What stretching exercises are recommended for a 4-month-old baby with mild torticollis?

Stretching Exercises for 4-Month-Old with Mild Torticollis

For a 4-month-old infant with mild congenital muscular torticollis, implement a home stretching program focusing on lateral neck flexion away from the affected side and rotation toward the affected side, performed multiple times daily with each stretch held for 10-30 seconds. 1

Core Stretching Techniques

The primary stretching exercises target the shortened sternocleidomastoid muscle and should be performed gently but consistently:

Lateral Flexion Stretch

• Position the infant supine (lying on back) or seated in your lap 2, 3
• Stabilize the shoulder on the affected side with one hand to prevent shoulder elevation 1
• Gently tilt the head laterally toward the opposite shoulder (away from the tight side) using your other hand 2, 1
• Hold for 10-30 seconds, repeat 3-4 times per session 4
• Perform multiple times throughout the day, ideally during diaper changes and feeding times to integrate into daily routines 1, 5

Rotation Stretch

• With infant supine or seated, stabilize the shoulders 1
• Gently rotate the chin toward the affected shoulder (the side with the tight muscle) 2, 3
• Hold for 10-30 seconds, repeat 3-4 times 4
• Combine with lateral flexion for comprehensive stretching 1

Frequency and Duration

Early intervention at 4 months of age is optimal - starting treatment before 1 month yields 98% success by 2.5 months, but intervention at your infant's current age still has excellent outcomes if performed consistently 1. The stretching program should include:

• Multiple sessions daily (minimum 3-4 times, ideally more) 1, 5
• Each stretch held 10-30 seconds 4
• 3-4 repetitions per stretch per session 4
• Brief rest periods (30-60 seconds) between stretches 4

Positioning Strategies Between Stretches

Beyond active stretching, corrective positioning throughout the day facilitates symmetry 5:

• During tummy time (≥30 minutes total daily, spread throughout the day), position toys to encourage the infant to turn toward the restricted side 4, 5
• During feeding, alternate sides and encourage head turning toward the affected side 5
• During sleep, position the infant to encourage looking away from the preferred position, though always follow safe sleep guidelines (back sleeping) 5
• During carrying, vary positions to avoid reinforcing the torticollis posture 5

Critical Pitfalls to Avoid

Never perform aggressive or forceful stretching - gentle, sustained stretches are effective and safe 1. Overly aggressive manipulation can cause pain, muscle guarding, and reduced compliance 3.

Rule out non-muscular causes before proceeding with stretching alone 2, 3. While congenital muscular torticollis is the most common cause in infants, you must exclude:

• Ocular torticollis from eye muscle weakness (observe if head tilt resolves when one eye is covered) 2, 4
• Sandifer's syndrome from gastroesophageal reflux (associated with feeding and arching) 2
• Benign paroxysmal torticollis (episodic, painless, resolves spontaneously between episodes) 6, 2
• Cervical spine anomalies (if no improvement with therapy, imaging may be needed before any surgical consideration) 2, 3

Monitor for respiratory distress - head nodding synchronized with breathing indicates severe respiratory compromise requiring immediate medical attention, not stretching exercises 7.

Expected Outcomes and Follow-Up

Physical therapy referral is the preferred treatment approach for congenital muscular torticollis, with primary care providers making the diagnosis 1. At 4 months of age with consistent home stretching:

• Most infants achieve near-normal range of motion within several months of consistent therapy 1
• Success rates decrease if treatment is delayed beyond 6 months, potentially requiring 9-10 months of therapy 1
• Surgical intervention (sternocleidomastoid release) is rarely needed if conservative management begins early and is performed consistently 3, 1, 8

If no improvement occurs within 4-6 weeks of consistent stretching, or if range of motion worsens, reassessment is mandatory to exclude non-muscular causes 3, 5.