Congenital muscular torticollis (CMT) is a tightening of a muscle in the neck, called the sternocleidomastoid (SCM) muscle. The SCM muscle helps us move our head to side bending in one direction and rotating in the opposite direction. Tightening or shortening of the muscle on one side of the neck may result in a head tilt or preference for the infant to look to one side. This can lead to plagiocephaly, or flattening of the head, due to prolonged pressure on one part of the head. 

The exact cause of CMT is unknown. Torticollis may be present at birth or can be acquired during the first few months of life. Possible causes include: 

  • Breech presentation or the fetus’s position in the womb 
  • Long body length 
  • Lack of space in the uterus, with multiple fetuses (twins, triplets, etc.) 
  • Vision problems 
  • Remaining in one position for prolonged periods  

Symptoms of torticollis and/or plagiocephaly: 

  • Preference to look in one direction 
  • A consistent head tilt in one direction 
  • Flattening of the head 
  • Difficulty turning head in both directions 
  • Trouble breastfeeding on one side 
  • A small lump felt in the neck 


  • Tummy time (at least 60 minutes throughout the day) 
  • Limit the use of containers, such as bouncy swings/seats, jumpers, exersaucers, car seats, etc. (up to 10-15 minutes 1-2 times/day). 
  • Vary positions that your infant is in (tummy time, side-lying, baby wearing,  supported sitting) 
  • Modify the environment (i.e. crib location, changing table, play mat) to encourage  the infant to turn their head to the non-preferred side  
  • Turn their head to the non-preferred side when they sleep 
  • Alternate sides when breastfeeding 
  • Encourage your baby to turn their head in both directions when tracking toys 


If you have concerns that your infant has torticollis or plagiocephaly, reach out to your pediatrician. They can refer your child to physical therapy. Early treatment (especially before 6 months of age) will often result in better and faster outcomes. The earlier the 

better! If torticollis is left untreated, infants can develop a range of motion limitations in their neck, physical asymmetries, asymmetrical movement patterns, motor delays,  strength imbalances, balance impairments, and visual problems. Luckily, it is treatable and there are many ways we can encourage appropriate development!  

Pediatric Therapies Hawaii offers comprehensive physical therapy evaluations if you have concerns or think your child may have torticollis and/or plagiocephaly.

Dr. Sarah D’Astice is a Pediatric Physical Therapist with Pediatric Therapies Hawaii.  Dr. Amy Peterson is a Pediatric Physical Therapist and owner of Pediatric Therapies Hawaii.  For more information, please call (808) 446-2032 or visit us at