Torticollis in Newborns: Signs, Causes, and Gentle Chiropractic Solutions

By Dr. Andrew Biggs, DC | Principled Chiropractic | Royal Palm Beach, FL

You brought your newborn home, and something seems off. Maybe your baby always turns their head to the same side. Maybe they struggle to nurse on one breast but latch easily on the other. Maybe you've noticed a slight tilt to their head that never quite straightens out, or a flat spot developing on one side of the skull.

You mentioned it to your pediatrician and were told it might resolve on its own. Or perhaps you were referred to a physical therapist and given stretching exercises to do at home. Or maybe you were told your baby has torticollis and you left the appointment with more questions than answers.

If any of that sounds familiar, you are in the right place.

Torticollis is one of the most common conditions we see at Principled Chiropractic in Royal Palm Beach, and it is one of the conditions where gentle, specific chiropractic care can make a profound difference, often more quickly than parents expect. But understanding what torticollis actually is, what causes it, and why the approach matters is the first step toward getting your baby the right help.

What Is Torticollis?

The word torticollis comes from the Latin tortus (twisted) and collum (neck). It literally means "twisted neck." In newborns and infants, it refers to a condition in which the muscles of the neck, most commonly the sternocleidomastoid muscle (SCM) which the large muscle that runs from behind the ear down to the collarbone, are tight, shortened, or in a state of persistent tension on one side. This causes the head to tilt toward the affected side and rotate away from it.

The result is a baby who:

• Consistently turns their head to the same direction

• Has difficulty or shows discomfort when turned to the opposite side

• Tilts their head to one shoulder

• Prefers to nurse on one side only

• Has trouble tracking objects smoothly across their midline

• Develops a flat spot on one side of the head (plagiocephaly), which often develops as a consequence of always resting in the same position

Torticollis in newborns is more common than most parents realize. Estimates suggest it affects somewhere between 1 in 250 and 1 in 300 newborns, though many clinicians believe the true prevalence is higher because mild cases frequently go unrecognized or are attributed to normal newborn behavior.

The Two Primary Types

Muscular Torticollis

The most commonly diagnosed form is congenital muscular torticollis (CMT), which involves tightening or fibrosis of the sternocleidomastoid muscle on one side of the neck. In some cases, a firm, palpable mass or knot can be felt in the muscle itself, called a fibrotic nodule, though this is not always present.

Muscular torticollis is typically attributed to the physical forces of pregnancy and delivery on the developing neck muscles. However, as we'll discuss shortly, the muscular presentation is frequently the downstream expression of a structural problem in the underlying cervical spine, not simply a muscle issue in isolation.

Cervicogenic (Structural) Torticollis

This form of torticollis originates not in the muscle itself but in the joints and structures of the upper cervical spine, specifically the atlas (C1) and axis (C2) vertebrae at the very top of the neck. When these vertebrae are shifted out of their normal alignment due to the forces of birth, they can create a pattern of asymmetrical muscle tension as the surrounding muscles attempt to compensate for the underlying structural dysfunction.

This is the form of torticollis that responds most directly to NeuroStructural chiropractic care, and it is often the piece of the puzzle that is missed when torticollis is treated purely with muscle stretching or physical therapy.

What Causes Torticollis in Newborns?

Positioning in the Womb

The position a baby occupies during the final weeks of pregnancy is one of the most significant contributing factors to torticollis. When a baby is positioned in a way that keeps the head consistently rotated or tilted in one direction, due to limited space, breech presentation, multiple gestation, or low amniotic fluid, the cervical muscles and joints can develop asymmetrically under sustained positional stress.

By the time a baby is born, the structural pattern may already be established. This is why some babies present with torticollis immediately after birth, even in deliveries that were otherwise straightforward.

The Birth Process

The birth process places significant mechanical forces on the baby's head and neck. As the baby rotates and descends through the birth canal, and as the head is guided out by the delivering physician or midwife, the upper cervical spine can be subjected to compressive, rotational, and lateral forces that result in structural misalignment.

Births that carry a higher likelihood of producing upper cervical dysfunction include:

• Vacuum-assisted delivery — The suction cup creates a substantial pulling force on the skull, which transmits through the cervical spine

• Forceps-assisted delivery — Lateral forces applied to the head during forceps placement and rotation

• Prolonged pushing phases — Extended mechanical compression of the head and neck through the birth canal

• Precipitous (very rapid) delivery — The neck doesn't have time to accommodate the forces of rapid descent

• Cesarean section — Contrary to what many parents assume, cesarean births are not gentle on the cervical spine. Extracting a baby through the uterine incision, particularly when the baby is not in an ideal position, can involve significant traction forces on the head and neck

• Large birth weight or macrosomia — A larger baby's head and neck experience greater mechanical stress during descent

It is important to note, however, that torticollis can develop following any birth, including those with no interventions and no obvious complications. The forces of a normal, unassisted vaginal birth are still significant, and the upper cervical spine of a newborn is extraordinarily vulnerable.

