Torticollis, often called “wry neck,” is a common condition in infants where one of the neck muscles is shortened, causing the head to twist and tilt to one side. This muscular imbalance can be concerning for parents, but it is highly treatable, particularly when addressed early. A strong home-based strategy focusing on positioning and gentle exercises offers the best path toward resolution.
Identifying Torticollis and Its Causes
Torticollis is recognized through several observable signs related to head and neck movement. A noticeable tilt of the head, where one ear is consistently drawn toward the shoulder, is the most common visual cue. The baby strongly prefers to look in one direction, showing resistance when attempting to turn the head toward the opposite side due to the tight muscle.
The most frequent type, Congenital Muscular Torticollis (CMT), is often attributed to the infant’s positioning in the womb or trauma during birth. This strain causes the sternocleidomastoid (SCM) muscle, which runs along the side of the neck, to tighten and shorten. A small lump of scar tissue may be felt within the SCM muscle, which typically resolves on its own, but any sudden onset of Torticollis warrants a prompt medical evaluation.
At-Home Positioning and Exercise Strategies
Successful at-home management relies on consistently encouraging the infant to turn their head away from the preferred side. This approach uses the baby’s natural curiosity and desire to interact with their environment to stretch the tight muscle and strengthen the weaker one. Simple changes to the baby’s surroundings can have a large effect on promoting symmetrical movement.
Environmental Adjustments
Positioning the crib so the baby must turn their head to the non-preferred side to view the door or the parent encourages therapeutic rotation. When the baby is awake, toys and mobiles should be placed to the side they avoid looking toward. This gentle enticement stimulates the baby to actively turn their head to the full range of motion.
During feeding, parents should alternate sides and position the baby so they must turn away from their preferred resting position. When carrying the baby, using a “football hold” or a vertical carry encourages the head to be upright or tilted away from the tight side, working as a passive stretch. Minimize the time the baby spends in carriers, swings, or car seats outside of transport, as these restrict movement and reinforce the head preference.
Stretching and Range of Motion Exercises
Specific stretches gently lengthen the shortened SCM muscle. The two primary movements are rotation and side bending, which should be done slowly several times a day, such as at every diaper change. For rotation, stabilize the baby’s affected shoulder and gently turn the chin toward the opposite shoulder, holding the stretch briefly.
For side bending, stabilize the affected shoulder and gently bring the opposite ear toward the shoulder, holding the position for a short duration. The goal is to move the head only to the point of mild resistance, never causing discomfort or forcing the stretch. Consistency is more valuable than intensity for these home exercises.
Tummy Time
Tummy Time is a foundational activity that strengthens the neck and upper body muscles necessary for correcting Torticollis. When placed on their belly, the baby must lift their head against gravity, which strengthens the muscles on the side opposite the tightness. Parents can place themselves or engaging toys to the baby’s non-preferred side to prompt them to lift and turn their head in that direction.
The recommended goal is for babies to accumulate at least 60 to 90 minutes of supervised Tummy Time daily by four months of age, broken up into short, frequent sessions. Performing Tummy Time on a parent’s chest or lap can be an easier starting point for infants who struggle on the floor. This activity directly supports the development of symmetrical head control.
When Professional Intervention is Necessary
While at-home strategies are very effective, seeking professional guidance is necessary if little improvement is noted after four to six weeks of consistent home exercise. A severe head tilt or the presence of a firm lump in the neck muscle are also reasons for prompt consultation with a healthcare provider. The primary professional treatment is Pediatric Physical Therapy (PT), which has a high success rate, especially when started before six months of age.
A pediatric physical therapist conducts a detailed evaluation of the baby’s neck mobility, posture, and movement patterns. The therapist guides parents through advanced manual stretching and strengthening exercises tailored to the baby’s needs. These techniques include hands-on manual therapy to release tightness and functional activities to encourage symmetrical movement during play.
In the unusual event that Torticollis is severe and does not respond to several months of intensive physical therapy, a specialist may discuss other medical interventions. These can include botulinum toxin (Botox) injections to temporarily relax the tight muscle or, as a measure of last resort, a surgical procedure to lengthen the SCM muscle. Such procedures are generally reserved for a very small percentage of severe, non-responsive cases.
Managing Related Developmental Outcomes
Untreated Torticollis can lead to secondary physical issues due to the persistent head preference. The most common related outcome is deformational plagiocephaly, a flattening of the skull on one side. This occurs because restricted head movement causes the baby to rest their head consistently on the same spot, applying pressure to the soft skull bones.
For mild cranial asymmetry, the repositioning techniques used for Torticollis are often enough to allow the head to round out. For moderate to severe plagiocephaly, a non-surgical cranial orthosis, known as helmet therapy, may be recommended. The custom-fitted helmet applies gentle pressure to prominent areas while allowing growth in flattened regions, redirecting natural head growth.
Torticollis can also affect the achievement of gross motor milestones. Asymmetrical muscle development makes it difficult for an infant to roll over symmetrically or maintain a centered posture while sitting. Addressing the neck tightness restores the balance needed for the baby to achieve milestones like rolling, sitting, and crawling equally on both sides.