Ever woke up in the morning with a really bad neck ache? Maybe you might have been riding in a car or bus that went over a big bump whipping your neck in a funny direction only to leave it very stiff. The same thing can happen to a newborn baby where the neck muscle, or better known as the sternocleidomastoid (SCM), becomes very tight. Just like adults can undergo trauma to the neck so can newborns and toddlers. 

All of the above scenarios are referred to as the Latin word “torticollis” (“tortus” and “collum”), which means twisted neck, or wryneck. When we are referring to an infant that was born with the condition it is called Congenital Muscular Torticollis or in short CMT. This condition causes the infant’s head to tilt to one side as he or she has difficulty turning the head. 

Torticollis is extremely uncomfortable for adults causing them to keep their necks in a position that does not cause more discomfort and can often last days and sometimes weeks depending on the severity of the trauma to the neck. The major difference between infants and adults is that infants with CMT never had a regulated sternocleidomastoid muscle while adults had their neck muscles working properly and sustained tightness due to injury. The physical therapy for an infant with torticollis  is to teach them how to use the stiff muscle for the very first time. As for adults they need to undergo a therapy that soothes and loosen the area until the neck muscle quits hurting them.         

We will review what are the causes for Congenital Muscular Torticollis and what parents need to look for on a newborn. At the same time we will discuss various exercises outside of a physical therapy office that mom or dad can do at home. The content below should not be used as a diagnosis and always consult a pediatrician first before doing any of the exercises mentioned below. There is one rule of thumb when trying to stretch out an infant’s neck muscles. Never use your hands but allow the baby to use their own body and muscles to propel the neck in different directions. Even if they’re very small they won’t do anything that will hurt themselves. 

What Are The Causes For Infant Torticollis?

When a pediatrician tells a mom or dad that their infant has torticollis there is no reason to panic. About three in one hundred babies have torticollis and it’s important for parents to know that the condition is 100% treatable. Sometimes parents can be so consumed by the internet which brings on tremendous amounts of unneeded anxiety. It’s not a condition limited to infants and is similar to waking up with a sore neck. The only difference is that we need to teach the newborn how to use this muscle just like we need to teach them how to eat, crawl, and play. 

Here are some of the causes for torticollis:

• Baby was in a breech position: While the baby is positioned in an awkward way during a breech pregnancy, the neck can undergo trauma which can cause the baby to tilt their head towards one side after birth.   
• The use of forceps or vacuum during delivery: During delivery obstetricians will sometimes use a vacuum or forceps to try and help the baby exit the birthing canal. These tools can draw a little too much on the baby’s head causing trauma to the neck muscle resulting in torticollis.
• Womb positioning: Similar to the positioning of a breech baby there are a variety of positions in the mother’s womb that can bring on torticollis. The commonality between each of them is the stress on the sternocleidomastoid muscle.
• Difficult childbirth: All mothers anticipate that the labor and delivery go smoothly but not always is that the case. Just like a difficult childbirth is stressful to the mother, it is stressful to the baby that is trying to get through the birthing canal as well. This can bring on stress to the neck muscle bringing on the condition.
• Post birth positioning: Not always can we blame everything on the pregnancy, labor, or delivery. Sometimes there are outside elements such as car seats, baby rockers, and static feeding positions that cause one of the neck muscles to stiffen up. Just like with any muscle that if not being used it will tend to tighten the same applies to a baby’s neck muscles.      

Understanding the anatomy of how the muscles in the neck work is not complex. On each side of the infant’s neck are two muscles called the sternocleidomastoid muscle or better known as (SCM). When the right SCM is tight due to trauma or poor positioning the infant will lean or tilt their head to the right and when the left SCM is tight due to trauma or poor positioning the infant will lean or tilt their head to the left. It’s the muscle tightness that causes the baby to prefer one side over the other just like an adult that wakes up one morning with a stiff neck. Both will cause the infant to lean to the side that does not cause more discomfort.

How can a parent identify if an infant might have torticollis?

• Tilting or leaning of head to one side: If it appears that your baby is leaning or tilting their head to one side it is likely that it’s due to the muscle tightness in the other side. 
• Creases in baby’s neck: Parents may take notice of creases in the neck that stand out. This is caused by the lack of movement to flex the skin in that area leading to excessive creasing. 
• Rash on the baby’s neck: Due to the creases causing lack of air exposure very often water or bacteria can get caught leaving the baby with a small rash. Make sure to show the rash to your local pediatrician and be sure to clean inside the creases while bathing the infant.
• Trouble feeding on one side: During a feeding a parent may notice that the baby will feed only on one side. When you try to put them on the other side they will show discomfort.
• Looking to only one side: At playtime one may notice that the baby will choose only to position their head in one direction. Even when trying to look in the other direction they will seem to come to a stop only to return their head to the original position to the side of preference.     

Before reviewing some of the exercises for infant torticollis it is important to understand what our objective is when treating torticollis. As discussed above the reason for why the baby is leaning or tilting their head to one side is due to the stiffness in the neck muscle. What we are looking for is that the baby should stretch out the stiff neck muscles, loosening them up until leaning or tilting is resolved. Babies cannot hurt themselves by turning their heads on their own. They have feelings and know what hurts them. As for the exercises below they are all done by the baby themselves. You as a parent will stimulate those weak sternocleidomastoid muscles to stretch out until the torticollis goes away.    

Torticollis Exercises For Infants

• When holding the baby alternate sides: The nature of a baby is always to look to the side of the person that is holding them. Alternating the side of holding the baby will force the baby to stretch the neck muscle for each direction where it will turn its face. This is an effective workout for the weakside giving the SCM a good stretch.
• Switch off the direction to which your baby sleeps: Orientation of how the baby sleeps can get the baby to get a good stretch of weak neck muscle throughout the night. When the sleeping position of the baby changes the baby will face the opposite side. 
• Using toys to draw the baby’s attention: While the baby is on their back take a rattle or toy that the baby likes and slowly draw it from one side to the other. The objective is to get the baby to turn their neck to the direction which they don’t like. This is an effective way to stretch out the SCM muscle. 
• Tummy Time & Tummy Tilt: One of the favorite exercises for infant torticollis is Tummy Time. As the baby is on their stomach it forces them to bop their head up causing a good stretch to the weak muscle. While in this position mom or dad can slightly tilt the baby (almost like they are up on two wheels) that gives an even better stretch to the poor neck muscle.
• Hold their head up high: While holding your baby, elevate their head just above the shoulder. This will make them use their neck muscles to try and find a comfortable position which is usually mom or dad’s shoulder.

Final Words

Seeing your baby with a tilted neck can be quite worrisome but parents should know that it’s quite treatable. Often pediatricians will recommend physical therapy while other times they may require just at home exercise. It’s not uncommon for a baby with torticollis to have a secondary condition referred to as positional plagiocephaly. This is a flat spot that is caused by the uneven weight distribution from the head resulting in a flat spot or slightly misshapen head. The earlier the treatment the better the outcome. Parents should never be afraid to seek out help or go for a second opinion if something does not seem right to them. As the saying goes “Mom knows best”!