Muscle Injury During Birth

In some cases, the sternocleidomastoid muscle itself sustains a partial tear or hematoma (localized bleeding into the muscle tissue) during birth, leading to scarring and fibrosis as the muscle heals. This fibrotic tissue is less elastic than normal muscle, causing the persistent shortening and tightening that produces the characteristic head tilt and rotation.

Postural Habits After Birth

In today's world, babies spend significant time in car seats, bouncers, swings, and other devices that position the head in a fixed relationship to the body for extended periods. When combined with an underlying structural predisposition, these positioning habits can reinforce and perpetuate a torticollis pattern that might otherwise have gradually self-corrected.

Tummy time, which is recommended by pediatricians precisely because it counteracts these positional forces and strengthens the neck and shoulder girdle, is an important part of addressing torticollis, but it works most effectively when the underlying structural component has also been addressed.

Why Torticollis Matters Beyond the Head Tilt

Parents often ask whether torticollis is really a significant concern, or whether it's the kind of thing that will simply resolve with time. It's a fair question, and the honest answer is: it depends on what's causing it and whether it's being appropriately addressed.

Left untreated or inadequately treated, torticollis can lead to:

Plagiocephaly (Flat Head Syndrome)

When a baby consistently rests their head on the same side, the skull, which is still soft and moldable in the early months, can develop a flat spot. This positional plagiocephaly can become significant enough to require helmet therapy (cranial orthosis) if the underlying torticollis is not resolved early. Early correction of torticollis is one of the most effective ways to prevent plagiocephaly from becoming severe enough to require a helmet.

Feeding Difficulties

Breastfeeding requires a baby to turn, extend, and flex the neck in coordinated ways during the latch and feeding process. When the cervical spine is structurally compromised, this can produce pain or discomfort on one side that makes latching difficult, causes the baby to pull off repeatedly, or leads to one-sided nursing preference. Many mothers who struggle with breastfeeding have a baby with undiagnosed torticollis or upper cervical dysfunction — and many of those struggles resolve once the structural issue is addressed.

Delayed Developmental Milestones

As we discussed in our post on developmental milestones, every motor achievement depends on the nervous system functioning symmetrically and efficiently. A baby with untreated torticollis may have difficulty with tummy time, rolling, sitting, and crawling, not because they are developmentally behind, but because the structural asymmetry in their neck makes those movements neurologically difficult or physically uncomfortable.

Visual and Vestibular Development

The eyes and the inner ear (vestibular system) work in close coordination with the cervical spine to establish spatial orientation and visual tracking. Upper cervical dysfunction can subtly alter this coordination, contributing to difficulties with tracking, depth perception, and the development of the visual system during a critical window of neurological growth.

Long-Term Spinal Compensation

If the structural asymmetry at the top of the cervical spine is not corrected in infancy, the body will compensate for it as it grows. The thoracic spine, lumbar spine, and pelvis will make postural adjustments to counterbalance the cervical tilt, building a pattern of structural compensation into the developing spine that can persist for decades and eventually contribute to pain, dysfunction, and premature degeneration in adulthood.

This is why early identification and correction matters so much. A structural problem addressed at two months of age is far simpler to correct than the same problem addressed at twelve years ... or forty.

How Conventional Treatment Approaches Torticollis

The standard medical approach to infantile torticollis typically involves:

Watchful waiting — For mild cases, many pediatricians will adopt a wait-and-see approach, monitoring the condition over several weeks or months to see whether it resolves spontaneously.

Physical therapy and stretching — The most common active intervention involves teaching parents a series of passive stretching exercises to perform at home, designed to lengthen the tight sternocleidomastoid muscle. Physical therapists may also work with the baby directly on active range of motion, strengthening, and positioning strategies.

Repositioning and tummy time — Encouraging parents to minimize time in devices that restrict head movement and to prioritize supervised tummy time.

Helmet therapy — If plagiocephaly has become significant, a custom cranial orthosis (helmet) may be recommended to reshape the skull during the window of rapid head growth.

Surgery — In rare, severe cases that do not respond to conservative care, surgical lengthening of the sternocleidomastoid muscle may be considered.

These approaches have their place, and we do not discourage families from pursuing physical therapy alongside chiropractic care. In fact, we frequently recommend it as a complement to structural correction. However, the limitation of approaches that focus exclusively on the muscle is that they are addressing the effect without necessarily addressing the cause.

