Torticollis associated with Plagiocephaly

As many as 9 out of 10 infants diagnosed with torticollis may also have plagiocephaly.

Torticollis is derived from two Latin terms, tortus, meaning twisted, and collum, meaning neck. Simply stated, it describes an abnormal neck posture. It causes a baby to have a head tilt and/or turn preference. The condition is caused when the SCM muscle is abnormally tight and it pulls the skull from where it attaches behind the ear (as shown in the image). Torticollis affects both females and males equally. The tilt is more often to the left than the right.

Torticollis can affect facial symmetry, ear alignment and can lead to difficulties interacting with the environment. It can limit a child’s ability to turn his head to see, hear, and interact freely with his environment and can lead to delayed cognitive development, delayed whole body awareness, muscle weakness, and difficulties with balance. In more severe cases, it can also contribute to a scoliosis in the spine.

Infants with untreated torticollis may be at increased risk for early motor delay, global delay, impaired balance and coordination, delay in acquisition of gross motor skills, and reinforcement of altered movement patterns due to adaptive motor behavior.

Often, the presence of neck and facial asymmetry is visible the first week after birth. The baby’s head may tilt to one side, giving him or her a limited range of motion. Torticollis, or wry neck, can result from placement in utero or the birth process. It may also appear when babies are constantly in the same position in car seats, swings, etc. and do not turn their necks to both sides. With the baby favoring one side, he or she may develop plagiocephaly (flat head syndrome) in addition to torticollis. In the past, some physicians used irregular head shapes as diagnosis tool for torticollis.

Infants who have been diagnosed with congenital muscular torticollis have a high likelihood of also having plagiocephaly. Studies show that plagiocephaly is estimated to coexist in as many as 90 percent of babies with torticollis.

Below, we’ve provided some examples of mild, moderate and severe cases of torticollis.

             Mild                                    Moderate                                Severe

Additional Clinical Evidence

  • There is a 23 percent increased risk of congenital muscular torticollis when plagiocephaly is present at birth.
  • Early treatment for torticollis (earlier than 2 months) can greatly reduce treatment time to as little as 4-6 weeks.
  • Delayed treatment of torticollis (after 3 months) can increase treatment time to more than 6-9 months.

Should your baby demonstrate signs of torticollis, you and your pediatrician should also be looking for and potentially treating associated conditions such as a plagiocephaly or in fewer instances, brachycephaly. To help determine if your child also has plagiocephaly or brachycephaly, we encourage you to visit a Cranial Technologies Clinic for a free consultation and digital imaging to assess your child’s head shape.