Head tilt is a condition that causes a child to hold her head or neck in a twisted or otherwise abnormal position. She may lean her head toward one shoulder and, when lying on her stomach, always turn the same side of her face toward the mattress. This can cause her head to flatten on one side and her face to appear uneven or out of line. If not treated, head tilt may lead to permanent facial deformity or unevenness and to restricted head movement.
Most cases of head tilt are associated with a condition called torticollis, although in rare instances a head tilt can be due to other causes such as hearing loss, misalignment of the eyes, reflux (a flowing back of stomach acid into the esophagus), a throat or lymph node infection, or, very uncommonly, a brain tumor.
Acquired torticollis (due to injury or inflammation)
This is more likely to occur in older children, up to the age of nine or ten. This type of torticollis usually results from an inflammation of the throat caused by an upper respiratory infection, a sore throat, an injury, or some unknown factor. The swelling, for reasons still not known, causes the tissues surrounding the upper spine to loosen, allowing the vertebral bones to move out of normal position. When this happens, the neck muscles go into spasm, causing the head to tilt to one side. Onset of this condition is typically sudden and very painful.
Congenital muscular torticollis
By far the most common cause of head tilt among children under age five is congenital torticollis. This condition commonly occurs due to positioning while the baby is still in the womb and rarely may occur during birth (particularly breech and difficult first-time deliveries).Whatever the cause, this condition usually is detected in the first six to eight weeks after birth, when the pediatrician notices tightness in one of the muscles of the neck. About half the time there may be a small lump in the muscle. The affected muscle is the sternocleidomastoid muscle, which connects the breastbone, head, and neck. Later the muscle contracts and causes the head to tilt to one side and look toward the opposite side.
Each type of head tilt requires different treatment. It is very important to seek such treatment early, so that the problem is corrected before it causes permanent deformity. Your pediatrician will examine your child’s neck and may order X-rays of the area in order to identify the cause of the problem. X-rays or ultrasound of the hip also may be ordered, as some children with congenital muscular torticollis also have an abnormality known as developmental dysplasia of the hip.
If the doctor decides that the problem is congenital muscular torticollis, you will learn an exercise program to stretch the neck muscles. The doctor will show you how to gently move your child’s head in the opposite direction from the tilt. You’ll need to do this several times a day, very gradually extending the movement as the muscle stretches.
When your child sleeps, it is best to place her on her back with her head positioned opposite to the direction of the tilt. In rare instances, your pediatrician may suggest adjustments to her sleep position. When she is awake, position her so those things she wants to look at (windows, mobiles, pictures, and activity) are on the side away from the injury. In that way, she’ll stretch the shortened muscle while trying to see these objects. Your pediatrician may also recommend placing her on her stomach while awake and turning her face away from the affected side.
These simple strategies cure this type of head tilt in the vast majority of cases, preventing the need for later surgery. (Your pediatrician may refer your child to a physical therapist to help work on this condition.)
If the problem is not corrected by exercise or position change, your pediatrician will refer you to a pediatric neurologist or orthopedist. In some cases, it may be necessary to lengthen the involved tendon surgically. If your child’s head tilt is caused by something other than congenital muscular torticollis and the X-rays show no spinal abnormality, other treatment involving rest, a special collar, gentle stretching, massage, traction, application of heat to the area, medication, or, rarely, further imaging or surgery may be necessary.
For treating torticollis due to injury or inflammation, your doctor may recommend applying heat, as well as using massage and stretching to ease head and neck pain. Your pediatrician can refer you to a specialist for a definitive diagnosis and treatment program.