If torticollis originates from or is perpetuated by a structural misalignment in the upper cervical spine, which in our clinical experience is very frequently the case, then stretching and strengthening the muscle provides limited and often temporary relief. The muscle keeps tightening because the structural problem driving the tension has not been resolved.

The Chiropractic Approach: Addressing the Structural Root

At Principled Chiropractic, our approach to torticollis in infants begins where the condition often begins, at the level of the upper cervical spine.

The Initial Evaluation

When a family brings in a baby with torticollis, we begin with a thorough history. We want to understand the pregnancy, the birth story, the delivery method, any interventions that were used, and the parents' observations about their baby's behavior, feeding, sleep, and movement patterns. We ask about which side the baby prefers, when the tilt was first noticed, and whether there are any associated concerns such as feeding difficulty, colic, or fussiness.

We then perform a gentle, comprehensive examination of the baby's spine, with particular attention to the upper cervical region. We assess the range of motion of the neck in all directions, noting any restriction, asymmetry, or discomfort. We evaluate the symmetry of muscle tone throughout the neck, shoulders, and upper back. We look at the shape of the head for early plagiocephaly. And we assess neurological tone and function for signs of dysregulation.

We are looking for NeuroStructural Shifts, misalignments in the upper cervical spine that are creating the structural tension driving the torticollis pattern.

The Adjustment

If we identify a structural shift that we believe is contributing to the torticollis, we correct it with a gentle, specific adjustment.

We want to be very clear about what this means in the context of an infant, because it is almost universally different from what parents imagine.

There is no cracking. There is no popping. There is no forceful manipulation of any kind.

The adjustment of a newborn's upper cervical spine involves very light fingertip pressure, in many cases, no more force than you would use to check the ripeness of a tomato, applied to the specific vertebra that has shifted out of position. The technique is precise, it is brief, and the vast majority of infants find it completely comfortable. Many fall asleep during or immediately after their adjustment. Some parents cry, because they can see their baby relax in ways they haven't seen before.

What Happens After

Following upper cervical correction, many families report noticeable changes within days, sometimes within hours. A baby who has been consistently turning to the right may begin turning to the left. One-sided nursing preferences may resolve. Sleep may improve. The general level of fussiness that often accompanies structural dysfunction in infants may decrease.

These changes happen not because we stretched a muscle, but because we removed structural interference from the nervous system. When the nervous system can communicate symmetrically and without interference, the muscles on both sides of the neck receive balanced signals and the torticollis pattern begins to release.

Full structural correction typically requires a series of visits over several weeks, depending on the severity and duration of the condition. The sooner torticollis is addressed, the fewer visits are typically needed and the more complete the resolution tends to be.

We frequently recommend combining chiropractic care with physical therapy stretching and tummy time, as these approaches complement each other well. Chiropractic addresses the structural root; physical therapy supports the muscular and functional recovery.

When Should You Bring Your Baby In?

The honest answer is: as soon as possible after birth.

You do not need to wait for a diagnosis of torticollis. You do not need to wait until the head tilt is obvious, or until breastfeeding has become a struggle, or until a flat spot has developed on your baby's skull.

At Principled Chiropractic, we recommend that every newborn receive a spinal evaluation in the first few weeks of life, not because we expect every baby to have a significant problem, but because the earlier any structural dysfunction is identified, the simpler it is to correct and the less impact it has on development.

If your baby has already been diagnosed with torticollis, or if you have noticed any of the signs described in this post, we encourage you to schedule an evaluation sooner rather than later. The first few months of life represent a window during which the cervical spine is highly responsive to gentle correction, a window that narrows as the baby grows and the structural patterns become more established.

A Word to Worried Parents

We know that bringing a newborn to a chiropractor can feel unfamiliar, perhaps even daunting. The image of chiropractic that most adults carry, loud adjustments, dramatic manipulations, has nothing to do with the care we provide for infants.

What we offer your baby is gentle, specific, and informed by years of specialized training in pediatric chiropractic through the International Chiropractic Pediatric Association. We have worked with many newborns and young infants, and we approach every one of them with the same care we would want for our own children.

If you have questions before scheduling, we welcome a conversation. Our complimentary consultations exist exactly for this purpose, to give you the information you need to make a confident, informed decision for your family.

Take the First Step

If you are concerned about torticollis, head shape, feeding asymmetry, or any of the signs described in this post, we invite you to reach out.

Principled Chiropractic serves families throughout Royal Palm Beach, Wellington, West Palm Beach, Loxahatchee, Lake Worth, and the surrounding Palm Beach County communities. We have been caring for infants and children since 2008, and we are honored to be trusted with the health of so many young families in our community.