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Torticollis Questions and Answers for Parents

From Care Rehab, Baltimore, MD

What is Torticollis?

Torticollis is a condition which affects the neck and spine in many infants. A common name for Torticollis is "wry neck". The literal translation is "crooked neck". It is a very treatable condition, but should be taken seriously and discussed with your child's pediatrician. Physical therapy treatment is often recommended.

There are many underlying conditions that can cause a head and neck position that would be considered Torticollis. The version of torticollis most commonly found in infants is Congenital Muscular Torticollis CMT) meaning:

Congenital - present at birth
Muscular - affecting the muscles
Torticollis - literally means 'twisted neck'

CMT is caused by damage to or a shortening of the Sterno-cleido-mastoid muscle in an infant's neck. Sometimes, but not in all cases, there is a hematoma (lump) in the muscle where it was damaged. That lump will eventually go away as the muscle heals and is stretched. The most common causes of CMT are in utero positioning, lack of space in utero (big baby or little mom), a traumatic birth, multiple births (lack of room), and low amniotic fluid in utero.

What are the symptoms?

Often Torticollis is mistaken for the normal 'floppy' neck of a newborn. Generally, parents may notice a 'tilted' head associated with Torticollis in the first week to 10 days of life. If your child is affected by CMT there will be a tightening of the Sternocleidomastoid muscle (SCM) on one side of the neck. Because the SCM controls both tilt and rotation (ability to look from side to side), a child with Torticollis will tilt one way and look toward the opposite side. The head tilt does not need to be severe to be Torticollis. Any inability to straighten the head or inability to turn his/her head both directions equally could be Torticollis.

When should children be referred to a physical therapy?

Addressing this condition early and following prescribed physical therapy stretching and exercises will usually correct CMT by the time child is 18 months old. Care Rehab also treats children who are older than 3 months, but with these children treatment may take longer.

How will my child be evaluated?

Upon referral from your child's primary care physician or specialist, a pediatric physical therapist will evaluate your child's status in the following areas:

  • Range of motion
  • Flexibility
  • Strength
  • Resting posture
  • Performance in age appropriate gross motor skills
What are the typical treatment strategies?

After evaluating your child, a pediatric physical therapist will provide gentle passive range of motion exercises to help develop balanced neck muscles through play-based and functional activities in prone, supine and sitting. The treatment targets the use of the opposite muscle facilitating tilting and turning the chin toward the non-favored side. Therapists may use:

  • Stretches to improve muscle extension and joint flexibility
  • Myofascial techniques to increase muscle range
  • Active range of motion exercises
  • Strengthening exercises
  • Specialized orthotic devices
To support treatment, Care Rehab patients will receive individualized home exercise programs that include: written parent education information, recommendations for carrying techniques, feeding, positioning suggestions for crib, car seat, and other seats. With severe torticollis, use of a tubular orthosis for Torticollis (TOT) or collar may be recommended. Our therapists are able to issue, size, and instruct parents in its use. Care staff can refer parents to equipment sources for helmets, Dynamic Orthotic Cranioplasty (DOC) bands and other devices.

How long will my child need Physical Therapy?

Care Rehab recommends weekly therapy until a child has mastered sitting and crawling or standing. At that point, the child may be able to reduce therapy to every other week or monthly. Children should be followed until they are walking. For some children, walking increases head tilting.

Infants Torticollis can be worrisome for parents at first but it doesn't have to be. With early diagnosis and physical therapy it can be corrected. Should your pediatrician suggest physical therapy, contact Care Rehab for an evaluation and treatment.

From CARE REHAB, in Baltimore, MD. Providing Pediatric Occupational, Physical and Speech Therapy

Care Rehab's ultimate goal is to give children functional skills that will help them today while decreasing their need for future services. Founded in 1983, Care is unique in that parents and other caregivers participate in all therapy so they can carry on the child's program at home. Find us at:, or by phone at: 410.583.1515.

Disclaimer: Internet Special Education Resources (ISER) provides this information in an effort to help parents find local special education professionals and resources. ISER does not recommend or endorse any particular special education referral source, special educational methodological bias, type of special education professional, or specific special education professional.


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