Congenital torticollis

You've just noticed that your baby always holds their head tilted to the same side. It's normal to be concerned. As pediatric physiotherapists, we see this concern in many parents. Congenital torticollis (a stiffness in the neck muscle) affects 2 to 16% of newborns. It is one of the most common conditions in infants.¹

• Congenital torticollis is not painful for your baby (this is different from torticollis in adults)¹
• The earlier treatment begins, the shorter it is: approximately 1.5 months if started before 1 month of age²
• Pediatric physiotherapy is the treatment recommended by clinical guidelines³
• Home exercises, such as tummy time, speed up recovery

This guide will help you understand this condition, recognize the signs in your baby, and discover how physiotherapy can help. To learn more about our services, visit our page on pediatric physiotherapy.

What is congenital torticollis in infants?

Congenital torticollis is a contracture of the sternocleidomastoid (SCM) muscle, the large muscle on the side of the neck. This stiffness causes the baby's head to tilt to one side and turn to the other. The condition affects 2 to 16% of newborns. It is the 3rd most common congenital musculoskeletal anomaly, after hip dysplasia and clubfoot.¹

The SCM muscle extends from the bone behind the ear (the mastoid) to the collarbone and sternum. Normally, this muscle allows the head to tilt to the same side and turn to the opposite side. In congenital torticollis, the muscle is shortened or contracted, which limits head movements.

A reassuring point for parents: this condition is not painful for your baby. It is different from torticollis in adults, which is very painful. Your baby does not suffer, even if they maintain an asymmetrical posture.

This condition can be present from birth or appear in the first weeks of life. The good news is that it responds very well to physiotherapy, especially when treated early.

What are the three types of congenital torticollis?

The three types are postural torticollis (20% of cases), muscular torticollis without a mass (30%), and torticollis with a nodule in the muscle (50%). The type affects the duration of treatment, but not the success rate if treated early.²

Postural torticollis is the mildest form. The baby prefers to turn their head to one side but can still move it in the other direction. This type responds quickly to repositioning and simple exercises.

Muscular torticollis involves a true shortening of the muscle. The physiotherapist may feel tension in the muscle during evaluation, but there is no lump. This type requires more regular stretching.

Torticollis with a nodule (also called a pseudotumor) presents as a small mass in the neck muscle. This lump usually appears 2 to 4 weeks after birth and gradually decreases with treatment. Even though it might seem more concerning, this type also responds very well to physiotherapy.

The physiotherapist determines the type during the first evaluation to tailor the treatment plan to your baby's needs.

What are the causes of congenital torticollis?

Causes include the baby's position in the womb, a difficult birth (forceps, vacuum extraction), weakness of the neck muscles, and postnatal factors such as a lack of varied positions. In many cases, the exact cause remains unknown.¹

In some cases, no specific cause is found despite a complete evaluation. The good news is that regardless of the cause, physiotherapy treatment remains the same and just as effective.

How to recognize congenital torticollis in your baby?

Signs include a head always tilted to the same side, a preference for looking in one direction, difficulty breastfeeding from one side, flattening of the skull, and using the same hand to reach for toys.

• Always looks to the same side
• Often has their head tilted in their car seat
• Head always tilted to the same side
• Appears to have a flat spot on the back or side of their head
• Always uses the same hand to reach for toys or their mouth
• Dislikes tummy time
• Difficulty breastfeeding from one breast (always prefers the same side)

If you observe several of these signs, a pediatric physiotherapy consultation is recommended. The earlier the diagnosis, the more effective and shorter the treatment.

Plagiocephaly (flat head syndrome) accompanies torticollis in 67 to 90% of cases.² The flattening of the skull develops on the side where the baby rests their head most often. You might also notice slight facial asymmetry or one ear appearing more forward than the other.

In cases of torticollis with a nodule, parents or the doctor may sometimes feel a small, firm lump in the neck muscle. This lump is not painful and disappears with treatment.

What is the link between torticollis and plagiocephaly (flat head syndrome)?

Torticollis and plagiocephaly (flat head syndrome) often occur together: in 67 to 90% of cases. When a baby consistently keeps their head turned to the same side, the prolonged pressure flattens that part of the skull. Treating torticollis early also helps prevent or improve flat head syndrome.²

An infant's skull is still malleable during the first months of life. When a baby consistently keeps their head turned to the same side due to torticollis, the constant pressure on that area causes gradual flattening.

1. Torticollis causes the baby to keep their head turned to the same side
2. Prolonged pressure flattens one side of the skull
3. The flattened surface becomes more comfortable for the baby
4. The baby maintains this position even more
5. The flattening becomes more pronounced

Treating torticollis breaks this vicious cycle. By restoring neck mobility, the baby can vary their head positions, allowing the skull to regain a more symmetrical shape. This is why early intervention is doubly important: it treats torticollis AND prevents or improves flat head syndrome.

If your baby already has plagiocephaly, the physiotherapist will evaluate both conditions and adapt the exercise program accordingly.

Why is it important to treat congenital torticollis early?

Treatment before 3 months of age offers a 98 to 100% success rate without surgery. After 6 months, only 40% of babies respond well to treatment. Treatment started before 1 month typically resolves in an average of 1.5 months. After 6 months, it can take 9 to 10 months.²

The message is clear: earlier = shorter and more effective.

