Twisted neck in babies (torticollis)

Kakī takawiri ki ngā pēpi

Torticollis (or wry neck) is when a baby's neck is bent or twisted to one side.

Torticollis is usually caused by a tight or short muscle at the side of the neck. It first appears when the pēpi (baby) is 2 or 3 weeks old. Torticollis may be caused by the baby's position in the womb.

Flat head in babies (plagiocephaly) is often associated with torticollis. This is because having the neck twisted to one side for a long time may cause a flat area on that part of the head.

Symptoms of torticollis

A pēpi with torticollis may:

not move their head much in one direction and prefer to turn it to the other side
tilt their head to one side and tilt their chin to the other side.

Treating and preventing torticollis

Almost all torticollis caused by muscle tightness will get better before your pēpi turns 1 year old.

If the torticollis has not gone by then or if you're concerned that it isn't improving earlier than this, see your general practice team for advice.

Doing the activities below can help and will reduce the chances of your pēpi getting a flat head.

Sleeping

To reduce the risk of sudden unexpected death in infancy (SUDI), always put your pēpi to sleep on their back and keep their face clear. Also see Safe sleeping for babies.
When your pēpi is asleep, turn their head to one side and alternate sides for each sleep time.
Encourage your pēpi to turn their head to the non-preferred side while they're lying in their cot. Your pēpi may turn their head towards points of interest (such as doorways, windows or toys). If this happens, you may need to change the end of the cot the pēpi sleeps at or turn the cot around.

Side lying and carrying

Lie your pēpi on their non-preferred side with support under their head. This will gently stretch the tight neck muscles on that side.
Play with your pēpi while they're lying on their non-preferred side. They can either be in your arms or on the floor. When your pēpi lifts their head, this will strengthen the neck muscles on the opposite side.
Carry your pēpi in a way that encourages them to turn their head to their non-preferred side.

Feeding

Sit on different sides of your pēpi each time you feed them, so they have to turn their head different ways (or just on the opposite side to their preferred side).

Tummy time

Place your pēpi on a firm surface allowing them to breathe freely.
You can do tummy time in a variety of ways. For example, with your pēpi on your chest, over a wedge, over a cushion, over a rolled-up towel or over your legs.
Put toys on both sides of their face to encourage them to turn their head (or just on the opposite side to their preferred side).
Interact with your pēpi from both sides (or just on the opposite side to their preferred side).
Encourage your pēpi to use both hands equally and to play in the midline of their body.
Your baby may not tolerate long times on their tummy to start with. Build up the time with short, frequent periods of practice throughout the day. For example, after each nappy change.
Start with just a minute or two (or less if necessary) and gradually increase to as much time as your pēpi can manage.
Take breaks when your pēpi shows signs of tiredness. For example, grizzling, grunting and so on, but before they start crying.
Aim for at least 30 minutes a day. This can be over several short periods throughout the day.

Other

Limit the time in car seats, prams, strollers and so on. Take your pēpi out of the equipment when it isn't needed.
Make sure your pēpi is positioned well when travelling.

If you've tried the above advice for a month and your baby's neck isn't getting any better or if you are worried, contact your general practice team or Well Child Tamariki Ora provider.

Written by Child Development Service, Montreal House, Canterbury DHB. Adapted by HealthInfo clinical advisers. Last reviewed August 2022.

Sources

Page reference: 241920

Review key: HITNB-241920