Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Torticollis in infants with neonatal abstinence syndrome



To report the incidence of torticollis diagnosed in infants treated for neonatal abstinence syndrome (NAS) and compare neonates with and without torticollis.

Study design

This prospective cohort study reports on infants examined at 1–4 months of age. Numerous obstetrical/newborn factors and other drugs used during gestation were compared.


Of 501 neonates treated for NAS, 421 (84%) were seen for follow-up. Of these, 105 (24.9%) were diagnosed with torticollis. The only significant obstetrical/newborn factor identified was a lower rate if the parents were the primary caregiver after hospital discharge. Of the 105 cases, 88 (84%) were right-sided and 17 (16%) were left-sided.


These data demonstrate that torticollis is a common diagnosis in infants examined at 1–4 months of age after being treated for NAS with a predilection for this to be right-sided. The etiology for this is uncertain, but newborns treated for NAS need close follow-up post discharge.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence of geographic distribution of neonatal abstinence syndrome: United States 2009–2012. J Perinatol. 2015;35:650–5.

    Article  CAS  Google Scholar 

  2. Patrick SW, Bauer AM, Warren MD, Jones TF, Wester C. Hepatitis C virus infection among women giving birth—Tennessee and United States, 2009–14. Morbidity Mortal Wkly Rep. 2017;66:470–3.

    Article  Google Scholar 

  3. Towers CV, Hyatt BW, Visconti KC, Chernicky L, Chattin K, Fortner KB. Neonatal head circumference in newborns with neonatal abstinence syndrome. Pediatrics. 2019;143:e20180541.

    Article  Google Scholar 

  4. McAllister JM, Hall ES, Hertenstein GER, Merhar SL, Uebel PL, Wexelblatt SL. Torticollis in infants with a history of neonatal abstinence syndrome. J Pediatr. 2018;196:305–8.

    Article  Google Scholar 

  5. Burnette T, Chernicky L, Towers CV. The effect of standardizing treatment when managing neonatal abstinence syndrome. J Matern Fetal Neonatal Med. 2019;32:3415–9.

    Article  CAS  Google Scholar 

  6. Cheng JC, Tang SP, Chen TM, Wong NW, Wong EM. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—a study of 1086 cases. J Pediatr Surg. 2000;35:1091–6.

    Article  CAS  Google Scholar 

  7. Boere-Boonekamp NM, van der Linder-kuiper LT. Postural preference: prevalence in infants and follow-up after two years. Pediatrics. 2001;107:339–43.

    Article  CAS  Google Scholar 

  8. Do TT. Congenital muscular torticollis: current concepts and review of treatment. Curr Opin Pediatr. 2006;18:26–29.

    PubMed  Google Scholar 

  9. Nuysink J, van Haastert IC, Takken T, Helders PJ. Symptomatic asymmetry in the first six months of life: differential diagnosis. Eur J Pediatr. 2008;167:613–9.

    Article  Google Scholar 

  10. Stellwagen L, Hubbard E, Chambers C, Jones KL. Torticollis, facial asymmetry and plagiocephaly in normal newborns. Arch Dis Child. 2008;93:827–31.

    Article  CAS  Google Scholar 

  11. Hall ES, McAllister JM, Wexelblatt SL. Developmental disorders and medical complications among infants with subclinical intrauterine opioid exposures. Popul Health Manag. 2019;22:19–24.

    Article  Google Scholar 

  12. Van Vlimmeren LA, Helders PJM, Van Adrichem LNA, Engelbert RHH. Torticollis and plagiocephaly in infancy: therapeutic strategies. Pediatr Rehabil. 2006;9:40–46.

    Article  Google Scholar 

  13. Kuo AA, Tritasavit S, Graham JM. Congenital muscular torticollis and positional plagiocephaly. Pediatr Rev. 2014;35:79–86.

    Article  Google Scholar 

  14. Andersen KW, Siebner HR. Mapping dexterity and handedness: recent insights and future challenges. Curr Opin Behav Sci. 2018;20:123–9.

    Article  Google Scholar 

  15. Faurie C, Schiefenhovel W, Le Bomin S, Billiard S, Raymond M. Variation in the frequency of left-handedness in traditional societies. Curr Anthropol. 2005;46:142–7.

    Article  Google Scholar 

  16. Van Agtmael T, Forrest SM, Williamson R. Parametric and non-parametric linkage analysis of several candidate regions for genes for human handedness. Eur J Hum Genet. 2002;10:623–30.

    Article  Google Scholar 

  17. Ransil BJ, Schachter SC. Test-retest reliability of the Edinburgh Handedness Inventory and Global Handedness preference measurements, and their correlation. Percept Mot Skills. 1009;79:1355–72.

    Article  Google Scholar 

  18. Basco WT. Torticollis: a consequence of neonatal abstinence syndrome? Medscape; 2018. Accessed 26 Dec 2019.

Download references


Presented at the 39th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine; February 11–16, 2019; Las Vegas, Nevada.

Author information

Authors and Affiliations



CVT conceptualized and co-designed the study, coordinated and supervised the maternal and neonatal data collection, carried out the initial analyses, drafted the initial manuscript, and approved the final manuscript as submitted. AK and RN carried out the maternal/neonatal data collection, critically reviewed the manuscript, and approved the final manuscript as submitted. MG and TB co-designed the study, supervised the neonatal data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. MH supervised the maternal data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Craig V. Towers.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Towers, C.V., Knapper, A., Gaylord, M. et al. Torticollis in infants with neonatal abstinence syndrome. J Perinatol 41, 615–618 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


Quick links