Congenital Torticollis: Treatment & Physical Therapy (What Studies Say)

Congenital Torticollis, Infant Torticollis: What Is It?

Do you feel like your baby always has their head turned or tilted to one side? In medical terms, you will be told that your baby has congenital torticollis, also known as infant torticollis [1].

“Congenital torticollis” means exactly the same thing as “baby always has their head turned to one side (or tilted to one side).” The first expression sounds more medical, that’s all.

“Torticollis” means “head turned excessively to the right or left,” and “congenital” means “at birth.” “Torticollis” can also mean that it is more or less difficult to turn the head in one direction.

That said, we can now ask:

• But why does the baby always have their head turned or tilted to one side?
• Tilted head or turned head: is it the same thing?

Why does my baby have congenital torticollis?

The presence of congenital torticollis can be explained by:

1. Poor positioning of the baby’s head during pregnancy.
2. Trauma to one of the neck muscles during childbirth [2].

In both cases, it is referred to as congenital muscular torticollis. Out of 100 births, between 1 and 2 newborns would be affected by this form of torticollis [3,4].

Although rarer, there are also forms of non-muscular congenital torticollis (bone-related, ocular, neurological, etc.) [2,5].

Tilted head or turned head: is it the same thing?

In the case of congenital muscular torticollis, the muscle responsible for your baby’s head position is called the sternocleidomastoid. There is one on the right and one on the left.

These muscles allow both tilting and turning of the head.

Whether your baby tends to tilt their head, turn their head, or both at the same time does not matter. It is always one of the two muscles that is involved, and the course of action is the same.

How do I know if my baby really has torticollis?

As parents, you are well-placed to detect if your baby tends to position their head excessively to the right or left. If so, then you can consider that your little one is affected by a form of torticollis.

More difficult is figuring out what type of congenital torticollis is at issue. Is it a congenital muscular torticollis? Is it a non-muscular torticollis?

By the time you read these lines, it is very likely that your baby has already seen at least one pediatrician or general practitioner.

Therefore, there is a good chance that if your doctor has not told you anything specific, your child is affected by a simple muscular torticollis.

My baby has congenital muscular torticollis: should I worry?

If you are reading this article, it is probably because you are already a little worried… And that’s a good thing!

A healthy dose of concern is a good motivator for action. The key is to make sure not to worry excessively.

To do that, you first need to understand the different types of congenital muscular torticollis.

Different Types of Congenital Muscular Torticollis

There are three types of congenital muscular torticollis [6]:

1. Those associated with a contracture of the sternocleidomastoid muscle, responsible for the mispositioning of the head to the right or left.
2. Muscular torticollis associated with the presence of a lump in the sternocleidomastoid muscle.
3. Those where there is neither contracture nor lump in the sternocleidomastoid. These are referred to as postural muscular torticollis.

For the first two types of torticollis, early treatment ensures excellent results for more than 9 out of 10 children. Ideally, this treatment should start within the first month of the child’s life.

For postural muscular torticollis, the situation is even better. No treatment may be necessary; they could improve on their own without doing anything special.

In doubt, however, it is reasonable to adopt some simple measures to encourage the child to reposition their head correctly.

What Are the Consequences of Persistent Congenital Muscular Torticollis?

The persistence of congenital muscular torticollis after 1 year can lead to deformation of the skull and face.

What could be the consequences of this deformation? Beyond an obvious aesthetic dimension, some authors mention [3]:

1. Delays in motor development.
2. Dental occlusion problems.

It is important to note, however, that more than 9 out of 10 babies fare wonderfully with appropriate intervention started on time (ideally within the first month of life).

(Note: Deformations of the skull caused by persistent congenital muscular torticollis differ from positional plagiocephaly or brachycephaly.)

What Are the Treatments for Congenital Muscular Torticollis?

The primary treatment involves:

1. Providing parents with stimulation and positioning advice, such as:
   • Placing anything likely to stimulate your baby on the side opposite the mispositioning of their head (if mispositioned to the right, place the mobile above the bed to the left).
   • Stimulating your baby yourself as much as possible on the side opposite the mispositioning (if mispositioned to the right, talk to your baby as often as possible while standing to their left).
2. Gentle mobilizations and stretches of the baby’s head and neck. In this regard, it is recommended to consult a pediatric physiotherapist (or a physiotherapist with experience working with babies). They may also show you how to perform these exercises on your own, in addition to their own work.

In more than 9 out of 10 cases, seeking a generalist or pediatric physical therapist as soon as possible will lead to excellent results [6].

In rare cases where the torticollis persists, surgery may be indicated and successfully treat the problem [7].

***

Here’s what I wanted to tell you about this! Do you have any comments or questions? Your comments are welcome 🙂 !

You may also like: Treatment of Flat Head (positional plagiocephaly)

 📚 SOURCES

[1] Nilesh, K., & Mukherji, S. (2013). Congenital muscular torticollis. Annals of maxillofacial surgery, 3(2), 198–200. https://doi.org/10.4103/2231-0746.119222

[2] Lacher M., Peter S., Zani A. (Editeurs), Pearls and Tricks in Pediatric Surgery, Springer, 2021.

[3] Antares, J. B., Jones, M. A., King, J. M., Chen, T., Lee, C., Macintyre, S., & Urquhart, D. M. (2018). Non‐surgical and non‐pharmacological interventions for congenital muscular torticollis in the 0‐5 year age group. The Cochrane Database of Systematic Reviews, 2018(3), CD012987. https://doi.org/10.1002/14651858.CD012987

[4] Cheng, J. C., & Au, A. W. (1994). Infantile torticollis: a review of 624 cases. Journal of pediatric orthopedics, 14(6), 802–808.

[5] Ballock, R. T., & Song, K. M. (1996). The prevalence of nonmuscular causes of torticollis in children. Journal of pediatric orthopedics, 16(4), 500–504. https://doi.org/10.1097/00004694-199607000-00016

[6] Cheng, J. C., Tang, S. P., Chen, T. M., Wong, M. W., & Wong, E. M. (2000). The clinical presentation and outcome of treatment of congenital muscular torticollis in infants–a study of 1,086 cases. Journal of pediatric surgery, 35(7), 1091–1096. https://doi.org/10.1053/jpsu.2000.7833

[7] Kim, H. J., Ahn, H. S., & Yim, S. Y. (2015). Effectiveness of Surgical Treatment for Neglected Congenital Muscular Torticollis: A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery, 136(1), 67e–77e. https://doi.org/10.1097/PRS.0000000000001373