congenital muscular torticollis
/ tor-tih-KOLL-iss; CMT /
Parents notice that their newborn always tilts her head to one side and turns her face to the other, as if she only likes looking one way. Often there is a small firm lump in the neck muscle. This common, treatable condition, present in early infancy, is congenital muscular torticollis — from the Latin for 'twisted neck'. It is one of the everyday developmental orthopaedic problems a paediatric rehabilitation team handles.
The cause is a tightness or shortening of one of the large neck muscles, the sternocleidomastoid, which runs from behind the ear down to the collarbone. When that muscle on one side is short, it tilts the head toward that shoulder and rotates the chin away to the opposite side — a fixed, lopsided posture. It is thought to come from cramped positioning or a minor injury to the muscle around birth, sometimes leaving a small fibrous mass you can feel. Because it is mechanical and caught early, it usually responds beautifully to simple treatment, and it must be distinguished from other causes of a tilted head (bony, eye, or neurological problems) that need different care.
It matters because of what unfettered growth does to a baby's pliable skull and what the asymmetry can hide. Left alone, the constant head tilt can flatten one side of the soft infant skull (positional plagiocephaly) and entrench facial asymmetry, and the baby misses experiences on the neglected side. The mainstay is early stretching and positioning therapy taught to parents, encouraging the baby to turn the harder way, with most infants resolving fully when started young; the few that do not may need further evaluation or, rarely, surgery. The honest caveat: a tilted head is a sign, not a diagnosis — confirm it is the muscle before treating it as such.
A six-week-old always tilts her head right and looks left, with a firm pea-sized lump in the right neck muscle. The therapist teaches the parents gentle daily stretches and how to position toys to coax her to turn the harder way. By a few months old her neck moves symmetrically and her head shape evens out.
A short neck muscle tilts the head one way; early stretching and positioning usually resolve it fully.
A tilted head is a sign, not a diagnosis: bony anomalies, eye-muscle imbalance, or neurological causes can mimic it and need very different management, so the muscular cause must be confirmed first. Starting stretching early gives the best results; untreated, it can flatten the soft infant skull.