From the Research
For a 2-month-old male with torticollis showing asymmetric sternocleidomastoid (SCM) muscle thickness (9mm right, 5mm left), I recommend starting with conservative management through physical therapy, as most congenital muscular torticollis cases respond well to this approach when started early 1. This should include gentle passive stretching exercises performed 3-5 times daily during diaper changes, holding each stretch for 10-30 seconds.
- Parents should be taught proper positioning techniques, including carrying the baby to encourage looking toward the affected side and placing toys to promote active head turning.
- Tummy time for 10-15 minutes, 3-4 times daily, is essential to strengthen neck muscles. Additionally, implement repositioning strategies during sleep to prevent positional plagiocephaly, alternating the infant's head position while maintaining supine sleeping for SIDS prevention.
- Physical therapy sessions should occur 1-2 times weekly for the first month, then gradually decrease as parents become proficient with home exercises. The asymmetry in SCM thickness suggests fibrosis or hematoma in the right SCM, which typically resolves with consistent stretching and positioning. If no improvement occurs after 2-3 months of therapy, further evaluation with ultrasound or MRI may be warranted to rule out other causes, and consideration of botulinum toxin injection into the affected SCM may be necessary, as it has been shown to be effective in treating resistant cases of congenital muscular torticollis 2.