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What is it?

Torticollis is where one side of the neck is tight. It is usually noticed at a couple of months of age. The infant holds the head tilted to one side and rotated to the other side—sometimes called a cock-robin position. The baby may have difficulty turning it to the opposite side.

What causes torticollis?

There are many causes of torticollis. One common cause is a contracture, or tightness, in the sternocleidomastoid muscle, a condition called congenital muscular torticollis. The cause is unknown, but there are several theories as to how this occurs.  One theory is how the patient is positioned in the uterus.  Another theory is that there is pressure on that muscle during the time of delivery.  Other known causes of torticollis in infancy include eye muscle weakness and reflux.  Babies can also develop torticollis by habit if they always have their head turned to one side.

Torticollis, if first seen after infancy, may have a neurologic cause and needs to be evaluated. Brain tumors and other problems in the brain and spinal column (neck bones) are known causes of torticollis in childhood.

How is it diagnosed?

Torticollis is diagnosed by physical exam. The child will hold the head tilted to one side and rotated to the opposite side.  They may not be able to turn the head to the opposite side with gentle manipulation of the neck.  Often there is a bulge around the tight neck muscle that can be felt during physical exam.  One side of the back of the head is often flatter than the other because of pressure. An xray of the cervical spine may be done to look for a bony cause of the torticollis, especially in older children.  An MRI of the brain and neck may be performed if a neurologic problem is suspected.

About one in five children with torticollis due to muscle tightness will also have hip dysplasia. A hip ultrasound should be done to rule out hip dysplasia.

How is torticollis treated?

The treatment depends on the cause and severity.  For torticollis due to muscle tightness and habit, stretching exercises are taught for the parents to do at home.  They can also make some adjustments at home during play, sleep, or feeding to encourage the infant to look in the direction that is harder for them.  If the torticollis is more severe or if it does not improve with the home adjustments and stretching, then physical therapy will be recommended.  In very rare cases, if the torticollis does not improve with therapy, the child may need a surgical lengthening of the tight sternocleidomastoid muscle.

Torticollis due to other problems is treated differently.  An ophthalmologist, or eye doctor, may need to evaluate the child if an eye muscle problem is suspected. Neurologic causes may require treatment by a neurosurgeon or neurologist.  Problems with the neck bones may require a neck brace, traction and in rare cases surgery.

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