Positional Torticollis in Infants: Causes and Recovery

Postural torticollis

Dr.
Chen: Hello, I have a nephew who was diagnosed with torticollis at his 2-month vaccination appointment.
The pediatrician advised us not to let him sleep on the same side.
A week later, we visited another pediatrician at a different hospital, and when we inquired about the torticollis, the doctor examined my nephew's neck and found no lumps or signs of rigidity, suggesting we continue to observe and check again at 4 months.
Later, at over 3 months, we returned to the pediatrician to ask about the torticollis again.
The doctor examined the neck once more and still found nothing.
Therefore, we decided to take him to a medical center, starting with the pediatric surgery department.
The doctor there also couldn't find anything and suggested it was likely postural torticollis, referring us to the rehabilitation department.
At the rehabilitation department, the doctor arranged for an ultrasound examination, which showed no abnormalities and confirmed it was postural torticollis.
They then scheduled rehabilitation sessions.
When we met with the physical therapist, they conducted neck assessments and noted that my nephew's neck stiffness was only at the level of a 2-month-old, even though he was already 3 months and 20 days old.
They also observed that the muscle tone on either side of his neck was different, with one side being weaker, which contributed to the tilt.
They taught us some exercises to improve neck muscle tone, suggesting that this might help alleviate the torticollis.
I have two questions for Dr.
Chen, and I would appreciate your insights.
First question: At what age do infants typically develop neck stiffness (as older family members say it shouldn't be so early)? Second question: Can postural torticollis fully recover?

Xiao Hei Zhu, 30~39 year old female. Ask Date: 2012/08/01

Dr. Chen Wayda reply Rehabilitation

Postural torticollis is not an issue of neck stiffness; it is characterized by differing muscle tension on either side of the neck.
It is a condition that can be resolved.

Reply Date: 2012/08/01

More Info

Positional torticollis, often referred to as "wry neck," is a condition commonly seen in infants, characterized by an abnormal, asymmetrical head or neck position. It can arise due to various factors, including the baby's positioning in utero, tightness in the neck muscles, or even external pressure on the head during delivery. In your nephew's case, it appears that the pediatricians have ruled out more serious conditions, which is a positive sign.

To address your questions:
1. When do infants typically develop neck muscle strength?
Generally, infants begin to gain neck control around 2 to 3 months of age. By this time, they should be able to hold their head up while lying on their stomach and turn their head from side to side. By 4 to 6 months, most infants can sit with support and have more developed neck and upper body strength. However, it is important to note that each child develops at their own pace, and some may take a little longer to achieve these milestones. If your nephew's neck muscles are still at a 2-month level at 3 months and 20 days, it indicates a delay, but with appropriate intervention, improvement is likely.

2. Can positional torticollis be resolved?
Yes, positional torticollis can often be effectively treated and resolved with appropriate physical therapy and exercises. The key is to encourage the infant to use both sides of their neck and head. This can be achieved through various methods, such as:
- Tummy Time: Encouraging the baby to spend time on their stomach while awake helps strengthen neck muscles.

- Positioning: Altering the baby's position during sleep and play can help prevent them from consistently turning their head to one side. For example, placing toys or interesting objects on the side opposite to where they tend to look can encourage them to turn their head.

- Stretching Exercises: A physical therapist can provide specific exercises to stretch the tight muscles and strengthen the weaker ones. These exercises should be done gently and consistently.

In most cases, with early intervention and consistent therapy, infants with positional torticollis can recover fully. It is essential to follow the recommendations of the healthcare providers and continue monitoring your nephew's progress. If there are any concerns about his development or if he does not show improvement, further evaluation by a pediatric specialist may be warranted.

In conclusion, while your nephew's condition may seem concerning, it is reassuring that the medical evaluations have not indicated any serious underlying issues. With the right approach and support, he has a good chance of overcoming this condition. Regular follow-ups with the pediatrician and physical therapist will be crucial in ensuring he develops the necessary muscle strength and coordination.

Similar Q&A

Understanding and Managing Congenital Torticollis in Infants

Hello, Dr. Chang. I have a troubling question that I hope you can help me with. Thank you. (I just gave birth to a daughter on August 7th this month.) It was a natural delivery, but when I was discharged, the nurse informed me that my daughter has congenital "torticollis.&qu...

Dr. Zhang Qiongwen reply Rehabilitation
If a child has right-sided torticollis, they can try sleeping on their stomach with their head turned to the right or sleeping on their right side. During activities, it is also important to encourage the infant to turn their head to a neutral position. Taking the infant to a reh...

Understanding Torticollis Treatment and Care for Infants

I have a 4-month-old baby who is still quite floppy. Since birth, he has been receiving physical therapy for torticollis for the past 3 months, and it seems to have improved. I would like to know if torticollis might reoccur in the future and how we should care for him. Thank you...

Dr. Chen Xianchang reply Rehabilitation
Hello, thank you for your inquiry. Here are my responses to your questions along with some relevant suggestions: 1. Generally speaking, newborns are influenced by "reflexes," which can cause differences in muscle tension on both sides of the body during movements or wh...

Understanding Eye Misalignment in Children: Seeking Expert Advice

Hello Dr. Chen, my daughter is currently one and a half years old. She was diagnosed with left-sided torticollis at nine months old. After undergoing rehabilitation, her head tilt is currently about five degrees. However, when she looks straight at objects, her head involuntarily...

Dr. Chen Jianzhi reply Otolaryngology
Dear Inquirer, Thank you for reading my paper published a few years ago. However, it is important to note that ocular deviation can be classified into pathological and physiological types. The pathological type must be differentiated from several common conditions, such as torti...

Understanding Head Positioning and Eye Issues in Infants

My child is now over three months old. His head always tilts to the right. Will this situation improve as he gets older? Also, why does his right eye tear up every time he yawns? Is this a normal phenomenon, or does he need to see a doctor?

Dr. Wang Jiayi reply Pediatrics
Your child seems to have "torticollis." It is essential to consult a pediatrician for a proper examination and confirmation. Typically, it is caused by the tightening of neck muscles, resulting in the head tilting to one side. About two-thirds of infants with torticolli...