Cranial Technologies

Baby with head tilt caused by torticollis

Torticollis and Plagiocephaly - How Do They Relate?

Torticollis, also known as Wry neck, is caused when the Sternocleidomastoid Muscle (SCM) is abnormally tight or damaged. The neck muscle pulls the skull from where it attaches behind the ear, causing the head and neck to tilt to one side.

graphic showing how the Sternocleidomastoid muscle is affected by torticollis

There are two main types of infant torticollis:

  • Congenital torticollis is when the baby is born with the condition. Usually because of womb placement, limited space in utero, or the birth process.
  • Acquired torticollis develops after birth when babies are in the same position in car seats, smart sleepers, and other restrictive devices.

Frequently asked questions

If my baby has torticollis, will they also have plagiocephaly?

Though torticollis and plagiocephaly are associated conditions, having one does not guarantee the occurrence of the other. Rather, torticollis leads to a much higher risk of developing a flat spot(s).

Is torticollis dangerous?

Generally, torticollis is not dangerous and can be alleviated with mild intervention. However, failure to treat can lead to other conditions like plagiocephaly and tight neck muscles. In more severe cases, it can also contribute to scoliosis in the spine.

Torticollis ranging from mild to severe

What does torticollis look like in infants?

Torticollis can usually be observed at birth or shortly after. Infants with this condition can show a variety of signs ranging from mild to severe including:

  • An abnormal head tilt and/or turn preference to one side
  • Preference to sleep on one side of the head
  • A limited range of motion in the neck
  • A small lump can be felt on one side of the neck
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The relation between torticollis and flat head syndrome

Infants diagnosed with congenital muscular torticollis are likely to also develop plagiocephaly. Studies show that it is estimated to coexist in as many as 90% of babies diagnosed with the condition.

Download: You're Not Alone - A Parent's Guide to Plagiocephaly

Plagiocephaly is typically caused by prolonged pressure to the skull during activities like back sleeping. Since the condition causes the baby to favor one side, there will be increased pressure to this side of the skull.

What are the signs of plagiocephaly?

Plagiocephaly (flat head syndrome) is when a baby's head is misshapen because of a positional deformity. The condition ranges from mild to severe and presents in a variety of ways.

Note: A plagiocephaly head shape is more likely with infant torticollis due to the baby favoring a particular side.

Common signs of plagiocephaly include:

  • Back of the head is flat on one side
  • Asymmetry of the facial features
  • Misalignment of the ear canals

How is torticollis treated?

Both torticollis and plagiocephaly adopt similar physical therapy techniques for prevention and treatment.

  • Repositioning exercises help to strengthen and/or stretch the neck muscles. This helps loosen the SCM muscle, so the baby sleeps in various positions, preventing flat spots from developing.
  • Tummy Time is another popular method of prevention that sees the baby spend more time on their stomachs. This also helps strengthen the neck muscles allowing the baby to move their head more freely.
  • Neck muscles stretches may also be prescribed to do on a daily basis. Similar to repositioning, this helps loosen the neck muscle, alleviating the head tilt.

More Frequently Asked Questions

Does torticollis only affect one side?

While torticollis typically affects one side of the neck, there are variations of the condition that can involve both sides or present with different patterns of muscle involvement.

Does gender play a role in diagnosis?

No, there is no evidence to suggest that one gender has a greater instance of the condition over the other.

Further Clinical Evidence

  • There is a 23 percent increased risk of torticollis when plagiocephaly is present at birth.
  • Prompt treatment for torticollis (earlier than 2 months) can reduce treatment time to as little as 4-6 weeks (about 1 and a half months).
  • Delayed treatment of torticollis (after 3 months) can increase treatment time to more than 6-9 months.