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  • Strategies for Working with Children with Torticollis(current)

What Does the Research Tell Us?Mom Laughing with Baby

Physical therapy and helmet treatment are considered the conservative strategies for positional torticollis, congenital muscular torticollis, and deformational plagiocephaly.1  Retrospective and prospective studies of conservative measures have reported, “good to excellent results, with success rates ranging from 61% to 99% when intervention was initiated before one year of age.”(p.370)2   Ellen Brennan, PT, DPT, physical therapist, Children’s Specialized Hospital stated, “successful intervention for the child with torticollis is fully dependent on how successful the caregivers are in integrating treatment strategies into the child’s daily routine.”3

Strategies for Stretching the Infant with Torticollis

Most of the infants I work with don’t like the stretches for torticollis, not because it causes them discomfort, but because they do not like being restrained.  If I can make the stretches and exercises more tolerable for the infant, then the likelihood that the caregivers will be successful with the exercise program will increase.  Below are some simple strategies to incorporate into an infant with torticollis’s daily routine.

If you are not a physical therapist, you can still help families implement these stretches but be sure that a PT shows you how to do them with the child and family first!

Rotation stretch: When holding the infant’s shoulder down and gently rotating the infant’s head all the way to one side until the chin is over the shoulder, encourage the infant to look to that side by:

  • Having a caregiver, peer or sibling play peek-a-boo
  • Activate a musical toy
  • Look at themselves in a safety mirror
  • Reach for a household pet

Side-bend stretch: When holding the infant’s shoulder down and gently, but firmly, side-bend the infant’s ear to the same shoulder, encourage the infant to maintain this position by encouraging the caregiver to:

  • Blow “raspberries” on the side of the neck that is being stretched
  • Give “Eskimo” kisses to their infant’s nose
  • Kiss the baby on the side of the neck that is being stretched
  • Chat with the infant
  • Sing songs so that the infant watches the caregiver’s face

Here’s a video illustrating both of these stretches:

Football hold: For example, if the infant has left torticollis, the infant’s left ear rests against your left forearm as they face away from you.  Place your other arm between the child’s legs and support the child’s body. Encourage caregivers to carry the infant in this hold as much as possible.

This video shows the “Football hold” – a great way to hold a baby with Torticollis to stretch the tight side (tight side is against the caregiver’s forearm):

Tummy time: Place the infant on their tummy and place toys to the opposite side of where the infant normally looks.  Encourage the infant to look to that side by:

  • Blowing bubbles for them to reach out to
  • Peers or siblings to entertain them
  • Activate musical toys
  • Look at themselves in a safety mirror
  • Tickles, songs, funny faces

Rolling:4 Encourage the infant to roll towards the tight side, first on flat surfaces then on inclines.  This exercise can be incorporated during:

  • Diaper changes
  • Changing clothes
  • Tummy time

Head/body righting reactions: Make a game of holding the infant facing you at eye level.  If they are heavy, you can rest their bottom on the top of your knees.  Slowly tilt the infant towards their tight side.  As you slowly tilt them back to eye level, encourage them to bring their weak side up by:

  • Chat with the infant
  • Sing songs (e.g. I’m a little teapot)
  • Make funny faces
  • Make silly noises                                                          

Feeding: When bottle feeding the infant, present the bottle so they look opposite to their preferred side.

  • Hold the bottle towards the tight side
  • Encourage the infant to finish the bottle in this position

Do you have some strategies to make torticollis exercises and stretches more tolerable for the infant or family?  Share your ideas on how to incorporate these exercises into the family’s daily routines!


  1. Van Vlimmeren LA, Helders PJM, Van Adrichem LNA, Engelbert RHH.  Torticollis and plagiocephaly in infancy: Therapeutic strategies.  Pediatric Rehabilitation, January 2006; 9(1):40-46.
  2. Campbell  S, Vander Linden  D, & Palisano R. (2006). Physical Therapy for Children, third edition. St. Louis: Saunders Elservier.
  3. Mayer R.  Tackling Torticollis.  Advance for Physical Therapy & Rehab Medicine, January 2012.  Retrieved May 23, 2013 from: physical-therapy.advanceweb.com/Features/Articles/Tackling-Torticollis.aspx
  4. Long T, Toscano K.  (2002).  Handbook of Pediatric Physical Therapy, second edition.  Philadelphia:Lippincott Williams & Wilkins.

