Congenital Torticollis and Plagiocephaly

An infant who keeps his or her head tilted to one side may have a condition called congenital torticollis. It is usually diagnosed by the pediatrician in the first two or three months of life. It can be caused by a tight sternocleidomastoid muscle on one side of the neck that pulls the head (ear) down toward one shoulder as the chin tilts to the opposite side. There also may be a lump or swelling in the muscle that gradually disappears. Limited range of motion may be present in the neck muscles. If you notice that your child consistently holds the head tilted to one side, consult your baby’s physician. Conditions other than congenital muscular torticollis may result in this head position and the doctor must eliminate them as possible causes.

Congenital muscular torticollis is generally painless and can be treated with a consistent program of stretching exercises. A physical therapist will instruct the caregivers in a series of exercises that must be done several times a day. Parents will also be instructed in positioning, play, feeding, and carrying activities that will stretch the tight muscles. Observation of the infant’s ability to perform age appropriate motor skills is an important component in the assessment of the infant with torticollis. Intolerance of prone positioning is a common problem in infants with this condition. Congenital muscular torticollis usually improves with massage, tummy time, range of motion and stretching exercises. If your child’s head lies in the same position all of the time with continuous unilateral weight bearing on the cranium, positional plagiocephaly and facial asymmetry may develop. One side of the face may be flattened and the skull may appear oblong instead of round. Since the initiation of the “back to sleep” program, deformational plagiocephaly is on the rise. Repositioning is a required element of early management of both torticollis and plagiocephaly. A remolding orthosis/helmet could be necessary as an adjunct to treatment.

Goals of physical therapy include:

  • Restoration and maintenance of active and passive range of motion of neck and trunk.
  • Centered posture of the head and neck without persistent head tilt to the involved side.
  • Symmetrical shape of the face, head and neck.
  • Development of postural reactions in all directions.
  • Symmetry of gross movement patterns throughout infant’s development.
  • Family/Caregiver instruction in techniques to facilitate the above.

Gradual improvements in range of motion and cranial symmetry can be expected over the course of treatment. Initially, patients are seen by the physical therapist several times a week until the family is comfortable with the home program of exercises and positioning techniques. Progress is monitored over a few months. In some cases infants are referred to a certified orthotist for a remolding helmet.