Congenital torticollis is a condition in which a baby is born with a tight or shortened neck muscle that causes the head to tilt and/or turn to one side. It is usually noticed within the first few weeks of life.
Although the exact causes of congenital torticollis are still not fully understood, it seems to be linked to the baby’s position in the uterus or to pressure on the neck muscle before or during birth. These factors can make one neck muscle tighter and shorter, which causes the baby’s head to tilt to one side.
If congenital torticollis is suspected, it is important to see a pediatrician to confirm the diagnosis. Treatment is usually done with physical therapy, although surgery may sometimes be recommended to correct the condition.
Main symptoms
The main symptoms of congenital torticollis are:
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Reduced head movement
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A lump or swelling on one side of the neck
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Head turned and/or tilted to one side
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Difficulty moving the head
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A preference for certain positions
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Asymmetry of the head and/or face
Congenital torticollis is usually identified within the first weeks of life. However, in some cases it may not be noticed until the child begins to show abnormal posture or difficulty moving the head.
If it is not treated, congenital torticollis can affect the development of the bones of the face and skull. This may cause asymmetry of the head or face, difficulty breastfeeding, and, as the child grows, scoliosis, which is an abnormal curve in the spine.
Confirming a diagnosis
Congenital torticollis is diagnosed by a pediatrician based on the baby’s symptoms and physical exam. During the exam, the provider will usually look for neck swelling, limited movement, or an abnormal head position.
In some cases, the provider may also order imaging tests, such as a cervical spine X-ray, neck ultrasound, or MRI, to confirm the diagnosis.
According to the American Academy of Pediatrics, the pediatrician may also check for related conditions, such as hip problems, during the evaluation, because some children with congenital muscular torticollis may also have developmental dysplasia of the hip.
Possible causes
The exact cause of congenital torticollis is not fully understood. It appears to be related to the baby’s position in the uterus, pressure or injury to the neck during birth, or, less commonly, differences in how the neck muscles or bones develop.
Congenital torticollis is also more likely to occur in first pregnancies, when there is less amniotic fluid, and when there are delivery complications, especially during the baby’s birth.
Treatment options
The American Physical Therapy Association’s Academy of Pediatric Physical Therapy emphasizes that starting physical therapy early for congenital muscular torticollis is important, as children tend to have better results when treatment begins as soon as possible.
However, surgery may be considered in persistent cases when limited neck movement and head tilt do not improve enough with conservative treatment.
If torticollis makes breastfeeding difficult, it is recommended to talk to a pediatrician or another qualified healthcare professional about different breastfeeding positions and techniques.
It is also important for parents or caregivers to learn how to do certain exercises at home to support and improve the results of physical therapy.
Main exercises
The baby’s physical therapist should teach stretching and muscle-release exercises for the affected muscle so parents can do them at home as part of treatment.
Some exercises for congenital torticollis include:
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Getting the baby’s attention with an object that makes noise by placing it in front of the baby and then slowly moving it to the side, encouraging the baby to turn the neck toward the affected side.
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Laying the baby on the bed and sitting beside them so that, to look at you, the baby has to turn the neck toward the affected side.
A physical therapist may recommend using warm compresses or warmed towels before doing the exercises to help relax the neck and reduce discomfort.