For more info on torticollis, motor delays and development, visit the VA Early Intervention Professional Development Center’s Motor Delays & Disabilities page.

Kim SmilingKim Lephart, PT, DPT, MBA, PCS is a dynamic pediatric physical therapist with nearly 20 years of experience.  She is board certified Pediatric Clinical Specialist.  She is a team player who enjoys the collaborative model of working with parents, teachers, occupational, speech and vision therapists to meet a child’s individual therapeutic needs.  She has worked with children in a variety of clinical settings including private clinics, school systems, home health, outpatient rehabilitation, aquatics, and early intervention programs.  She currently works for Rappahannock Rapidan’s Early Intervention Program.  Of all of Dr. Lephart’s accomplishments both professionally and personally, she is most proud of her four children.  She is a busy mother of children ranging in ages from high schooler to pre-schooler.

7 comments on “Strategies for Working with Children with Torticollis

  • Janet Hammond says:

    Torticollis can be secondary to Sandifer Syndrome (http://www.ncbi.nlm.nih.gov/pubmed/17168985), which is a response to painful reflux.

    Screening for reflux and referral ro GI should be part of a torticollis work up.

    Another nod to the team-based model.

    • That’s really interesting info, Janet. I’m curious…if the child is treated for Sandifer Syndrome, does the torticollis usually resolve itself or do you also have to treat the head tilt? Thanks for sharing the link and starting this discussion!

  • […] in with your pediatrician if there is any concerns about torticollis. This is an excellent article from a pediatric physical […]

  • Sharon Smith, PT says:

    I wondering what the usual protocol for treatment on average for diagnosis of torticollis and Plagiocephaly? How many weeks etc., HEP, what is skilled treatment vs things parents can do.

  • Kim Lephart, PT, DPT, MBA, PCS says:

    These are great questions! The APTA’s Academy of Pediatric Physical Therapy (APPT) has some wonderful resources that will help answer all of your questions. If you go to https://pediatricapta.org website. Click on the “Professionals” tab. Then click on the “Clinical Practice Guidelines”. There are resources on torticollis for parents and caregivers; healthcare providers; and clinicians and educators. There is also a Fact Sheet on Plagiocephaly: Under the “Professionals” tab, click on the “APPT Fact Sheets” Under “Interventions” there is a fact sheet on Plagiocephaly. I hope you find this resource helpful in your quest for evidence-based practice!

  • Candice says:

    My daughter is 3 y/o now, and she was diagnosed with torticollis at 6 weeks. We did therapy until she was 1 y/o, and them she was discharged with home exercises. But since she turned 19 months, I noticed the torticollis was back. I can’t find information about exercise for toddlers with this condition. She is a big girl, and the exercises I used to do with her don’t work anymore.
    Do you have tips for toddlers?
    Thank you.

    • Thanks for your question, Candice. Here’s what Kim suggests:
      Hello Candice!
      Thank you for reaching out. Most children with torticollis will have recurrence of their torticollis if they: 1. Don’t feel good 2. Are tired 3. Growth spurt and/or 4. New gross motor milestone (i.e. walking, climbing, etc.). While I don’t know your daughter, I would suspect that they recently went through a growth spurt and perhaps started climbing or walking up stairs or achieved some other new gross motor milestone. The Clinical Practice Guideline (CPG) for Physical Therapy Management of Congenital Muscular Torticollis recommends that parents try the exercises and stretches they were taught during previous PT sessions if they notice the torticollis returns. If after two weeks of trying the exercises and stretches, the torticollis is still present, the CPG recommends that you follow up with a pediatric physical therapist.
      You’re right, the same passive stretches and activities won’t work now that your daughter is older. When kiddos are older I use more active stretching and range of motion. In other words, placing desired toys or objects in a place where they have to look, that will stretch their neck muscles without touching their necks. The older kiddos just don’t tolerate those passive stretches.
      I recommend you follow up with a local pediatric physical therapist who can give you new ideas for stretching and strengthening now that your daughter is older. The PT will also be able to determine if your daughter needs to see an Ophthalmologist to rule out any visional component to the torticollis.
      I hope that helps!


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