Pediatric torticollis

What are the signs and symptoms of pediatric torticollis?

Congenital torticollis

• Head tilting, favoring one side
• Movement of the head to one side more than the other
• Small bump in the middle of the neck muscle
• Preference to look one way more than the other
• Preference of resting their head on one side rather than the other when feeding or eating
• Unusual head shape or a flat spot on the head (plagiocephaly)

Acquired torticollis

• Head always tilted to one side
• Temporary spells of head tilting, lasting a few hours or days, that can also cause vomiting
• Bulge in your child’s neck
• Limited range of motion in the head and neck
• Vision problems

How is pediatric torticollis diagnosed?

Our doctors diagnose pediatric torticollis with a physical examination. During the exam, we’ll discuss your baby’s medical history, check their head shape and test how they move their neck. Sometimes, we recommend X-rays and vision exams to help confirm a diagnosis.

• Although congenital torticollis occurs at birth, it may go unnoticed for several weeks. On average, most babies with congenital torticollis are diagnosed within the first few months of life.
• Acquired torticollis typically develops in the first four to six months of a child’s life but can occur later.

What causes pediatric torticollis?

The cause of pediatric torticollis depends on the type.

Congenital torticollis results from the shortening or tightening of the neck muscle, which can happen because of:

• The way the baby was positioned in the womb during pregnancy
• Unusual development of the neck muscle
• Injury during birth

Acquired torticollis usually results from an injury (trauma) or underlying health condition, such as:

• Mild infection
• Head or neck injury
• Sandifer syndrome (movement disorder)
• Gastroesophageal reflux disease (GERD)
• Klippel-Feil syndrome or other conditions that affect the bones of the neck (cervical spine)

How is pediatric torticollis treated?

At Children's Health, we offer care from a team of experts who have special training in helping children overcome torticollis and many other conditions. Our doctors and physical therapists (PT) will pinpoint what's causing your child's torticollis. Then we'll build a custom treatment plan just for them.

• Treatment for congenital torticollis  typically begins with physical therapy (PT) to stretch and strengthen the neck. Most babies improve their head and neck movement after a few months of PT. We will also show you ways to support your child’s recovery at home, with tummy time and stretching routines.
• Treatment for acquired torticollis aims at addressing the underlying cause to improve movement and symptoms.

Your child’s care plan may include:

• Medication to relieve pain and other symptoms
• Physical medicine and rehabilitation (PM&R), including PT
• Orthopedic surgery, neurosurgery or plastic surgery, in rare cases, to lengthen the neck muscle

The children we see with torticollis almost always completely recover. If torticollis affects the shape of your baby’s head, we fit babies for safety helmets at our specialty clinic.

What are the long-term effects of pediatric torticollis?

Care and treatment from the right physical therapist can help children overcome torticollis.

If the condition doesn’t improve, it can cause long-term effects such as:

• Permanent muscle tightening
• Unusual appearance in facial features (asymmetry)
• Flat spot on one side or back of the head (plagiocephaly)
• Difficulty swallowing (dysphagia)
• Motor development problems
• Eye alignment problems that can lead to crossed eyes (strabismus)
• Difficulty with balance

Does infant torticollis go away?

Our care team recommends treatment for torticollis to prevent long-term complications. With proper care, children with torticollis usually fully recover.

Does pediatric torticollis cause developmental delays?

Infant torticollis can delay important physical milestones, such as rolling over, sitting upright, crawling, standing and walking. Torticollis can also affect the quality of movement, making it harder for a baby to sit up, crawl or walk.