Congenital torticollis

Carers should be instructed on a home programme to include the following:

• Gentle stretching using carrying and play techniques to promote active neck rotation towards the affected side and to discourage tilting of the head towards the affected side.

• Turning the head of the infant while sleeping supine to encourage rotation to the non-favoured side.

• Encouraging head rotation to the side of the affected muscle by arranging the environment with visually stimulating items on that side or changing the crib orientation if necessary.

• Strengthening the contralateral neck muscles by carrying the infant with his/her body tilted to the affected side, practising assisted rolling to the contralateral side, or side-lying on the affected side. These activities use the head righting response to strengthen the weak contralateral side.

• Alternating carrying and feeding positions.

• Encouraging mid-line head position in infant carriers with the use of rolled towels.

• Prone time to play several times a day (newborns often tolerate a more inclined position). This position also facilitates bilateral sternocleidomastoid elongation.

Following resolution of the torticollis, carers should be educated about a possible intermittent head tilt occurring when the patient is fatigued or unwell. They should be advised to return for any recurrence of torticollis or concern for developmental delay, as these are not expected.