Torticollis

Gillette Children’s Specialty Healthcare offers comprehensive treatment for infants who have, or are suspected to have, torticollis. We also evaluate babies for deformational plagiocephaly (flat head syndrome), a condition that often accompanies torticollis. Because torticollis can affect a baby’s growth and development, prompt treatment is critical.

In most cases, torticollis resolves with physical therapy. If infants have both torticollis and plagiocephaly, our craniofacial experts use the Gillette CranioCap® orthosis to address head shape while our physical therapists address neck mobility.

Why Choose Gillette?

  • Our early intervention leads to optimal results, whether torticollis occurs alone or alongside plagiocephaly. 
  • We integrate rehabilitation therapies services with advanced medical care.
  • Our craniofacial specialists are experts in diagnosing and treating torticollis and plagiocephaly, evaluating more than 1,000 cases each year.
  • Our physical therapists treat hundreds of babies with torticollis every year.

Definition

The term “torticollis” means “twist neck.” Muscular torticollis is present when a muscle on the side of a baby’s neck, called the sternocleidomastoid, is shortened or tightened.

The tightening of the muscle pulls the head toward the affected side and limits the baby’s ability to turn toward the affected shoulder. That results in a tilted or rotated head position. The prolonged, one-sided head positioning can cause deformational plagiocephaly (flattening on the affected side of the head). Left untreated, torticollis can affect vision and balance.


Torticollis Causes and Risk Factors

Torticollis is often diagnosed in newborns who prefer positioning their head to the left or right. It can result from intrauterine positioning and is often accompanied by deformational plagiocephaly. Torticollis also can result from damage to the sternocleidomastoid (a muscle on the side of a baby’s neck) that occurs because of birth trauma or because the muscle didn’t develop properly. 

Rarely, torticollis is caused by superior oblique palsy or abnormalities of the cervical spine. In rare cases, it can be a symptom of an underlying genetic condition. As such, torticollis is sometimes associated with other disorders of infancy, such as developmental dysplasia of the hip (DDH).  Early diagnosis and management by experts, who have access to additional medical specialists when needed, is vital for successful outcomes.


Symptoms and Effects of Torticollis

Babies with torticollis have difficulty moving their neck because of muscle stiffness. They also tilt the head noticeably in one direction, and they might compensate for the condition by leaning back to view objects. Their chin might point slightly upward.

More than half of babies with torticollis also have deformational plagiocephaly, or a flat spot on the affected side of the head, which is caused by lying consistently in one position.

Less commonly, some babies with torticollis also have developmental dysplasia of the hip (DDH). Like torticollis, DDH can result from intrauterine positioning or birth trauma.  The correlation between the two disorders is not well understood; it can be missed in routine examinations.


Diagnosing Torticollis

Torticollis usually becomes evident by approximately 4 months—the age when infants gain head control. Severe cases are noticeable in newborns.

A baby’s family or pediatrician might notice the neck stiffness and irregular head tilt that can indicate torticollis. The infant should see a specialist for evaluation and treatment as soon as the condition is suspected. 


Treatments for Torticollis

Our craniofacial team evaluates infants who have, or are suspected to have, torticollis.  Once a diagnosis is confirmed, we begin treatment with physical therapy to stretch and strengthen the muscles of the neck. (Physical therapy is most successful when it begins early in life.) Regular therapy exercises encourage babies to move the affected side of their neck, creating balance. In most cases, a short episode of therapy (lasting from a few weeks to a few months), coupled with daily exercises at home, is sufficient to resolve torticollis. The condition is unlikely to recur as a baby grows.

Additional Treatment Options

If therapy isn’t effective after several months, or if progress plateaus, our craniofacial surgeons re-evaluate patients. At that time, we typically perform cervical spine films (X-rays) and an ophthalmologic examination to rule out a cervical spine anomaly or ocular (eye) cause for torticollis. If other methods of treatment are ineffective, we might discuss surgical release of the neck muscle. 

Torticollis and Deformational Plagiocephaly (Flat Head Syndrome)

Because moderate to severe forms of torticollis can significantly affect head shape, we offer the Gillette CranioCap® orthosis. The orthosis gradually reshapes a baby’s skull, rounding the head over three to four months. Assistive Technology staff work closely with our craniofacial team to custom-fit the orthosis and make adjustments as a baby develops.

By reducing the time a child spends in one position, physical therapy can help decrease the extent of plagiocephaly that results from torticollis. Because deformational plagiocephaly has no known long-term medical effects, the decision to fit a child with a Gillette CranioCap® orthosis ultimately rests with parents or caregivers.


Our Torticollis Services

Early diagnosis and treatment increases the chances for a successful correction of torticollis. Early intervention also helps decrease the degree of plagiocephaly (flat head shape) that results from torticollis. Gillette’s interdisciplinary team of craniofacial experts, rehabilitation therapists and assistive technology practitioners guide families through the services needed to effectively treat torticollis and any associated conditions.

Specialties and services most often associated with torticollis care include:

For more information about the services we provide at Gillette, search Conditions and Care.


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