Torticollis | Diagnosis & Treatments

How is torticollis diagnosed?

Here at Boston Children’s, our specialists will obtain a full medical history and perform a comprehensive physical exam of your child. When an infant is believed to have torticollis along with an underlying skeletal abnormality, x-ray imaging or magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis.

Medical history

Your child’s doctor will begin by asking you a series of questions that will help determine the type of torticollis your child has. Questions may include:

  • How old is your child?
  • When did the torticollis develop?
  • Did the torticollis happen suddenly or slowly?
  • Was there any trauma to the head or neck?
  • Does your child have a fever?
  • [Does your child have an infection?
  • Has your child had any surgeries in the head and/or neck?
  • Have you noticed any other symptoms?
  • Has your child been exposed to any medications or drugs?

Physical examination

Your child’s doctor will perform a complete physical and neurological exam to determine the type of torticollis she has. This exam involves:

  • checking the range of motion of the head and neck
  • palpating (examining by touch) the SCM muscle in the neck to see if there is a small lump, or “pseudo tumor,” that happens in about one in three cases of congenital muscular torticollis
  • looking for the presence or absence of asymmetry or unevenness of the face and head to check for a condition called plagiocephaly (it’s important to check for this because the child’s head and face may develop unevenly due to the pull of gravity upon the tilted head)
  • checking your baby’s hips and how they rotate (this is because there is a slightly higher chance that babies with congenital muscular torticollis may develop hip dysplasia)

Your doctor may also request other imaging studies, such as ultrasound, to look for certain abnormalities in the spine that may be a sign of rare but serious health problems.

What are the treatment options for torticollis?

Congenital muscular torticollis

Once your doctor has determined that your child has congenital muscular torticollis, you and your child will begin a program of physical therapy designed to lengthen the shortened SCM muscle.

Physical therapy programs will include specific exercises you can do at home on a set schedule, such as during diaper changes. In addition, you will learn how to hold your baby and tailor his environment to encourage him to turn his head and stretch the SCM muscle.

Your child's physical therapist may recommend using a simple device called a “TOT collar.” TOT stands for Tubular Orthosis for Torticollis, which is really just a small piece of plastic tubing that fits around your baby's neck. The TOT collar is designed to help babies straighten their heads and strengthen their neck muscles. Your physical therapist will teach you the proper way to use a TOT collar.

At Boston Children's, we're also dedicated to the needs of children who have torticollis with asymmetry of the face and head, known as plagiocephaly. We have found that these kids usually respond very well to non-surgical, minimally invasive interventions like:

  • customized, corrective helmets and molding cups
  • sleep position changes
  • special exercises

Sometimes other measures, such as surgery, are required to correct the shortened SCM muscle in torticollis and any asymmetry that may happen with plagiocephaly. Boston Children's offers a range of treatment options in our Orthopedic Center and Department of Plastic and Oral Surgery to address your child's specific treatment needs.

Acquired torticollis

Your child's treatment plan will vary based on the cause of the torticollis. Some common therapies include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and discomfort related to musculoskeletal injury
  • antibiotic therapy for children whose torticollis is caused by infection
  • medications to stop gastroesophageal reflux for children whose primary cause of torticollis is reflux