Torticollis in Babies: Why Your Infant Tilts Their Head to One Side

If you’ve noticed your baby consistently tilting their head to one side or struggling to turn their neck in both directions, they may have infant torticollis—a condition where tight or shortened neck muscles cause the head to tilt or rotate preferentially. While this can be concerning for new parents, the good news is that with early detection and appropriate physiotherapy treatment, most babies recover completely and achieve normal neck movement.

At Healyos Physiotherapy, we understand how worrying it can be when something seems different about your little one’s development. Our team specializes in pediatric care and provides both in-clinic and at-home physiotherapy services in Pune, making it convenient for families to access expert treatment in a comfortable setting.

What Is Infant Torticollis?

Torticollis, also called wryneck, is a condition where a baby’s head tilts toward one shoulder while the chin points toward the opposite shoulder. This happens due to tightness or shortening of the sternocleidomastoid muscle (SCM)—the large muscle that runs along each side of the neck from behind the ear to the collarbone.

Congenital torticollis is present at birth or develops shortly after, making it one of the most common musculoskeletal conditions in newborns, affecting approximately 1 in 250 babies. The condition can range from mild to severe, but the earlier it’s identified and treated, the better the outcome.

Why Do Babies Develop Torticollis?

Understanding the causes can help parents recognize risk factors and seek timely intervention. Here are the primary reasons babies develop torticollis:

Birth-Related Factors

• Difficult or prolonged labor that puts stress on the neck muscles
• Breech position or other unusual positioning in the womb
• Use of forceps or vacuum during delivery
• First-born babies, who may experience tighter space in the birth canal

Positional Factors

• Prolonged time in one position in the womb, especially in the third trimester
• Multiple births (twins or triplets) where space is limited
• Consistently lying in the same position after birth
• Spending excessive time in car seats, bouncers, or swings

Other Causes

• Muscular abnormalities or fibrosis in the SCM muscle
• Rarely, underlying bone or spine abnormalities (which is why medical evaluation is important)

How to Recognize Torticollis in Your Baby

Early detection is crucial for successful treatment. Watch for these signs of torticollis:

Head Position and Movement:

• Head consistently tilts toward one shoulder
• Chin rotates toward the opposite shoulder
• Difficulty turning head fully in one or both directions
• Preference for looking in only one direction
• Asymmetrical head turning during feeding or play

Physical Signs:

• A small lump or thickening in the neck muscle (sometimes present)
• Flat spot on one side of the head (plagiocephaly), often developing alongside torticollis
• Uneven shoulder height
• Limited range of motion during diaper changes or dressing

Behavioral Indicators:

• Frustration when trying to turn head in the restricted direction
• Preference for breastfeeding on one side only
• Difficulty tracking objects or faces on one side

Connection Between Torticollis and Plagiocephaly

Many babies with torticollis also develop plagiocephaly, or flat head syndrome. Because the baby’s head remains in one position for extended periods, the soft skull bones can flatten on one side. This creates a cycle where the flat spot makes it more comfortable for the baby to keep their head in that position, worsening both conditions.

How Is Infant Torticollis Diagnosed?

Diagnosis typically involves:

1. Physical Examination: Your healthcare provider will assess your baby’s neck range of motion, muscle tightness, and head shape
2. Medical History: Discussion of pregnancy, delivery, and any concerns you’ve noticed
3. Imaging (if needed): In rare cases, X-rays or ultrasound may be ordered to rule out bone or spine abnormalities

A pediatric physiotherapist can also perform a detailed assessment, measuring the degree of neck rotation and tilt to establish a baseline for treatment.

Treatment Options: How Physiotherapy Helps

The primary treatment for infant torticollis is physiotherapy, which has an excellent success rate when started early. Here’s what treatment typically includes:

Stretching Exercises

Your physiotherapist will teach you gentle stretching techniques to lengthen the tight SCM muscle. These exercises are performed multiple times daily and become part of your baby’s routine.

Strengthening Activities

Activities that encourage your baby to turn their head in the restricted direction help strengthen the weaker neck muscles and build symmetry.

Positioning Strategies

• Place toys and interesting objects on the affected side to encourage head turning
• Alternate which end of the crib you place your baby in
• Carry your baby in different positions throughout the day
• Encourage tummy time to strengthen neck, shoulder, and core muscles

Active Play and Engagement

Making therapy fun through play ensures better cooperation and faster progress. Your physiotherapist will demonstrate age-appropriate activities tailored to your baby’s developmental stage.

Parent Education and Home Exercise Program

At Healyos Physiotherapy, we believe parents are essential partners in treatment. We provide clear instructions, demonstration videos, and ongoing support so you feel confident performing exercises at home between sessions.

