Orthopedic and movement

Torticollis in Babies

A head tilt with a treatable cause — why the hips get checked too, and how long it usually takes.

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Reviewed by Dr. Eva Lassey, PT, DPT · Last updated September 3, 2026

Congenital muscular torticollis is a tightening of one of the muscles running down the side of the neck, present from birth or appearing in the first weeks, which holds a baby's head tilted toward one side and rotated toward the other. It is one of the most common musculoskeletal conditions in infants, and it responds very well to physical therapy — particularly when treatment starts early. Two things are worth knowing beyond the neck itself: torticollis frequently causes a flat spot on one side of the head, because a baby who cannot turn easily rests on the same side; and it is associated with hip dysplasia, so the hips should be examined as part of assessment. Not every head tilt is muscular, and a tilt that appears suddenly, or does not respond to treatment, needs a different look.

When a head tilt needs medical assessment rather than stretching

Contact your child's doctor promptly if:

  • The tilt appeared suddenly in a baby or child who did not have it before
  • There is fever, irritability, drooling, or difficulty swallowing alongside the tilt
  • Your child seems to be in pain when the head is moved
  • There is weakness, unusual eye movements, or a change in alertness
  • The tilt has not improved after several weeks of consistent therapy
  • The tilt has appeared alongside feeding difficulty or breathing changes

Most torticollis is muscular and responds to therapy. These are the situations where it may not be, and where a different assessment is what is needed.

What is congenital muscular torticollis?

One muscle, the sternocleidomastoid, runs from behind the ear down to the collarbone. When it is tighter on one side, it pulls the head into a characteristic position: tilted toward the tight side, turned toward the opposite side.

That combination is the signature. A baby with a tight right sternocleidomastoid tilts right and looks left.

Sometimes there is a firm lump in the muscle, most often noticed in the first weeks. It is usually not painful and typically resolves as the muscle lengthens. It is alarming to find and worth having examined, but it is a recognized feature rather than a separate problem.

What are the signs of torticollis in a baby?

  • A consistent head tilt toward one shoulder
  • A strong preference for looking one way, and difficulty turning the other
  • Feeding more comfortably on one side than the other
  • Resisting or disliking tummy time, particularly turning the head in one direction
  • A flat spot developing on one side of the head or face
  • Facial asymmetry — one eye or cheek appearing slightly different
  • Reaching mostly with one hand, or rolling only one way
The clearest test at home: watch which way your baby looks when lying on their back, over several days. A consistent preference is the thing to mention.

Why does torticollis happen?

Frequently, position before birth. Limited room in the uterus — from a large baby, multiples, low fluid, or a particular position held for a long time — can leave one side shortened.

Sometimes birth-related. Assisted or difficult deliveries are associated with it.

Sometimes nothing identifiable. That is common and does not change treatment.

And after birth, position contributes. Extended time in car seats, swings, and carriers, plus limited floor time, reduce the varied movement a baby needs to even things out.

This is not something a parent caused. It is a positional and mechanical problem, and the response is treatment rather than blame.

What else can cause a head tilt?

Most infant torticollis is muscular. Not all of it is, and the distinction changes the treatment entirely.

Ocular torticollis — a head tilt that compensates for a vision problem, so the child can see more clearly. Stretching will not help, and the tilt returns until the eyes are addressed. If a tilt persists despite good therapy, an eye assessment is reasonable to ask about.

Reflux-related posturing — arching and twisting associated with reflux, sometimes mistaken for torticollis.

Acute onset in an older child — a tilt that appears suddenly, particularly with pain, fever, or after an illness, is a different clinical picture from congenital muscular torticollis and needs prompt assessment.

Neurological causes — less common, and part of why a tilt that is not responding to therapy gets reassessed rather than stretched harder. Low muscle tone can also affect head control; see hypotonia.

Spinal differences — bony variation in the neck, which shows on imaging where that is indicated.

The practical rule: a tilt present from the early weeks that responds to therapy is very likely muscular. A tilt that appears suddenly, hurts, or does not respond needs a different look.

How is torticollis assessed, and why are the hips checked?

A physical therapist assesses how far the head turns and tilts each way, muscle length and any thickening, head shape and facial symmetry, motor development, and how your baby uses each side.

Ask about the hips

Congenital muscular torticollis is associated with developmental dysplasia of the hip, so a hip examination belongs in a complete assessment. If nobody has mentioned your baby's hips, ask.

It is worth knowing what the association actually amounts to, because the figure often quoted is too high. Across the older literature the reported correlation ranges from 2% to 29%, most of it predating routine ultrasound.3 In a series of 292 infants with torticollis, 16 had hip dysplasia — a coexistence rate requiring treatment of 4.5%, which the authors noted is lower than the commonly accepted 20%.

