Torticollis is a common condition in infants where the head is persistently tilted to one side and rotated to the opposite side. This posture results from the tightening or shortening of the sternocleidomastoid muscle along the side of the neck. The most common type, congenital muscular torticollis, is highly treatable, especially when intervention begins early. If the muscle restriction is left unaddressed, the limited range of motion can initiate a cascade of secondary issues affecting the child’s physical development and overall well-being.
Craniofacial Deformities
The most immediate consequence of untreated torticollis is the development of structural changes to the skull and face, known as deformational cranial asymmetries. The infant prefers holding the head in a fixed position, applying constant pressure to the soft skull bones. This uneven pressure results in a misshapen head, seen in up to 90% of affected babies.
The most frequent asymmetry is Plagiocephaly, characterized by an oblique flattening on one side of the back of the head. This flattening can cause the ear to shift forward, sometimes accompanied by a bulging forehead and a fuller cheek. Brachycephaly involves a generalized flattening across the entire back of the head.
These conditions do not affect brain development. However, asymmetry can extend to facial features, leading to unevenness of the jaw, which may cause issues with dentition or feeding. Early repositioning and physical therapy are crucial to allow the skull to return to a symmetrical shape before the bone structure becomes rigid, typically around six months.
Impaired Motor Skill Development
The physical restriction imposed by a shortened neck muscle directly interferes with the acquisition of motor skills. The inability to freely turn the head prevents the child from establishing strong midline control, essential for gross motor development. This restriction means the child cannot look equally to both sides.
Lack of head control leads to delayed milestones, such as lifting the head evenly during tummy time or rolling. Children with untreated torticollis develop asymmetrical movement patterns, preferring to roll only to one side or using one hand more than the other. This compensation can translate into delayed sitting up, asymmetrical crawling, and poor balance.
The neck tightness can affect the entire trunk and limb control, leading to secondary issues like tightness in the hips and arms. Learning motor tasks incorrectly means the child may need to unlearn these compensatory habits later. Early therapeutic intervention is more effective for promoting proper physical development and preventing asymmetrical patterns necessary for skills like speech production.
Persistent Alignment and Visual Issues
If the muscle imbalance is not corrected during infancy, torticollis can transition from temporary postural habits to chronic musculoskeletal and visual problems. The persistent head tilt leads to permanent postural changes beyond the neck. This long-term asymmetry places uneven stress on the spine, increasing the risk of infantile scoliosis.
Musculoskeletal issues manifest as chronic misalignment of the shoulders and neck, causing ongoing discomfort or pain as the child grows. The body adapts to the head tilt, resulting in a fixed, awkward posture that is harder to correct later. This persistent head position also directly affects the child’s visual system, potentially causing long-term complications.
To see horizontally, the child constantly adjusts their head to compensate for the neck tilt, which can lead to problems with depth perception and visual tracking. This adaptation can contribute to the development of Strabismus, or “lazy eye,” as the child consistently favors one visual field. The tight muscle forces this compensatory head position, ultimately affecting the eyes’ ability to work together effectively.