Regarding Congenital Toicollis true are all except:

AlthoughLarge infants who have had difficult veex deliveries as well as those who are breech or those with hip dysplasia are at special risk for developing toicolis, it is not always associated. Congenital Muscular Toicollis Muscular toicollis is the most common variety and is presumed to result from injury to the sternocleidomastoid muscle during delivery. In toicollis the head is tilted toward and rotated away from the tight sternocleidomastoid muscle. Congenital toicollis is usually secondary to intrauterine moulding but may present with fixed sternocleidomastoid contracture or with a palpable 'tumour' within the muscle. There is a strong correlation with DDH. Most cases resolve with stretching but persistent cases develop facial asymmetry and require surgical release of the sternocleidomastoid at one or both ends. Acquired toicollis is less common and may be caused by gastro-oesophageal reflux, posterior fossa tumour/other regional abnormality, inflammation/infection, ocular problems or atlanto- axial rotatory subluxation. Treatment In patients with a suggestive history and appropriate physical findings, programs of positioning and stimulation and gentle passive stretching exercised staed within the first month of life often result in resolution. The parents should be instructed to rotate the chin gently toward the side of head tilt while simultaneously bringing the head to the upright position. As range of motion improves, the chin can be rotated past neutral and the head titled toward the opposite side. Significant correction usuall;y occurs within the first few months of life in patienys with muscular toicollis. When deformaity persists, the patient should be referred for ohopedic evaluation. Soft collars are not effective in treatment, and rigid devices producesecondary mandibular deformity. Surgical release of the sternocleidomastoid muscle is occasionally required in such patients and should be performed before the development of secondary facial asymmetry (plagiocephaly)