What is congenital torticollis?

Congenital muscular torticollis (CMT) is a shortened neck muscle that causes the neck to twist. Congenital means that the condition is present at birth. Torticollis means "twisted neck." Most frequently CMT involves the muscle that goes diagonally across the neck from the collarbone (clavicle) to the head just behind the ear. This muscle is called the sternocleidomastoid muscle.

CMT causes the back of the head to turn toward and the face to turn away from the affected side. Your child will not want to move his or her face towards the affected side because of pain.

What is the cause?

The cause of torticollis is not completely understood. One theory is that there is stretching of the muscle during the delivery of the head. Severe stretching leads to bleeding into the muscle. If enough bleeding and swelling occurs, pressure builds up and damages the muscle. Then, scar tissue replaces some of the muscle. Other theories are that it is caused by crowding inside the uterus, a blood vessel problem, or a primary muscle problem. Whichever theory is correct, the baby keeps the neck turned in one direction.

How is it diagnosed?

CMT is diagnosed after an exam by your healthcare provider.

What is the treatment?

Many times children with CMT get better on their own. You can help your child improve by putting your child in situations where she has to stretch the affected muscle on her own. For example, lay the child in the crib so that if she wants to see what is going on in the room, she will have to turn her chin towards the shoulder of the affected side. This will stretch the affected muscle and help cure the torticollis naturally.

Treatment of CMT involves passive stretching exercises. This means that you help your baby move her neck. Exercises to improve CMT are described below. Do these exercises in sets of 10 repetitions, three times each day.

1. Side bend: Place one hand on the shoulder of the affected side of the neck (the side with the tight cord-like feeling in the muscle) and the other hand on the top of the child's head. Gently move the neck so that the child is looking straight ahead. With the child looking straight forward, gently bend the neck so the ear opposite the affected side goes toward or touches the shoulder on that side. Gentle downward pressure can also be applied to the shoulder on the affected side.
2. Head turn: With the hand on the shoulder of the affected side and the other hand on the top of the child's head, gently move the neck so that the child is looking straight ahead. Now gently turn the child's head so that the chin moves toward the shoulder of the injured side. (The opposite direction of the way the child prefers to turn the head.) Gentle downward pressure can also be applied to the shoulder on the affected side.

Your baby will probably be referred to a physical therapist to help determine how the treatment is going. If the condition is still present after the age of 1 year, your child may need surgery to restore movement of the muscle.

When should I call my child's healthcare provider?

Call your child's provider if:

• You need to set a follow up appointment.
• The torticollis gets worse.
• You have other questions or concerns.