There is swelling, redness, or warmth in the neck area.
• Neurological symptoms are present (difficulty feeding, eye movement abnormalities, developmental delay).

These signs may indicate causes other than muscular torticollis (such as atlantoaxial instability or a cervical vertebral anomaly) which require different management.

Torticollis and Helmet Therapy

If plagiocephaly has developed alongside torticollis, helmet therapy may be recommended to correct the head shape after the neck movement range has improved sufficiently with physiotherapy. The two treatments work best in parallel: physiotherapy addresses the cause, while helmet therapy corrects the resulting shape deformity.

For information on the steps from assessment to helmet fitting, you can visit CranioWell Orthopaedic Centres.

Frequently asked questions

Does torticollis resolve on its own?

Mild torticollis may show some improvement over the first weeks, but waiting without treatment is not recommended. Physiotherapy significantly improves outcomes and reduces the risk of secondary flat head deformity.

How long does torticollis treatment take?

Most cases of congenital muscular torticollis respond to physiotherapy within 3–6 months. Severe cases with a significant fibrotic mass may require longer treatment, and rarely, surgical release of the SCM muscle.

My baby has torticollis — do they definitely need a helmet?

Not necessarily. If torticollis is detected early and treated effectively before significant plagiocephaly develops, a helmet may not be needed. However, if moderate-to-severe flat head deformity has already developed, helmet therapy alongside physiotherapy offers the best outcome.

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