What New Parents Should Know About Infant Torticollis (Head Tilt)

Torticollis is the medical term that describes a head-tilt, chin-lift combination. In babies, it’s typically caused by tightened neck muscles. Babies with torticollis hold their heads in a twisted position.

Most babies develop torticollis because of how they were positioned in the womb. So, while you can’t prevent your baby’s torticollis, you can do a lot to relieve it. Treating torticollis prevents long-term issues, like facial and jaw asymmetry and plagiocephaly (flat head syndrome).

What causes torticollis?

Babies can develop torticollis if they’re positioned in the womb in a way that contracts their neck muscles. This affects how their neck muscles stretch and develop. This head-tilt and neck-twist combination is called congenital muscular torticollis.

Once babies are born, they can’t immediately lift their head or move their neck like older infants can. The result: They stay in a similar position as they were before birth. This continues to impact a baby’s neck muscles stretching and development.

Many babies have more mild forms of torticollis. That means they keep their head tilted, but the neck muscles are flexible.

Other babies have more severe torticollis, meaning their neck muscles are very tight and resist movement. In these cases, babies may have a lump in their neck, which is where the neck muscle is coiled. This is called fibromatosis colli.

Some babies have forms of torticollis that are in between. They have some tightening of neck muscles, but the muscles still stretch with gentle help.

How common is torticollis in infants?

Research shows that between 3.9% and 16% of babies develop torticollis. In fact, it is the third most common orthopedic diagnosis in infants in the U.S.

The reason torticollis is so common in infants is because there’s nothing that can be done to  prevent your baby from developing torticollis before they’re born.

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How is torticollis diagnosed in infants?

It’s usually easy for a caregiver or healthcare provider to tell that a baby has torticollis just by looking at them. You might notice that your baby:

• Tilts their head to one side

• Keeps their chin lifted and pointed in the opposite direction from their head tilt

• Prefers to only look in one direction (right or left)

• Resists having their head turned in one direction

• Has tighter neck muscles on one side

Signs of torticollis start becoming noticeable when a baby is between 2 weeks and 4 weeks old. 

Your child’s healthcare provider might suggest doing an ultrasound of your baby’s neck if they feel a lump, just to make sure the lump is fibromatosis colli.

What’s the difference between congenital and acquired torticollis?

It’s important to point out that there is another type of torticollis: acquired torticollis.

Acquired torticollis describes a head tilt caused by another medical condition. Some of these conditions can be quite serious, like neck infection, vision problems, or even brain tumors.

So, if your older infant or child suddenly develops a head tilt when they didn’t have one before,  get medical help right away.

How do you treat torticollis?

Treating congenital muscular torticollis starts at home. Some babies will need extra help from physical therapists. Here’s some things you can do at home to try to help.

Gentle stretches

If your child has mild torticollis, you can try gentle stretching a few times a day at home. This involves simply turning your child’s head so that it’s straight.

Over time, you can stretch a little more, to work on a normal range of neck flexion and rotation. You’ll want to be very gentle. If your baby resists or it feels like the muscles won’t stretch, don’t push. If you’re not sure how to do the exercises, talk to your child’s healthcare provider or work with a pediatric physical therapist.

Promote movement

You also want your baby to try to stretch their neck themselves.

Some ways you can help a baby stretch their neck by themselves includes:

• Placing interesting toys, crib mobiles, baby mirrors, and other objects on the side that you want them to turn to. This will naturally get them moving their neck so you don’t have to stretch for them.

• Move their crib (or place them in their crib), so they turn their head to the side in order to see the room.

• Alternate feedings and carrying positions, which encourages them to turn their head and neck in both directions.

• Offer increasing amounts of “tummy time”.

• Minimize time spent in car seats and infant carriers.

One thing you shouldn’t do is prop your baby’s head and neck while they sleep. Always keep your baby’s sleep space safe. If they sleep with their head tilted, that’s OK. The activities above will maximize their awake time for stretching.

Physical therapy

Most children do very well with just gentle exercises and movement. But if your baby isn’t getting better after about 4 to 6 weeks, it’s time to see a physical therapist.

Your child’s healthcare provider might also ask you to start working with a physical therapist right away if your child has tighter neck muscles or fibromatosis colli.

You can decide to start working with physical therapy right away, too. There is some data showing that babies who started with physical therapy right away got better faster. The American Physical Therapy Association recommends that babies with torticollis attend physical therapy. So don’t hesitate to ask for a referral or set up an appointment if you want to try it right away.

New treatments

Some babies don’t improve even with physical therapy. This isn’t common. But if your baby has other medical conditions that affect their muscles or ability to move, these options may help:

• Microcurrent stimulation

• Soft bracing or immobilization

• Kinesiology taping (when done by physical therapists)

• Therapeutic ultrasound and massage

These treatments are still being studied, so it’s unclear how well they work for every child.

Can torticollis cause developmental delays?

There is some research showing that babies with torticollis can experience delays in their developmental milestones. Specifically, research has shown that untreated torticollis can affect how quickly babies’ learn their movement milestones.

Torticollis is not associated with delayed speech (late talking), trouble with social milestones, or autism.

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Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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