General Guidelines

Please note that many times this is either directly related to or in conjunction with eye muscle problems. Make an appointment with a pediatric ophthalmologist (not optometrist) to have your child’s eyes thoroughly checked to make sure that this is addressed early.

Help your baby to stretch the affected muscle, after you have been properly trained by a professional physical therapist.

This treatment consists of 15 to 20 stretches, 5 or 6 times a day. While the child is lying on his back, the head is tilted away from the affected muscle. Lay your baby on his or her back. Cradle his/her head in your hand and place your other hand on the same side shoulder and gently stretch away from the tilt. The other stretch is with your baby still on his or her back  and the face is turned toward the tilt or affected side just enough to apply a gentle stretch.

Remember: We are much stronger than them and can easily be too rough with this. It is a GENTLE stretch.  Distract your baby by singing gently or talking and watch their response for signs of the stretch being too much, like pulling away or getting fussy. When done correctly, a little stretch can be held for 20 to 30 seconds with no distress.

Keep your baby active to promote exercise of the neck muscles. When playing, hold toys to the same direction of the tilt, bottle feed so the baby must stretch the affected muscle and place your baby in the crib so that stimulating pictures and activities are in the same side direction of the tilt. Strengthening the opposite side of the neck, as well as the upper body and arms, can also help to stretch and relieve the affected muscle.

Carry your baby in a position facing away from you, so that the affected side rests against your forearm. Place your opposite arm between your baby’s legs to support her body. You should carry your baby in this position as much as possible.

Frequently apply gentle massage to the affected muscle to help relieve pain and allow the muscle to relax. Massage and stretching exercises should never hurt, so only use as much strength as your baby can handle comfortably.

This can get confusing so think of it this way:

The head is tilted one direction which causes your baby to turn to the side. We want to encourage your baby to look the OTHER way.

Activities for children with torticollis

For children with torticollis, it is very important that they play in all the following positions: prone (on tummy), lying on their side, sitting and supported standing. These are appropriate and necessary at any age. Encourage them to look at and interact with toys that promote rotation of the head and body to the child’s non-preferred side. Set up the child’s environment (i.e. orientation of toys, crib and play mat) to promote exploration toward the baby’s non-preferred side.

Prone (tummy):

During stroller rides place grasp toys in front of or to the non-preferred side of the baby.

Put your baby on your stomach over your lap. Hold toys above and to the non-preferred side.

Carry your baby horizontally by scooping your hand under the baby’s chest so its legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.

Get down on the floor facing your baby with or without toys placed between you. Approach the baby from the non-preferred side. Hold toys above and to the non-preferred side.

Lying on their side:

Encourage bilateral hand play (this promotes midline alignment).

Place toys in a way that encourages downward gazing.

This is an easy posture to start rolling to the stomach.

Sitting and standing (supported or independent): 

Encourage head turning to the non-preferred side with toys or visual engagement.

Encourage looking and reaching with the baby’s non-preferred hand.

Encourage bilateral hand play in midline.

Carry your baby:

Against your chest with baby facing out.

Over or up against your shoulder.

From under their tummy like a football.

Tummy time (see tummy time page for more info)

It is important that all infants spend time awake on their stomachs (tummy time). Tummy time allows babies to strengthen and stretch muscles that are important for developing basic valuable motor skills such as crawling, standing, sitting and walking. Tummy time also facilitates visual development as your baby learns to move his/her head to look at objects and track movement. Tummy time should always occur while the baby is awake and be supervised by an adult. To reduce the risk of Sudden Infant Death Syndrome (SIDS) all healthy infants should sleep on their backs until they are able to roll from their tummies to their backs easily.

Babies who do not spend enough time on their tummy and spend too much time on their back generally:

Walk later than babies who have spent time on their tummy.

Have tight muscles in their necks.

Have flat spots on the back of their heads.

Have weaker back and stomach muscles which may lead to difficulty sitting, standing straight or balancing in upright positions.

Aim for your baby to spend half their waking time throughout the day on their tummy. Start tummy time the day of your baby’s birth. The sooner a baby spends time on his/her tummy the more comfortable this position will be as he/she continues to develop. If a baby is not used to spending time on his/her tummy, they may not enjoy it at first. Try introducing small amounts of tummy time and build up to the half day slowly. Try the following positions to give your baby some quality tummy time:

Place a thin blanket and toys on a firm surface (such as the floor) and lay your baby on his/her tummy to play. This is a great position for babies to look at toys and practice lifting their head.

Place your baby on his/her tummy on your stomach while you are lying on your back. This way your baby can easily make eye contact with you.

Put your baby on his/her tummy over your lap.

Carry your baby horizontally by scooping your hand under the baby’s chest so its legs straddle your forearm. Play airplane or “so big” in this position in front of a mirror.

For more information about playing with a purpose with your child, see available books HERE


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