Torticollis in Babies: Spotting the Signs, Physiotherapy, and Home Exercises

Torticollis — the technical name for a neck tilt or turned head that a baby cannot easily correct — is more common than many parents realise. It is usually entirely treatable, particularly when identified early. Understanding what to look for, what the treatment involves, and how to help at home puts parents in a strong position to act quickly if it affects their baby.

What Is Congenital Muscular Torticollis?

Congenital muscular torticollis (CMT) is a condition in which the sternocleidomastoid muscle (SCM) — the long muscle running from behind the ear down to the collarbone — is shortened or tightened on one side. This tightness causes the baby's head to tilt toward the affected side and rotate toward the opposite side.

In other words, if the right SCM is tight: the head tilts to the right (ear toward right shoulder) and the chin turns to the left.

CMT is thought to affect approximately 0.3 to 2 per cent of newborns. It is caused by one of several mechanisms:

• Intrauterine positioning — prolonged pressure on the muscle in the womb, particularly common in first pregnancies or with a large baby in a crowded uterine environment
• Birth trauma — particularly following difficult deliveries, forceps or ventouse use, or prolonged labour
• A localised collection of blood or fibrous tissue in the SCM — sometimes a palpable lump (called a fibrotic mass or SCM tumour) can be felt in the affected muscle in the first few weeks of life

CMT is not the only cause of torticollis in babies — other causes include cervical spine abnormalities (Klippel-Feil syndrome), visual problems where the baby turns to compensate for strabismus, and neurological causes. These are less common, and physiotherapy assessment will help distinguish them.

Signs to Look For

Many parents notice something is slightly different about how their baby holds their head, though the signs can be subtle in mild cases:

• Head tilt. The baby consistently holds their head tilted to one side. When placed on their back on a flat surface, the head rests more naturally turned or tilted to one side.
• Preference for looking in one direction. The baby turns to look at you or follow stimuli from one direction much more readily than the other. They may consistently look toward one side during feeding.
• Difficulty breastfeeding on one side. The neck tightness that makes rotating the head in one direction difficult also makes feeding comfortably in certain positions harder. Difficulty latching or feeding on one specific breast is sometimes the first clue parents notice.
• Flat spot on the head. Because babies with CMT prefer to rest the head in one position, they often develop a flat area (positional plagiocephaly) on that side of the skull. Flat head and torticollis are closely linked — one often accompanies or causes the other.
• A lump in the neck muscle. In approximately 20 per cent of CMT cases, a firm, smooth lump can be felt in the sternocleidomastoid muscle. This is benign — it resolves with stretching — but it is worth mentioning to a clinician.

How Physiotherapy Helps

Physiotherapy is the primary treatment for CMT, and the earlier it begins, the better the outcome. Stretching the shortened SCM gradually restores range of motion, and in most cases of CMT identified in the first three to four months, full resolution is achieved.

A physiotherapist will:

• Assess the degree of restriction in range of motion
• Identify any associated flat head and its severity
• Teach parents a programme of stretching exercises to perform at home (typically two to three times per day)
• Provide guidance on positioning to encourage the baby to look toward the restricted side

What the exercises generally involve:

• Lateral neck stretching: Gently bringing the baby's ear toward the opposite shoulder (the ear away from the affected side). The physiotherapist will show you exactly how much stretch to apply and how long to hold it.
• Rotational stretching: Gently turning the baby's chin toward the affected side (the side the head tends to turn away from).
• Strengthening in the opposite direction through play — positioning toys and activity to encourage the baby to actively turn toward their restricted side.

These exercises do not need to be forceful. Babies often cry during stretching — this is a normal response to mild discomfort, not a sign of injury. Your physiotherapist will help you calibrate the appropriate level of stretch.

What to Do at Home Between Appointments

Positional management is as important as formal exercises:

• During supervised awake time, use toys, mirrors, and your face to draw the baby's attention toward their restricted side
• During feeding, position feeds to encourage the baby to turn toward their restricted side (if bottle feeding, hold the bottle on that side; if breastfeeding, adjust hold positions as guided by your physiotherapist)
• Ensure that tummy time is done daily from the early weeks — tummy time strengthens neck muscles and reduces the time the head rests in one position
• Alternate the end of the cot or pram from which your baby is approached, so they have a reason to look both ways
• Car seat positioning: consider which side stimulation comes from during car journeys

The Link to Flat Head (Positional Plagiocephaly)

Flat head syndrome and torticollis frequently co-occur, because a baby who preferentially rests on one side of their head will develop flattening of that area due to the softness of the skull in the early months. Treating the underlying torticollis — which removes the reason for the head preference — is the cornerstone of treatment for positional plagiocephaly in these cases.

Reassessment of head shape every few weeks during torticollis treatment allows the physiotherapist to determine whether the flattening is improving alongside the neck movement, or whether additional measures are warranted.

When to Seek Help

If you notice consistent head tilt or turning preference in your baby, raise it with your GP or health visitor at the next appointment — or sooner if the tilt is marked. A GP referral to a paediatric physiotherapist, or an NHS paediatric physiotherapy self-referral in areas that allow this, is the appropriate next step.

Early treatment — in the first three to four months of life — offers the best outcomes. Cases identified later still respond well to physiotherapy, but the duration of treatment is typically longer.