Clinical Reference Systems: Pediatric Advisor 10.0
Congenital Muscular Torticollis
Congenital muscular torticollis (CMT) is an injury to a neck
muscle that happens at birth. Congenital means that the
condition is present at birth. Torticollis means twisted
neck. Most frequently the injury occurs to the muscle that
goes diagonally across the neck from the collarbone
(clavicle) to the head just behind the ear. This is muscle
called the sternocleidomastoid muscle.
CMT causes the back of the head to turn toward and the face
to turn away from the affected side. Your child will not
want to move his or her face towards the affected side
because of pain.
Injury to the muscle usually occurs during birth. The
injury is caused by stretching of the muscle during the
delivery of the head. When the stretching is severe, there
is tearing and bleeding into the muscle. If enough bleeding
and swelling occurs, pressure builds up and damages the
muscle. Then, scar tissue replaces some of the muscle. As
a result the baby keeps the neck turned in one direction.
There can be other causes of twisting of the neck of a
newborn but none of these cause the swelling in the
sternocleidomastoid muscle that occurs in CMT.
CMT is a diagnosis that should be made after an exam by a
Many times children with CMT get better on their own. You
can help your child improve by putting your child in
situations where she has to stretch the affected muscle on
her own. For example, lay the child in the crib so that if
she wants to see what is going on in the room, she will have
to turn her chin towards the shoulder of the affected side.
This will stretch the affected muscle and help cure the
Treatment of CMT involves passive stretching exercises.
This means that you help your baby move her neck. Exercises
to improve CMT are described below. Do these exercises in
sets of 10 repetitions, three times each day.
- Side bend: Place one hand on the shoulder of the
affected side of the neck (the side with the tight
cord-like feeling in the muscle) and the other hand on
the top of the child's head. Gently move the neck so
that the child is looking straight ahead. With the
child looking straight forward, gently bend the neck so
the ear opposite the affected side goes toward or
touches the shoulder on that side. Gentle downward
pressure can also be applied to the shoulder on the
- Head turn: With the hand on the shoulder of the affected
side and the other hand on the top of the child's head,
gently move the neck so that the child is looking
straight ahead. Now gently turn the child's head so
that the chin moves toward the shoulder of the injured
side. (The opposite direction of the way the child
prefers to turn the head.) Gentle downward pressure can
also be applied to the shoulder on the affected side.
Your baby may be referred to a physical therapist to help
determine how the treatment is going. If the condition is
still present after the age of 1 year, your child may need
surgery to restore movement of the muscle.
Call Your Child's Physician If:
- You need to know how often your doctor wants to see your
- The torticollis gets noticeably worse.
- You have other questions or concerns.