Torticollis in Babies: 3 Signs Parents Shouldn't Ignore

Torticollis is a condition that primarily affects infants. It causes a tipping and turning of the head and neck to one side. Babies who have torticollis struggle to move their heads equally to both sides. There is also a high correlation between torticollis and other issues such as reflux, colic, and hip dysplasia. Babies with torticollis also tend to struggle with developing their motor milestones, and the persistent head tilt and rotation can cause changes in their visual perception and balance systems. It is not a condition to be taken lightly. 

Early intervention is crucial for resolving torticollis. It is significantly easier to treat in younger babies compared to older ones. In my clinical experience, babies who have their head tilts treated within the first 2 months of life resolve them within a month or two compared to babies who don’t start treatment until they are 4 months or older. Early intervention can start when parents know what to look for. Here are 3 early signs of torticollis that should prompt parents to seek an evaluation with a pediatric physical therapist:

Baby looks to the same side more than 75% of the time

Babies should be looking equally to the right and left sides. When they look to one side more than the other, it can be a sign of torticollis starting. Parents should be vigilant in monitoring the symmetry of baby’s resting head position, especially at night in the bassinet and in the car seat. These are the most common times to see that baby cannot (or will not) turn their head to both sides. 

Baby is developing a flat spot on one side of their head

New parents are exhausted and utterly in love with their new baby, so a head position preference can easily go unnoticed in those first few weeks. But what is often more readily noticeable and shouldn’t be ignored is a flat spot. Flat spots do not develop when baby is turning their head equally to both sides and adequately distributing pressure across the skull. Flat spots on the back of baby’s head develop most often because of persistent pressure on one side of the head. This persistent pressure is often perpetuated by torticollis. Changes in head shape should be evaluated immediately to determine their severity and appropriate treatment steps. There is a common myth among health care providers that flat spots are merely cosmetic, but this couldn’t be farther from the truth. Since these flat spots are highly correlated with torticollis, they come with all of the associated issues like reflux, hip dysplasia, and motor skill development issues. In addition, there are more serious issues of pressure on the brain where visual centers reside, and untreated flat spots can lead to  more severe skull deformation causing ear, eye, nose, and jaw shifts. These bony shifts can impact a child’s:

• Airway

• Speech

• Ability to nurse and chew

• Vision

  
  

Obviously, these are not just cosmetic issues. Flat spots should be taken with the utmost seriousness. At Foundation PT, we offer free head shape screenings so that you can have your baby’s head assessed and discuss the best course of treatment for your baby. If you aren’t local to Waukesha, WI, you can search for other pediatric PTs in your area who may offer a similar service, or contact your local Cranial Technologies clinic for an assessment. 

Baby’s body is curved to one side more than the other

A baby who tends to look one direction often has an associated body curve to one side. While most people consider torticollis to be a neck issue, there is often a fascial pull lower in the body and abdomen that is perpetuating the pull we see higher up in the neck. It has been my clinical experience that releasing tension throughout the abdomen will allow baby’s trunk to move in both directions and immediately free up their head and neck to also start moving more in both directions. These fascial pulls are easily treated in newborns, and they haven’t had as long to develop habits around their position preferences and head tilts. This makes treatment rapidly successful. Fascial pulls are still easily treatable in older infants as well, but once babies start holding up their own heads and learn to do so with a tilt, there is more muscle and motor skill retraining that must take place, and treatment often takes longer. 

These are crucial warning signs to take your baby in to see your local pediatric physical therapist. In Wisconsin, you do not need a referral from a physician or other provider. You can go straight to the physical therapist, and it is important that you do so if you feel that your concerns are being dismissed by another provider. At our clinic, we take every parent concern seriously and investigate thoroughly. 

Want to bring your baby in for a head shape screening or a full physical therapy evaluation? You can visit our website here. Helping tiny humans live pain free, move well, and thrive is our joy. 

Baby undergoing head shape measurements as part of a comprehensive torticollis assessment.

FAQ

What is torticollis?

Torticollis literally translates into “twisted neck” and describes what happens when the head and neck are turned and tipped to one side. Traditionally it’s thought to be due to tightness of the sternocleidomastoid (SCM) muscle, and many medical providers will treat it as such. However, there is often a full body component to torticollis, so the translation “twisted neck” is a bit misleading. 

How easy is it to treat torticollis? 

Very easy when treatment is started early! Torticollis treatment will take a longer time once baby has started to hold their own head up and become mobile. This is because baby will develop these skills and motor patterns in an asymmetrical fashion and it becomes a habit. Habits are more challenging to change and correct. 

What do I do if my pediatrician won’t take my concerns about torticollis seriously? 

You have every right to go straight to a pediatric physical therapist or seek a second opinion from another physician. It’s important that parents advocate strongly for their children. Unfortunately, I see a lot of pediatricians brush off early warning signs for torticollis, and it leaves children and families in a predicament of long term therapy that is often mediocre at best. It is better to get treatment early and proactively with a therapist who takes your concerns seriously. It will save you a significant amount of time and money in the long run. 

Dr. Sabrina Thorpe is a Doctor of Physical Therapy with a decade of clinic experience. She specializes in treating pregnant and postpartum women and their infants at Foundation Physical Therapy in Waukesha, WI.