Congenital Muscular Torticollis (CMT)
Baby’s got a twisted or crooked neck? It could be CMT. Here’s how to know and what to do.
What is congenital muscular torticollis (CMT)?
Congenital muscular torticollis is sometimes called twisted neck or wryneck. “It’s a change in the musculature of the neck, which forces the baby’s head out of neutral alignment,” says Natasha Burgert, MD, FAAP, pediatrician at Pediatrics Associates in Kansas City, Missouri. “The actual muscles of the neck are limiting the natural and neutral movements of the neck.”
The head of a baby with CMT is tilted to one side, and the baby will have difficulty turning his head, because the muscle on one side of the neck is shorter than the other.
What are the symptoms of congenital muscular torticollis (CMT)?
The primary symptom of CMT is the twisted neck look. All babies occasionally hold their heads in weird positions, but babies with CMT are unable to move their heads and necks into the typical relaxed, forward-facing position.
Are there any tests for congenital muscular torticollis (CMT)?
Appearance and a physical exam are usually enough to diagnose CMT. Your doctor might order some other tests, though, to rule out other problems. X-rays are sometimes used to make sure that the bones of the neck aren’t causing the problem. A doctor might also order an X-ray of baby’s hips, because CMT is sometimes associated with hip dysplasia, a condition that affects the hip joint.
How common is congenital muscular torticollis (CMT)?
According to Boston Children’s Hospital, CMT occurs in approximately 1 in 300 births.
How did my baby get congenital muscular torticollis (CMT)?
The word “congenital” means that it’s a condition that’s present at birth. Nobody knows exactly why it occurs, but some doctors think abnormal positioning or crowding in the womb might contribute to the development of CMT. Another possible cause is a neck injury before or during birth.
What’s the best way to treat congenital muscular torticollis (CMT) in babies?
Physical therapy and special stretching exercises are highly effective in treating CMT. Most often, a doctor will refer the parents and child to a physical therapist, who’ll teach the parents how to safely and gently stretch their baby’s neck. Do the stretching exercises at home multiple times a day. (Your doctor or physical therapist will tell you exactly which exercises to do and how often to do them.)
Vary baby’s position throughout the day to encourage neck movement. Position your face or a toy on the far side of baby’s face, so he has to turn his head to see.
Almost all cases of CMT can be fixed with a few months with physical therapy and exercise. “However, the longer we wait to get the therapy started, the longer we’re going to be working on it,” Burgert says. “I try to get kids with congenital muscular torticollis in by two to four weeks of age. The sooner we start working with them, the sooner they’ll have full range of motion.”
Rarely, a child will need surgery to correct CMT. If surgery is needed, it’s usually performed when the child is preschool-aged.
What can I do to prevent my baby from getting congenital muscular torticollis (CMT)?
Sorry, but there’s no known prevention for CMT. You can prevent another form of torticollis -- acquired torticollis -- by frequently switching up your child’s position. Acquired torticollis can occur when a child spends a lot of time facing in one direction.
What do other moms do when their babies have congenital muscular torticollis (CMT)?
“My daughter was diagnosed with torticollis at around seven-months-old, we did several months of physical therapy, she hit all of her major milestones (actually walking at nine months) and has been done with physical therapy for a several months now. She’s now 18-months and we have seen no regression. Our physical therapist did reassure us that if she did regress, that it could be easily remedied with more therapy and stretches at home.”
“My son had it when he was an infant. We did the exercises and I thought he grew out of it. By a year old, there was nothing visible about how he held his neck. When he was about two-years-old a therapist asked if he had torticollis as an infant. I was surprised she knew because he looked fine. (I hadn't mentioned it to her.) She said that sometimes a residual side effect of torticollis is that the child will stick their stomach out in order to balance better. She saw this when he ran -- he looked a little awkward. He's now four-and-a-half. We worked on the stomach/shoulder thing and he's a lot better and keeps up with all the other kids in sports.”
“The good news is that the cause of all of this is muscular, and therefore all fixable. We need to do physical therapy exercises all day long throughout the day, and we have physical therapy appointments twice a week scheduled through the end of July, for starters. I'm nervous right now because I'm not sure I've got the exercises right. I feel a little sad, but I'm glad that in the big picture this is a minor thing.”
Are there any other resources for congenital muscular torticollis (CMT) in babies?
American Academy of Orthopedic Surgeons
The Bump expert: Natasha Burgert, MD, FAAP, pediatrician at Pediatric Associates in Kansas City, Missouri.
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Stiff Neck in Babies
When Will Baby Control His Head Movement?
Baby Milestone Chart
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Reminder: Medical info on The Bump is FYI only and doesn't replace a visit to a medical professional.