Condition guide
Is your baby’s head always tilted to one side, with their face always turned the other way? This may be congenital muscular torticollis, caused by a muscle on the side of the neck (the sternocleidomastoid) being short or tight. It appears at birth or within the first three months and is relatively common. The good news: with regular stretches, the right handling and play, most babies regain full movement of their neck.
Because a head tilt in babies can have other causes, a doctor and a children’s physiotherapist should assess your baby first.
The examples below are for a baby whose head tilts to the left and who prefers to look to the right (left-sided torticollis). If your baby’s right side is affected, reverse the directions.
Place toys, sounds and your face where your baby needs to look to the left. Position the cot so that they have to look left to see you.
Position the car seat so the window is on your baby’s left; they will turn their head left to look towards the light.
Carry your baby over your right shoulder: they will turn their head left to look around, and your cheek will limit turning to the right.
Playing while lying on their side helps them bring their hands together and develop hand–eye coordination; gravity also gives the neck a gentle stretch.
Stretching and play at home
A children’s physiotherapist should show you the stretches first. Do them slowly and gently, and repeat them several times a day. Your baby may protest, but they should not be hurt. The examples are for left-sided torticollis.
Lay your baby on their back. Gently hold down the shoulder on the affected side with one hand, cradle their head with the other and slowly bring the ear on the other side towards that shoulder.
Hold for 10–15 seconds, several times a dayWith your baby on their back, gently hold the shoulder on the other side steady and slowly turn their head towards the affected side, so they look over that shoulder.
Hold for 10–15 seconds, several times a dayCarry your baby lying on their side, facing away from you, with the ear on the affected side resting on your forearm. Your forearm lifts their head slightly away from the shoulder, giving a side-bending stretch; support their body with your other arm.
While carrying during the dayGive your baby time on their tummy every day while they are awake and you are with them. Put toys and your face on the side they find it harder to turn to; keep their elbows under their shoulders, and you can put a rolled towel under their chest.
Every day, while awakeMost babies do not feel pain from torticollis. Your baby may protest during the stretches, but they should not be hurt; keep the movements slow and gentle.
With treatment, most babies regain full movement of their neck; the muscle stretches as it grows and is stretched. Without treatment, neck movement may stay permanently limited and surgery may be needed later. If there is no improvement within 3 months of physiotherapy, an orthopaedic assessment may be requested.
There may be a small swelling in the affected muscle. It usually reaches its largest size in the first month, then slowly shrinks. If it does not go away, an ultrasound may be arranged.
Torticollis can lead a baby to always lie on the same side and the head to flatten on that side (plagiocephaly). This only affects appearance, causes no other symptoms and does not affect the brain. Your physiotherapist will give further advice if needed.
If you bottle-feed, hold your baby in the arm that means they have to turn their head towards the harder side. If you breastfeed, keep feeding from both sides and try different holds that encourage turning to that side.
For a sudden stiff neck in adults, see the wry neck guide.
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