Everything you need to know about congenital torticollis in infants

Congenital torticollis is a relatively common problem in infants. It can be detected shortly after birth and have long-term repercussions if left untreated. In this article, we cover the main characteristics of congenital torticollis, its causes, symptoms, and the treatments available to address it.

What is congenital torticollis?

Congenital torticollis, also known as congenital muscular torticollis, is a malformation of the sternocleidomastoid muscle (SCM) located in the neck. This condition causes the infant's head to tilt to one side and rotate towards the opposite side. Congenital torticollis can be caused by a difficult birth or by an abnormal position in the uterus during pregnancy.

Causes of congenital torticollis

The precise causes of congenital torticollis are not fully understood. Nevertheless, certain factors are associated with this condition:

Abnormal foetal positioning: if the baby is in a breech or transverse position in the uterus, this can put pressure on the SCM and cause torticollis.

Difficult birth: an instrumental delivery (forceps or ventouse) can cause trauma to the SCM and lead to congenital torticollis.

Heredity: although uncommon, some cases of congenital torticollis are linked to genetic factors.

Symptoms of congenital torticollis

The main symptom of congenital torticollis is a tilting of the infant's head to one side, generally the right, with a rotation towards the opposite side. This characteristic position allows the malformation to be detected from the first days of life. Other symptoms may be observed:

Discomfort or crying when attempting to straighten the baby's head;

A mass in the sternocleidomastoid muscle, also known as a fibrous lump;

Delayed motor development, such as difficulty sitting up or crawling;

Skull deformity, known as plagiocephaly.

Early diagnosis of congenital torticollis

The diagnosis of congenital torticollis is based on the physical examination of the infant by a doctor. The doctor will check for the presence of all the symptoms mentioned above and may prescribe a muscular ultrasound to confirm the diagnosis. It is crucial to identify this malformation promptly in order to establish appropriate treatment and prevent long-term complications.

Treatments for congenital torticollis

The treatment of congenital torticollis depends on the severity of the malformation and the associated symptoms. The aims of treatment are to allow the infant to hold their head straight and have normal neck mobility, to relieve any pain, and to prevent complications.

Passive stretching and muscle strengthening

Parents can help their child by performing stretching and muscle-strengthening exercises several times a day under the supervision of a physiotherapist. These exercises involve gradually and gently stretching the SCM muscle on the affected side and strengthening the muscle on the opposite side. Parents should be attentive to the infant's reactions and not force movements if they cause pain.

Appropriate positioning during sleep and waking hours

During waking periods, it is advisable to encourage the baby to turn their head towards the affected side by placing colourful toys or making sounds in that direction. At bedtime, it is recommended to position the infant in a way that encourages a natural rotation of the head towards the affected side.

Use of a cranial orthosis

If skull deformity is associated with the torticollis, the use of a cranial orthosis (helmet) may be considered to correct the plagiocephaly.

Surgery

In the most severe cases, and when conservative treatments have failed to improve the situation, surgical intervention may be proposed. The operation involves cutting the SCM muscle in order to release the tension and restore normal neck mobility.

Preventing complications from congenital torticollis

Appropriate and early management of congenital torticollis generally makes it possible to restore the head to a natural position and avoid long-term complications. It is essential to follow medical recommendations and to regularly carry out the prescribed stretching and muscle-strengthening exercises.

Finally, it is important to monitor the infant's progress and to consult a doctor if new symptoms appear or if there is no improvement after several weeks of treatment.