• Possible lasting facial asymmetry
• Severe flat head (sometimes requires a corrective helmet)
• Possible delay in motor development
• Higher risk of surgery
• Postural compensation (scoliosis)

In Quebec, you don't need a medical prescription to see a physiotherapist. As soon as you notice signs of torticollis in your baby, you can book an appointment directly. This easy access allows for quick intervention when treatment is most effective.

How does physiotherapy treat congenital torticollis?

Pediatric physiotherapy involves gentle neck muscle stretches, strengthening exercises, positioning techniques, and teaching parents how to do exercises at home. The success rate is 90 to 95% with an average of 6 to 12 sessions.²

• Assessment of neck mobility (rotation and tilt)
• Measurement of neck muscle strength
• Observation of overall motor development
• Check of the neurological and visual systems
• Examination of skull shape (to check for a flat head)

A large part of the treatment relies on exercises you will do at home between sessions. The physiotherapist will teach you:

• Specific exercises to practice daily
• Play positions that encourage development
• Strategies for breastfeeding or bottle-feeding
• Changes to make to the baby's environment

At Physioactif, we take the time to practice each exercise with you so that you feel confident and comfortable reproducing the techniques at home.

What exercises can you do at home for baby torticollis?

Home exercises include tummy time (30 to 60 minutes a day in small doses), stimulating the non-preferred side, varied positioning while awake, and gentle stretches taught by the physiotherapist. These exercises speed up recovery between sessions.

Tummy time is essential for strengthening neck muscles and preventing pressure on the skull. Aim for 30 to 60 minutes a day, in small doses of a few minutes.

• Start on your chest (skin-to-skin)
• Use a cushion or a rolled towel under their chest
• Place colorful toys in front of them
• Stay on the floor with them, at their eye level.
• Gradually increase the duration.

• Position yourself on the side where your baby has difficulty turning their head.
• Place toys, mobiles, and light sources on this side.
• When breastfeeding or bottle-feeding, alternate sides.
• Talk to your baby from this side to attract their gaze.

• Encourage positions where the head is not supported (baby carrier, bumbo seat, tummy time).
• Frequently vary positions while your baby is awake.
• Alternate the side of the room where the crib is located.
• Change the direction in which you lay your baby down.

The physiotherapist will show you safe stretching techniques. These stretches should always be gentle and never forced. Practice them during calm moments, such as after a bath or before bedtime.

How long does congenital torticollis treatment last?

The duration depends on the age when treatment begins. Treatment started before 1 month resolves in 1.5 months on average. For babies between 1 and 3 months, it takes 3 to 4 months. After 6 months, it can take 9 to 10 months. Most babies regain normal mobility with physiotherapy.²

The first few weeks are dedicated to establishing an exercise routine and observing how your baby responds. Most parents notice an improvement within the first 2 to 4 weeks. The physiotherapist regularly reassesses progress and adjusts the program as needed.

Sessions gradually become less frequent as mobility improves. Towards the end of treatment, you might see the physiotherapist once a month to ensure that the improvements are maintained.

When is surgery necessary for congenital torticollis?

Surgery is rarely necessary, affecting less than 5 to 10% of cases treated early. It is considered if physiotherapy treatment has not been effective after 6 months or more of intensive therapy, or if a severe skull deformation persists. Physiotherapy remains the first-line treatment.³

• Treatment failure after 6 months or more of intensive physiotherapy.
• Persistent restriction greater than 15-20 degrees despite treatment.
• Severe cranial deformation that does not improve.
• Age greater than 12-18 months with significant restriction.

Surgery generally involves releasing or lengthening the neck muscle. Less invasive techniques also exist. After the operation, post-operative physiotherapy is necessary to optimize the results.

The vast majority of babies treated early will never need surgery. This is why early intervention is so important. If you consult as soon as the first signs appear, the chances of your baby needing an operation are very low.

Next Steps

If you notice signs of torticollis in your baby, don't wait. Pediatric physiotherapy is effective and gentle, and the earlier treatment begins, the shorter and simpler it will be.

At Physioactif, our pediatric-trained physiotherapists gently assess your baby and support you every step of the way. We practice the exercises with you so that you feel confident doing them at home.

You don't need a medical prescription to consult. Book an appointment now for an assessment.

References

1. StatPearls. Congenital Torticollis [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2026 Jan 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549778/

1. Kaplan SL, Coulter C, Fetters L. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline. Pediatric Physical Therapy. 2018;30(4):240-290. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8568067/

1. APTA Academy of Pediatric Physical Therapy. Physical Therapy Management of Congenital Muscular Torticollis: 2024 Evidence-Based Clinical Practice Guideline [Internet]. 2024 [cited 2026 Jan 16]. Available from: https://pubmed.ncbi.nlm.nih.gov/39356257/

1. Choose PT (APTA). Physical Therapy Guide to Torticollis [Internet]. [cited 2026 Jan 16]. Available from: https://www.choosept.com/guide/physical-therapy-guide-torticollis

1. HAS France. Prévenir la plagiocéphalie sans augmenter le risque de mort inattendue du nourrisson [Internet]. 2020 [cited 2026 Jan 16]. Available from: https://www.has-sante.fr/jcms/p_3160772/fr/prevenir-la-plagiocephalie-sans-augmenter-le-risque-de-mort-inattendue-du-nourrisson