Torticollis in Babies: What It Is, How It Affects Head Shape and Treatment

What is torticollis?

Torticollis means "twisted neck". In babies it usually involves the sternocleidomastoid muscle, which runs from behind the ear to the collarbone. When it is short or tight, the head tilts towards that side while the face turns away, and the baby cannot comfortably turn in both directions.

What causes torticollis in babies?

• A cramped position in the womb for a long time
• Breech position, twins or limited space in the uterus
• Strain on the neck muscle during a difficult delivery
• Always lying facing the same direction after birth (positional torticollis)

Less commonly, torticollis can be related to differences in the neck vertebrae, vision problems, reflux or neurological causes, so a doctor should assess it.

How can I tell if my baby has torticollis?

• The head consistently tilts towards one shoulder
• Your baby prefers looking to one side and struggles to turn the other way
• A strong preference for one breast, or fussing when fed on the other side
• A small, firm, painless lump in the neck muscle in some babies, which usually fades over time
• A flat area on the back or side of the head, or slight asymmetry of the face or ears

How does torticollis affect head shape?

A baby who cannot turn the head easily rests on the same spot while sleeping on the back. Since the skull is soft and growing fast in the first months, constant pressure can flatten that area, known as positional plagiocephaly. The ear on that side may shift forward and the forehead may look more prominent on one side. The two problems can reinforce each other: the flat surface makes lying on that side easier, which can keep the neck tight.

How is torticollis treated?

The main treatment for congenital muscular torticollis is physiotherapy. When started early, most babies are known to respond well without surgery. A programme usually includes:

• Gentle stretching of the tight neck muscle
• Active movements to strengthen the opposite side
• Using toys, sounds and faces to encourage turning towards the harder side
• Advice on holding, feeding and positioning
• Plenty of supervised tummy time

Your physiotherapist will show you how and how often to do the exercises. Stretching should never be forced or done without being taught first.

What can I do at home?

• Alternate your baby's position in the cot so interesting things are on the less-preferred side.
• Alternate sides when breastfeeding or bottle feeding.
• Talk and play from the side your baby looks to less.
• Increase supervised awake tummy time.
• Limit time in car seats, bouncers and swings to what is necessary.

Safe sleep rules still apply: always on the back, on a firm flat surface, without pillows or positioning devices.

When is a helmet considered?

A cranial orthosis (helmet) does not treat torticollis; the neck needs physiotherapy. However, if the associated plagiocephaly remains significant or worsens despite repositioning and physiotherapy, helmet therapy may be considered. The decision depends on the baby's age, the measured degree of asymmetry (for example the CVAI value from a 3D scan) and the response to earlier measures. Learn more about the conditions we treat on our treatments page.

When should you see a specialist?

• Your baby always tilts or turns the head to the same side
• You feel a lump or firmness on one side of the neck
• You notice flattening of the head or uneven ears or forehead
• A sudden head tilt appears with fever, irritability or vomiting (seek urgent care)
• There is little improvement after several weeks of physiotherapy

Start with your pediatrician, who can refer you to physiotherapy and other specialists if needed. To have your baby's head shape measured, you can book an appointment.

Frequently asked questions

How long does torticollis take to improve?

It depends on severity, how early treatment starts and how consistently exercises are done. Earlier physiotherapy usually means faster progress; your care team can give a better estimate.

Is torticollis painful?

Congenital muscular torticollis is usually painless. A sudden head tilt with pain, fever or irritability needs prompt medical assessment.

Can a baby with torticollis do tummy time?

Yes. Supervised awake tummy time is especially recommended. Sleep, however, should always be on the back.

Which doctor should we see?

Start with your pediatrician, who may refer you to a physiotherapist, a rehabilitation specialist or a pediatric orthopaedic doctor.