Every one of those 16 was picked up by the clinical hip examination.2 On that basis the authors concluded that a baby with torticollis does not need routine hip imaging when the clinical examination is normal. So the thing to make sure of is that the hips are examined — not that your baby is sent for a scan.

Getting started

Under three in the US, early intervention is free in most states and a parent can refer their own child — no doctor's referral, no diagnosis needed. Search for your state's early intervention program.

Your pediatrician can also refer directly to physical therapy, and many families go that route.

RelatedFind a physical therapistMilestones and red flags

Why does torticollis cause a flat head?

A baby who can only comfortably turn one way rests on the same part of the skull, and that area flattens. Infant skull bones are soft and responsive to pressure, which is why it happens and also why it improves.

Treating the neck is what addresses the head shape, because it restores the ability to turn both ways.

What helps: varied positioning when awake · plenty of supervised tummy time · alternating which end of the crib you approach from, and which arm you feed with · less time in seats, swings, and carriers.

Safe sleep does not change. Babies sleep on their backs. The variation happens during waking hours.

Helmet therapy is considered in some cases, usually where flattening is significant and has not responded to positioning and therapy. It is used alongside treating the neck rather than instead of it, and it is a conversation with your pediatrician.

What does torticollis treatment involve?

Physical therapy is first-line, and the components are consistent:1

  • Gentle lengthening of the tight muscle, taught to parents and done at home.
  • Active turning — encouraging your baby to look toward the harder side using toys, voices, faces, and light.
  • Strengthening the weaker side, so the head holds in the middle rather than only reaching it passively.
  • Positioning through the day — how you carry, feed, play, and lay your baby down.
  • Tummy time, progressed gradually.

A therapist teaches you and checks the technique. Most of the treatment happens at home, in short sessions through the day.

Do the stretches as shown, not harder. More force is not faster, and a baby who finds it distressing is harder to work with. If it seems painful, stop and tell your therapist.

On chiropractic care: professional guidance for infants points to physical therapy as the evidence-based approach.1 Discuss any manual treatment for a baby with your pediatrician first.

What can I do at home?

The daily routine matters more than any single exercise, because it is what happens twenty times a day.

  • Alternate feeding sides, whether breast or bottle
  • Change which end of the crib you approach from, so your baby turns both ways to see you
  • Position toys and interest on the harder side
  • Carry in varied positions
  • Supervised tummy time, little and often
  • Reduce time in seats and swings when awake

Consistency beats intensity. Ten short opportunities through a day work better than one long session.

How long does torticollis take to resolve?

Most infants with congenital muscular torticollis improve substantially with physical therapy, and the strongest predictor of a shorter course is starting earlier.1

Babies who start in the first few months typically need a shorter course than those who start later. More severe restriction and later starts take longer.

The 2024 guideline's evidence review reports outcomes by the age treatment started. "Excellent" is the guideline's own term and means no remaining head tilt and full passive neck rotation — not simply improvement.1

Treatment startedReached an excellent outcomeAverage length of treatment
Before 1 month99%1.5 months
1 to 3 months89%5.9 months
3 to 6 months62%7.2 months
6 to 12 months19%8.9 months

Read the two columns together. Starting later does not only make treatment longer — it makes a complete result less likely, and the drop is steep: from 99% before one month to 19% after six. That is the whole argument for not waiting to see whether a head tilt settles on its own.

These are averages across a group, not a forecast for one baby. Severity, how consistently the home program is done, and any other conditions all move it, and your therapist's estimate for your child is better than a table.1

Why there are no percentages or week counts on this page. Earlier versions of it gave a resolution rate and three precise timelines with nothing to support them. Physical therapy management of this condition is governed by the American Physical Therapy Association's clinical practice guideline, updated in 2024, and its prognosis figures are not published where we can check them. Rather than repeat numbers we cannot source, this page describes the pattern. Your therapist can give you an expected course for your own baby, which is more use than an average anyway.

Therapy usually steps down rather than stopping abruptly, with a period of monitoring to confirm the tilt does not return as your baby becomes more active.

Does torticollis affect milestones?

Untreated torticollis can affect early motor development, because a baby who cannot turn easily gets less practice with half of everything.

What can be affected: rolling, often only one way · reaching and using both hands · tummy time tolerance, and the strength it builds · visual attention to one side · feeding.

Treated torticollis usually does not cause lasting delay. Most babies catch up quickly once movement is available on both sides.

RelatedDelayed motor milestonesMilestones and red flags

Can adults get torticollis?

Adults can develop torticollis too, and it is usually a different condition entirely.

Cervical dystonia is a neurological movement disorder causing involuntary contraction of the neck muscles. It is managed rather than resolved, typically with botulinum toxin injections alongside physical therapy. It has little in common with the infant condition beyond the word.

