Side Choose one First line
Right Left
Assessment Choose one
Head tilt toward the affected side with the chin turned away and limited neck rotation, consistent with congenital muscular torticollisDefault Positional preference with full neck range of motion Head tilt with atypical features; a cause other than a tight neck muscle is being evaluated
Neck mass Choose any
Firm sternocleidomastoid mass (fibromatosis colli)
Associated findings present Choose any
head flattening facial asymmetry an asymmetric hip exam
Associated findings absent Choose any
head flattening facial asymmetry asymmetric hip examDefault
Atypical features present Choose any
abnormal eye movements or tracking abnormal tone or arm weakness a tilt that alternates sides
Atypical features absent Choose any
abnormal eye movements or trackingDefault abnormal tone or arm weaknessDefault tilt that alternates sidesDefault
Plan Choose one
Referred to physical therapy for neck stretching, strengthening, and positioningDefault Home stretching and positioning taught today, with physical therapy if not improving Continue physical therapy and the home program Referred to pediatric orthopedics given torticollis not improving with physical therapy Referred to pediatric orthopedics given torticollis persisting beyond 12 months of age Referred to pediatric orthopedics given a sternocleidomastoid mass at 7 months of age or older Torticollis resolved with full neck range of motion
Home program Choose any
Recommended supervised tummy time several times a day while awakeDefault Recommended encouraging head turning toward the less-preferred side during feeding, play, and when laying the baby downDefault
Equipment Choose any
Recommended limiting time in car seats, swings, and carriers
Imaging Choose any
Neck ultrasound ordered given a neck mass Cervical spine x-rays ordered to look for vertebral anomalies Hip ultrasound ordered given an asymmetric hip exam
Specialist Choose any
Referred to pediatric neurology given atypical features Referred to pediatric ophthalmology given abnormal eye movements
Follow-up Choose one
in 1 monthDefault in 2 months at the next well child check after the specialist visit as needed
Follow-up reason Choose any Joins the line above
recheck neck range of motion recheck head shape
Counseling paragraph Choose one Paragraph
Torticollis in babies comes from a tight neck muscle on one side and improves best with early stretching and positioning, usually over weeks to a few months; starting early shortens treatment and helps prevent a flat spot on the head. The baby should still always sleep on the back on a flat surface in their own space, with tummy time only while awake and watched. Caregiver expressed understanding and agreement with plan. Answered all questions.Default A head turning preference with full neck movement usually improves with positioning and tummy time over a few weeks, which also helps prevent a flat spot on the head. The baby should still always sleep on the back on a flat surface in their own space, with tummy time only while awake and watched. Caregiver expressed understanding and agreement with plan. Answered all questions. Because some features today are not typical of a tight neck muscle, the specialist will look for other causes of the head tilt. The baby should still always sleep on the back on a flat surface in their own space. Caregiver expressed understanding and agreement with plan. Answered all questions. Torticollis that is not improving with therapy is checked by orthopedics, who may recommend imaging or other treatment. Stretching, positioning, and tummy time should continue until then. Caregiver expressed understanding and agreement with plan. Answered all questions. The neck now moves fully in both directions. Torticollis can look more noticeable again as the baby learns to sit and walk, so neck movement and head shape will be checked at well visits. Caregiver expressed understanding and agreement with plan. Answered all questions.
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Torticollis
• Head tilt toward the affected side with the chin turned away and limited neck rotation, consistent with congenital muscular torticollis
• No asymmetric hip exam
• No abnormal eye movements or tracking, abnormal tone or arm weakness, or tilt that alternates sides
• Referred to physical therapy for neck stretching, strengthening, and positioning
• Recommended supervised tummy time several times a day while awake
• Recommended encouraging head turning toward the less-preferred side during feeding, play, and when laying the baby down
• Follow up in 1 month
Torticollis in babies comes from a tight neck muscle on one side and improves best with early stretching and positioning, usually over weeks to a few months; starting early shortens treatment and helps prevent a flat spot on the head. The baby should still always sleep on the back on a flat surface in their own space, with tummy time only while awake and watched. Caregiver expressed understanding and agreement with plan. Answered all questions.