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Torticollis in Children

Causes | Symptoms | Tests | Treatment | Expectation | Prevention

What is Torticollis?

Torticollis, or wry neck, is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

Alternative Names

Wry neck; Loxia

Causes, Incidence, and Risk Factors

Torticollis in children may be:

  • Inherited, due to changes in genes
  • Acquired, developing as a result of damage to the nervous system, upper spine or muscles.

If the condition occurs without a known cause, it is called idiopathic torticollis.
Torticollis may develop in childhood or adulthood. Congenital torticollis (present at birth) may occur if the baby's head was in the wrong position while growing in the womb, or if the muscles or blood supply to the neck are injured.

Torticollis Symptoms

  • Limited range of motion of the head
  • Headache
  • Head tremor
  • Neck pain
  • Shoulder that is higher on one side of the body
  • Stiffness of neck muscles
  • Swelling of neck muscles

Signs and Tests

Tests or procedures may be done to rule out possible causes of head and neck pain. A physical examination will show:

  • Head tilts toward the affected side while the chin points to the opposite side
  • Shortening of the neck muscles
  • The entire head pulls and turns to one side (in more severe cases)

Tests that may be done include:

  • CT scan of the neck
  • Electromyogram (EMG) to see which muscles are most affected
  • MRI of the brain

Torticollis Treatment

Treating torticollis that is present at birth involves stretching the shortened neck muscle. Passive stretching and positioning are used in infants and small children. These treatments are often successful, especially if they are started within 3 months of birth.
Surgery to correct the neck muscle may be done in the preschool years, if other torticollis treatment methods fail.
Torticollis that is caused by damage to the nervous system, spine, or muscles is treated by identifying the cause of the disorder.

  • Applying heat, traction to the cervical spine, and massage may help relieve head and neck pain.
  • Stretching exercises and neck braces may help with muscle spasms.
  • Medications may be used, including the anticholinergic drug baclofen.
  • Injecting botulinum toxin can temporarily relieve torticollis, but repeat injections are usually needed every 3 months.
  • Surgery of the spine might be needed when the torticollis is due to dislocated vertebrae. In some cases, surgery involves destroying some of the nerves in the neck muscles, or brain stimulation.

Expectations (prognosis)

The condition may be easier to treat in infants and children. If torticollis becomes chronic, numbness and tingling may develop due to pressure on the nerve roots in the neck.
The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.
Wry neck (torticollis) can cause the following complications:

  • Muscle swelling due to constant tension
  • Nervous system symptoms due to pressure on nerve roots


While there is no known way to prevent this condition, early torticollis treatment may prevent it from getting worse.



Spiegel DA, Hosalkar HS, Dormans JP, Drommond DS. The neck. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 679.

Persing J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics. 2003;112:199-202.

Patel M, Shah K. Orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 42.

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