Comparative Trial of Botox in the Management of Children With Congenital Muscular Torticollis

Inclusion Criteria: * Infants diagnosed with CMT and referred by family physician, pediatrician or orthopaedic surgeon * Initial assessment and initiation of treatment prior to 4 months of age * Cervical spine radiograph, no focal bony abnormality * Head tilt greater than 5 degrees at 5 months of age * Lateral head righting past neutral in upright suspension * Restricted neck range of movement in lateral flexion or rotation or both * Signed consent form and willingness to participate in the study * Compliance with attending bi-weekly follow-up appointments Exclusion Criteria: * Any other diagnosis affecting tone or muscle function * Any condition that would preclude an anesthetic * Any vertebral abnormalities identified by radiograph * Attending other health practitioners for treatment, i.e., massage therapist, chiropractor * Any associated ocular problems as determined by a pediatric ophthalmologist