What to Expect During Physiotherapy Sessions

Whether you choose in-clinic visits or prefer the convenience of at-home services in Pune, here’s what a typical physiotherapy session involves:

• Initial Assessment: Comprehensive evaluation of your baby’s neck range of motion, muscle tone, and any associated conditions
• Personalized Treatment Plan: Based on severity and your family’s needs
• Hands-On Treatment: Gentle manual therapy techniques and guided exercises
• Education: Detailed instruction on home exercises and positioning
• Progress Monitoring: Regular reassessments to track improvement and adjust the treatment plan

Most babies require physiotherapy sessions 1-2 times per week for several weeks to months, depending on severity. Many families see significant improvement within 4-6 weeks when exercises are performed consistently at home.

Home Care Tips for Managing Torticollis

Between physiotherapy sessions, these strategies can accelerate your baby’s recovery:

During Feeding:

• Alternate which side you hold your baby for bottle or breastfeeding
• Position yourself so your baby must turn their head toward the restricted side to see you

During Play:

• Place toys on the affected side during tummy time
• Stand or sit on the side that requires more effort for your baby to see you
• Use mirrors, lights, or colorful objects to attract attention

During Sleep:

• Follow safe sleep guidelines (always place baby on back)
• Alternate which end of the crib your baby’s head is positioned
• Avoid prolonged time in car seats or bouncers when not traveling

Daily Activities:

• Maximize tummy time when awake and supervised
• Vary carrying positions throughout the day
• Engage your baby from different angles during diaper changes

When Is Surgery Necessary?

Surgery is rarely needed for torticollis and is only considered if:

• Physiotherapy has been consistently performed for 6-12 months without improvement
• The child is older (typically over 18 months) and has severe tightness
• There are structural abnormalities requiring surgical correction

The vast majority of babies—over 90%—improve with physiotherapy alone when treatment begins early.

Long-Term Outlook and Prevention

With appropriate treatment, most babies with torticollis achieve complete resolution by their first birthday. Early intervention is key—babies who begin physiotherapy before 3 months of age tend to have the fastest and most complete recovery.

Preventing Torticollis:

• Practice supervised tummy time from the first week of life
• Vary your baby’s head position during sleep (alternate ends of crib)
• Limit time in containers (car seats, swings, bouncers) when not necessary
• Hold and carry your baby in different positions
• Encourage active movement and play

Key Takeaways

• Infant torticollis is a common condition causing babies to tilt their head to one side due to tight neck muscles
• It affects approximately 1 in 250 babies and is often related to birth positioning or delivery factors
• Early signs include consistent head tilting, difficulty turning the neck, and preference for looking in one direction
• Physiotherapy is the primary and most effective treatment, with over 90% success rate when started early
• Treatment includes stretching exercises, strengthening activities, positioning strategies, and parent education
• Consistent home exercises between therapy sessions are crucial for faster recovery
• Most babies show significant improvement within 4-6 weeks and achieve full resolution by their first birthday
• Plagiocephaly (flat head) often occurs alongside torticollis but improves with proper treatment
• Surgery is rarely necessary—fewer than 10% of cases require surgical intervention
• Healyos Physiotherapy offers specialized pediatric care with clinic and at-home services in Pune

Frequently Asked Questions (FAQs)

1. Can torticollis go away on its own without treatment?

While some very mild cases may improve without intervention, most cases of infant torticollis require physiotherapy for complete resolution. Without treatment, the condition can persist and potentially lead to developmental delays, facial asymmetry, or permanent neck muscle tightness. Early physiotherapy significantly improves outcomes and prevents complications, so it’s always recommended to seek professional evaluation rather than waiting to see if it resolves on its own.

2. Is torticollis painful for my baby?

Torticollis itself is not typically painful for babies, though they may experience some discomfort when their head is moved in the restricted direction. The tight muscle creates a pulling sensation that babies naturally avoid, which is why they prefer one position. During physiotherapy stretches, babies may fuss initially, but the exercises should never cause significant pain. As treatment progresses and muscles loosen, babies usually become more comfortable with the movements.

3. Will my baby have any lasting effects from torticollis if treated properly?

When torticollis is diagnosed early and treated with consistent physiotherapy, the vast majority of babies experience complete recovery with no lasting effects. They achieve full neck range of motion, normal head shape, and meet all developmental milestones on schedule. However, delayed treatment or inconsistent therapy may lead to persistent muscle tightness, facial asymmetry, or developmental coordination issues, which is why early intervention is so important.

4. How long should each home exercise session last for my baby?

Home exercise sessions for infant torticollis should be brief but frequent. Each stretching exercise typically lasts 10-30 seconds and should be repeated 3-5 times per side, performed 4-6 times throughout the day. Rather than one long session, it’s more effective to integrate exercises into your daily routine—during diaper changes, after feeding, or during playtime. Your physiotherapist will provide specific guidance based on your baby’s tolerance and the severity of their condition.

5. Can my baby’s sleeping position affect torticollis recovery?

Absolutely. While babies should always sleep on their backs following safe sleep guidelines, you can vary which end of the crib they sleep at, encouraging them to look in different directions toward the door or window. Avoid using positioners or pillows to turn the head, as these are unsafe. During supervised awake time, maximize tummy time and varied positioning. The combination of safe back sleeping with intentional positioning during awake hours supports recovery without compromising safety.