You notice it in photos first. Your baby’s head always seems to be turned the same way. Then you notice they feed more easily on one side, and maybe a flat patch is starting to show on the back of their head.
It’s one of the most common things parents ask us about, and the good news is that it usually responds well to gentle care and a few changes at home.
What is torticollis?
Torticollis means “twisted neck”. In babies it usually comes from a tight muscle running down the side of the neck, from behind the ear to the collarbone. When that muscle is tight on one side, your baby tilts their head towards that shoulder and turns their face the other way.
It’s common. In a study that examined 102 healthy newborns before they went home from hospital, 16% had torticollis. It was linked to mums reporting that their baby had seemed “stuck” in one position in the womb for the last weeks of pregnancy (Stellwagen et al., 2008).
Signs to look for
- Your baby almost always turns their head to the same side
- Their head tilts towards one shoulder
- They find it hard to turn their head the other way
- Feeding is easier on one side than the other
- A flat spot is forming on one side of the back of the head
Flat head and how it’s linked
A newborn’s skull is soft. If your baby keeps resting their head in the same position, a flat spot can develop. You might hear it called plagiocephaly (flat on one side) or brachycephaly (flat across the back).
It’s very common. In a study of 440 healthy babies at their two-month clinic visit, almost half had some flattening, and most cases were mild (Mawji et al., 2013). A tight neck makes it more likely, because a baby who can only turn one way keeps lying on the same spot.
Babies should still always sleep on their backs (Moon et al., 2022). The work on head position happens while they’re awake.
Why early matters
A clinical guideline on managing torticollis recommends that babies start treatment as soon as it’s noticed rather than waiting to see if it settles (Kaplan et al., 2018).
How we help
A gentle assessment
We’ll ask about your pregnancy, the birth and what you’ve noticed, then gently check how your baby’s neck turns and tilts, how they move and the shape of their head. You stay with your baby the whole time, and you can feed or cuddle them whenever they need it.
Gentle hands-on care
With babies we use very light, steady pressure, often no more than you’d comfortably press on your own eyelid. There’s no cracking or twisting. The aim is to help the tight side of the neck relax and move more freely.
What you do at home
This is where a lot of the progress happens. We’ll show you:
- Gentle stretches for the tight side, and how to do them comfortably
- Positioning so your baby is encouraged to turn towards their harder side, such as where you put toys, which side you approach from and how you hold them
- Feeding and carrying positions that help rather than reinforce the habit
- Tummy time while your baby is awake
A guideline from neurosurgeons found that a structured therapy programme did better than positioning advice on its own for flat heads (Klimo et al., 2016), so we’ll combine both and adjust the plan as your baby grows.
Tummy time
Tummy time is supervised time on their front while your baby is awake. A review of 16 studies linked more tummy time with better gross motor development, such as rolling and crawling, and with preventing a flat back of the head (Hewitt et al., 2020).
Lots of babies protest at first. Short, frequent sessions are easier than long ones. Try lying your baby on your chest, or across your lap, and build up as they get stronger.
When to see your doctor first
See your GP, paediatrician or clinic sister, rather than booking with us, if your baby:
- Has a fever, is feeding much less than usual or has fewer wet nappies
- Seems floppy or unusually drowsy
- Has a head shape that is changing quickly, or a soft spot that looks sunken or bulging
- Suddenly starts holding their head to one side after being fine before
If anything we find needs a doctor’s attention, we’ll tell you and refer you. Some babies with a marked flat spot also benefit from a referral to discuss a helmet, and we’ll talk you through that if it applies.
How we can help
If your baby always turns one way or you’ve noticed a flat spot, it’s worth getting it checked early. We’ll assess your baby gently, explain what we find and show you exactly what to do at home.
Read more about how we care for babies and children, or book an appointment with Dr Kirsty Anley at our Sandton practice.
Frequently Asked Questions
How do I know if my baby has torticollis?
Look for a baby who almost always turns their head to the same side, tilts it towards one shoulder, finds it hard to turn the other way or feeds more easily on one side. A flat spot on one side of the back of the head is another clue. We can check how your baby's neck moves.
How common is a flat head in babies?
Very common. In a study of 440 healthy babies at their two-month clinic visit, almost half had some flattening, and most cases were mild (Mawji et al., 2013).
When should torticollis be treated?
As early as possible. A clinical guideline recommends that babies with torticollis start treatment as soon as it is noticed (Kaplan et al., 2018).
Should my baby sleep on their side to fix a flat spot?
No. Always put your baby to sleep on their back (Moon et al., 2022). Work on head position while your baby is awake instead, with tummy time, holding and play that encourages them to turn both ways.
Is treatment for torticollis gentle?
Yes. With babies we use very light, steady pressure, often no more than you would press on your own eyelid, with no cracking or twisting. Most of the work is gentle stretching, positioning and play that you carry on at home.
References
- Stellwagen L, Hubbard E, Chambers C, Jones KL. Torticollis, facial asymmetry and plagiocephaly in normal newborns. Archives of Disease in Childhood. 2008;93(10):827-831.
- Mawji A, Vollman AR, Hatfield J, McNeil DA, Sauvé R. The incidence of positional plagiocephaly: a cohort study. Pediatrics. 2013;132(2):298-304.
- Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA Academy of Pediatric Physical Therapy. Pediatric Physical Therapy. 2018;30(4):240-290.
- Klimo P Jr, Lingo PR, Baird LC, et al. Congress of Neurological Surgeons systematic review and evidence-based guideline on the management of patients with positional plagiocephaly: the role of repositioning. Neurosurgery. 2016;79(5):E627-E629.
- Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy time and infant health outcomes: a systematic review. Pediatrics. 2020;145(6):e20192168.
- Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 2022;150(1):e2022057990.