A child with torticollis (tightness in one side of the neck) will present with a head turned in one direction, and tipped in the opposite direction. Torticollis can lead to flattening on one side of the skull and issues with motor skills development. The estimated incidence of congenital muscular torticollis is <1% of all live births.[i] In this article we will look at why this condition occurs, complications that can arise, how it is diagnosed and pediatric torticollis treatment options.

What is Congenital Torticollis?

Congenital torticollis (congenital muscular torticollis) is the tightness of the sternocleidomastoid muscle on one side of the neck which causes the child’s head to turn in one direction, and tip in the opposite direction. It is named for the side that is affected: if the right sternocleidomastoid muscle is tight, the infant is said to have a right torticollis.

How Does a Child Get Congenital Torticollis?

Congenital torticollis can occur from in-utero positioning such as a baby with a breech presentation, or a very large baby. It can also be caused by trauma during delivery from forceps or vacuum use. This condition is commonly identified 6-8 weeks after birth as the infant starts to gain head control and develops a head-turning preference to one side, although it can be identified prior to this.

Complications from Congenital Torticollis

When torticollis is not identified early, other complications can arise such as positional plagiocephaly. This occurs when the infant’s head turning preference causes them to rest only on one side of their head which causes a flattening of one side of their skull. In more severe cases of plagiocephaly, infants may require a corrective helmet for cranial reshaping.

plagiocephaly diagram torticollis complication Propel Physiotherapy

Can Torticollis Cause Developmental Delays?

A head turning preference also means that the child is only receiving sensory input from one side of their body which may lead to vision issues and a preference for using one hand but not the other. This, in addition to trunk muscle tightness, can affect the development and symmetry of motor skills like rolling and crawling in the future.

How is Congenital Torticollis Diagnosed?

An official diagnosis will be made by a health care provider, but here are several signs that caregivers can monitor for to help identify torticollis early, including:

  • Will only turn their head in one direction and will not follow you with their eyes toward their non-preferred side
  • Leaning or bending toward one side when placed in a car seat or bouncer
  • More interest in toys on one side of their body
  • Preference for one side when breastfeeding, or prefer to be on a particular side if bottle feeding
  • The muscles on one side of their neck may feel tight or lumpy compared to the other side
  • Difficulty passively moving the child’s head in the non-preferred direction
  • May also have a flat spot on one side of their head (plagiocephaly)

Congenital Torticollis Treatment Options

After an infant is diagnosed with torticollis, there are several treatment options in-clinic, as well as strategies that caregivers can use at home.

Environment Set up & Positioning

  • Alternate which direction you place them on the change table each time you change them
  • Alternate which direction you place them in the crib or bassinet
  • Ensure that visually stimulating toys and other items are on both sides of the room
  • Limit container use such as swings and bouncers as much as possible
  • When placing them in their car seat or crib, ensure that their head is not turned to one side


  • While the baby is lying on their back, gently hold down one shoulder and stretch the neck in the opposite direction of tightness

  • Side-lying hold with the tight side down to provide a gentle stretch

  • Baby wearing in a wrap or carrier with the head gently turned away from the preferred side


  • Visual tracking exercises to the non-preferred side (using high contrast images for young babies, flashy toys or loud toys) to help strengthen the muscles on the opposite side of the neck
  • Trunk strengthening exercises (e.g., tipping side to side while sitting on a caregiver’s legs for babies with good head control)
  • Tummy time to strengthen neck, shoulder, and back musculature

Can Torticollis Be Cured?

If identified early, typically a physiotherapy program of 6-8 weeks is sufficient to correct the issue, although these infants should continue to be monitored. If not identified until later, a longer course of treatment will likely be required to help correct asymmetries and promote gross motor development.

Congenital torticollis has the best outcome with early identification and treatment. Contact us today to book your complimentary consultation, or to book an appointment with one of our physical therapists!

Written by

Alanna Holz
Alanna HolzRegistered Physiotherapist
Alanna Holz is passionate about helping her clients achieve their goals and get back to activities that are important to them. Her attentive and encouraging approach helps her develop a strong rapport with clients and makes them feel at ease.



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