Torticollis in Babies: Why Early Physiotherapy Matters
Torticollis (or neck tightness in babies) is one of the most common reasons children are referred to paediatric physiotherapy in Canberra, particularly in the first few months of life. While it may initially appear as a mild head tilt or side preference, growing evidence suggests it can have a much greater impact. When left untreated—or if not managed appropriately—torticollis can affect a baby’s feeding, sleep, head shape, and motor development.
The good news is that early physiotherapy intervention leads to excellent outcomes, especially when babies are assessed and treated within the first month of life.
What Is Torticollis?
Torticollis is a diagnosis that describes muscle tightness or imbalance through the neck muscles. The main muscle involved is the sternocleidomastoid muscle (SCM), which, when tight, typically causes the head to tilt to one side and rotate to the opposite side.
In babies, this may present as:
A consistent head tilt
A preference for looking to one side
Difficulty feeding (particularly associated with breast side preference, reduced supply on one side more than the other, or pain when baby is feeding on one side more than the other)
Difficulty turning the head fully in both directions
Reflux or gut discomfort symptoms
Crying or discomfort in the car or car seat
Hip crease asymmetry without a diagnosis of hip dysplasia
If any of these signs sound familiar, we strongly encourage booking an assessment with us to determine whether torticollis (baby neck tightness) is underlying. Torticollis is very treatable, and the best outcomes are associated with early intervention.
What Causes Torticollis in Babies?
Torticollis is rarely caused by a single event. Current research suggests it is most commonly related with in-utero positioning and space restrictions, rather than birth trauma. In fact, emerging evidence suggests that torticollis may be a contributing factor to birth trauma (such as vacuum- or forceps-assisted births, prolonged labour, or emergency caesarean sections).
Reduced space in utero relative to the size of the baby can result in a baby remaining in the same position for prolonged periods and contribute to the development of neck tightness. Many babies are born with subtle tightness that becomes more noticeable in the first few weeks of life.
We often hear from parents that they were told at birth by a doctor or paediatrician that neck tightness was present but that their baby would “grow out of it.” Current evidence does not support this. Research indicates that babies are unlikely to grow out of torticollis on their own, and that delayed treatment—particularly beyond 3 months of life often leads to a longer and more complex therapy required to fully resolve the condition. Later treatment is also linked with a higher risk of plagiocephaly (flattening of the back of the head). The ideal time to treat torticollis in babies is under 1 month of age.
How is Torticollis treated in Peadiatric Physiotherapy?
We work closely with families to provide exercises and strategies that are achievable and effective to help babies fully resolve torticollis. The best results occur with targeted, individualised treatment, which may include:
Stretching
This typically involves gentle stretching of the neck muscles—particularly the sternocleidomastoid muscle—but may also include stretching of the abdominal muscles, shoulders, and hips, as these areas can be affected also.
Strengthening
Babies with torticollis often have very strong neck and back extensor muscles, which can contribute to frequent arching. At the same time, they commonly have weakness in the muscles responsible for small neck movements, abdominal muscles that help with actiities such as rolling and crawling.
Improving muscle coordination
How muscles work together is crucial for fully resolving tightness. Without addressing coordination, babies may remain delayed and tightness can return over time.
Developing sensory maturity
Babies are born with developing sensory systems to allow them to visual track, develop and awareness of midline and vertical positioning, and know where their joints and muscles are in space (proprioception). Torticollis can interfere with this development and often requires targeted retraining through specific exercises.
Positioning and play advice
We provide families with practical education on optimal positioning and play strategies to support their baby’s development throughout the day.
If this sounds like your baby…
If you think your baby has neck tightness (torticollis), we strongly encourage booking an assessment as soon as you notice it. We treat babies from two weeks of age—often earlier when needed—as torticollis can significantly affect feeding and sleep. We prioritise children with torticollis at our clinic as we know that early intervention leads to the best outcomes for these babies - Call us on 6189 8986 or Book Online Now