Acute wry neck — a sudden painful spasm, often on waking — is different again, and usually settles within days to weeks.

RelatedNeck pain in adultsBaby development: the first year

Frequently asked questions

Is torticollis painful?

Usually not. Most babies with congenital muscular torticollis do not appear to be in pain, though they may resist turning toward the restricted side. A baby who seems genuinely in pain should be assessed, because that is less typical.

What is torticollis in a baby?

A tightening of one of the muscles at the side of the neck, holding the head tilted toward one side and turned toward the other. It is one of the most common musculoskeletal conditions in infants and responds well to physical therapy.

Should my baby's hips be checked?

Yes. Congenital muscular torticollis is associated with developmental dysplasia of the hip, so a hip examination belongs in a complete assessment. In one series of 292 infants, every case of hip dysplasia was picked up by the clinical examination, and imaging is not routinely needed when that examination is normal.

Will torticollis go away on its own?

Some mild cases improve as a baby becomes more active, but treatment produces better and faster results, particularly for head shape. Starting earlier is consistently associated with a shorter course.

Do I need a referral for physical therapy?

Not necessarily. In the US, early intervention is free in most states for under-threes and a parent can refer their own child, with no doctor's referral or diagnosis required. Your pediatrician can also refer directly.

What if the tilt does not improve with therapy?

That is a reason to reassess rather than to stretch harder. A tilt that does not respond may have a different cause, including a vision-related tilt, where stretching will not help.

Why does my baby have a flat spot on their head?

Because a baby who can only comfortably turn one way rests on the same part of the skull. Treating the neck is what addresses the head shape, since it restores turning in both directions.

Is chiropractic treatment appropriate for a baby with torticollis?

Professional guidance points to physical therapy as the evidence-based approach for infants. Discuss any manual treatment for a baby with your pediatrician first.

Find a therapist who treats torticollis

Torticollis is usually treated by a pediatric physical therapist. 311 practices in the DrSensory directory name torticollis among the conditions they treat — 291 physical therapy practices and 20 occupational therapy practices, across 48 states. They are grouped by state below.

Alabama7 practices
Alaska5 practices
Arizona11 practices
Arkansas1 practice
California20 practices
Colorado9 practices
Connecticut8 practices
Delaware3 practices
District of Columbia3 practices
Florida10 practices
Georgia9 practices
Hawaii3 practices
Idaho3 practices
Illinois14 practices
Indiana1 practice
Iowa3 practices
Kansas5 practices
Kentucky4 practices
Louisiana3 practices
Maine2 practices
Maryland4 practices
Massachusetts6 practices
Michigan5 practices
Minnesota4 practices
Mississippi2 practices
Missouri10 practices
Montana3 practices
Nebraska6 practices
Nevada8 practices
New Hampshire3 practices
New Jersey7 practices
New York9 practices
North Carolina16 practices
North Dakota1 practice
Ohio7 practices
Oklahoma5 practices
Oregon6 practices
Pennsylvania5 practices
Rhode Island2 practices
South Carolina5 practices
South Dakota1 practice
Tennessee8 practices
Texas30 practices
Utah3 practices
Vermont1 practice
Virginia10 practices
Washington3 practices
Wisconsin5 practices

Each practice appears here because its own listing names torticollis among the conditions it treats. A listing is not an endorsement or a referral, and inclusion does not mean we have verified a practice’s credentials, licensure or insurance — check those directly. Browse all physical therapy practices.

Sources

  1. Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical therapy management of congenital muscular torticollis: a 2024 evidence-based clinical practice guideline. Pediatric Physical Therapy. 2024;36(4):370–421. doi:10.1097/PEP.0000000000001114 (PMID 39356257) Outcome-by-age figures are from the Supporting Evidence under Action Statement 3, attributed there to Petronic et al. Free full text: PMC8568067.
  2. Minihane KP, Grayhack JJ, Simmons TD, Seshadri R, Wysocki RW, Sarwark JF. Developmental dysplasia of the hip in infants with congenital muscular torticollis. American Journal of Orthopedics. 2008;37(9):E155–E158. (PMID 18982188)
  3. von Heideken J, Green DW, Burke SW, Sindle K, Denneen J, Haglund-Akerlind Y, et al. The relationship between developmental dysplasia of the hip and congenital muscular torticollis. Journal of Pediatric Orthopaedics. 2006;26(6):805–808. doi:10.1097/01.bpo.0000235398.41913.51 (PMID 17065952)

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. A head tilt in a baby should be assessed by a qualified healthcare professional, who can tell you what is causing it and what will help. Always consult your pediatrician or therapist about your own child.