Torticollis

What is torticollis?

Torticollis means a tilted or twisted head posture. The most common form in babies is congenital muscular torticollis, where one of the neck muscles, the sternocleidomastoid, is tighter on one side than the other, causing the head to tilt towards the tight side and rotate to the opposite side.

It's usually noticed in the first few months of life. The cause isn't always clear, positioning in the womb, birth-related factors, and a small minority of cases relating to other underlying conditions all play a role.

The reassuring thing is that the great majority of babies with torticollis improve well with simple management, particularly when it's started early.

What does it feel like?

Babies with torticollis don't typically appear distressed by it: it's something parents notice in posture and movement:

• Head tilted consistently to one side

• Preference for turning the head one way

• Difficulty turning the head fully in the opposite direction

• A small lump in the neck muscle (sometimes felt in the first weeks)

• Sometimes associated with a flat area on one side of the head (plagiocephaly)

Older children or adults can develop torticollis from other causes, but the picture and approach are quite different from the baby form.

How is it diagnosed?

Diagnosis is based on examination, assessing the head posture, the range of neck movement, the muscle tightness, and the wider development of the baby.

Imaging isn't usually needed for typical congenital muscular torticollis. It may be considered if there are atypical features, if the diagnosis is unclear, or if there are other concerns about the baby's spine or hips (the two are sometimes associated).

Assessment also looks at hip development, since there's a small but recognised association between torticollis and hip dysplasia.

What are the treatment options?

Most cases respond well to a structured stretching programme, often delivered with input from a paediatric physiotherapist. Positioning during sleep and play, encouraging the baby to look in particular directions, and gentle daily stretches all play a role.

Most babies improve significantly within months. Surgical release of the tight muscle is rarely needed and reserved for the small number of cases that don't respond to thorough conservative management. Nev will work through what's right for your child at your consultation.

When should you get it checked?

Seek a specialist assessment if:

• Your baby's head consistently tilts to one side

• There's an obvious preference for turning one way

• There's a flat area developing on one side of the head

• You're concerned about the shape of the head or position of the neck

• Stretching at home isn't producing the improvement you'd expect

Early management gives the best results. Most babies with torticollis do very well, but the right plan started early sets the foundation for that.