Torticollis in babies

Daniel Smit | APA Titled Paediatric Physiotherapist

How physiotherapy can help with a head-turning preference

A persistent head tilt or preference to look one way is worth checking

Some babies consistently tilt their head to one side, turn more easily in one direction or find feeding more comfortable on one side. This may be related to congenital muscular torticollis, a condition involving tightness or shortening of a neck muscle, or a postural preference without clear muscle tightness. An assessment can help clarify what is contributing and whether support is needed.

Torticollis describes a head and neck position; it is not a diagnosis by itself. A new or sudden head tilt, especially when your baby is unwell or in pain, needs prompt medical advice because causes other than congenital muscular torticollis must be considered.

What you might notice

• Your baby often tilts their head towards the same shoulder, while looking or turning towards the other side.
• They seem to have an easier direction for looking, or become unsettled when positioned to look the other way.
• They prefer feeding on one side or have difficulty comfortably turning towards one breast or bottle position.
• There is a developing flat area on one side or at the back of the head, or the face looks slightly asymmetrical.
• They use one side of the body more, or movement during play looks less even.

These signs do not confirm torticollis. Some babies have a positional preference without muscle restriction, and head shape differences can have more than one contributor. Your GP, child and family health nurse or paediatric physiotherapist can assess your baby and guide next steps.

How paediatric physiotherapy can help

A paediatric physiotherapist looks at your baby’s whole movement pattern, not only the neck. The assessment may include preferred head posture, comfortable active and passive neck movement, neck muscle length and strength, head and facial symmetry, trunk and limb movement, early motor skills, feeding or positioning concerns, and signs that another health professional should assess. Your GP may also consider hip screening, as hip dysplasia can occur alongside congenital muscular torticollis.

Care is individualised to your baby and family. It may include:

• gentle, clinician-guided activities to support comfortable neck movement and strength
• play that encourages looking and moving in both directions and using both sides of the body
• practical positioning ideas for feeding, carrying, floor play and daily routines
• caregiver coaching and a simple home plan that fits your baby’s cues and tolerance
• monitoring of head shape, symmetry and developmental movement, with referral or collaboration when needed.

Physiotherapy is most useful when it begins early if a movement preference or restriction is present. The plan and expected progress vary from baby to baby; your physiotherapist will review movement, function and your goals over time.

Safe positioning and play at home

Everyday routines can provide chances to practise looking both ways. Follow your baby’s cues and choose positions that are comfortable and safe.

• Offer supervised tummy time while your baby is awake, using short, frequent opportunities if that suits them. Stay within arm’s reach.
• During awake play, place your face, voice or a toy on the less-preferred side to invite (not force) your baby to look that way.
• Vary the side you hold or carry your baby on, and alternate the direction you approach from during feeds and care when practical.
• Build movement opportunities into floor play and limit long stretches in car seats, capsules, swings and other containers when they are not needed for travel or care.
• For every sleep, place your baby on their back on a firm, flat, clear sleep surface. Do not use pillows, wedges, positioners or rolled towels to hold the head in place.

Do not pull or force your baby’s neck into a stretch. Ask your physiotherapist to demonstrate any hands-on technique and show you how to adapt it to your baby.

When to seek medical advice

Contact your GP or child and family health nurse if you notice a persistent head tilt, reduced turning to one side, increasing head-shape asymmetry, a neck lump, or difficulty with feeding or movement. Arrange an early paediatric physiotherapy assessment if the preference persists or movement seems restricted.

Seek prompt medical assessment for a sudden or painful head tilt, a tilt after a fall or injury, fever or appearing unwell, difficulty swallowing or unusual drooling, severe headache, repeated vomiting, unusual eye movements or vision changes, poor balance, weakness, unusual sleepiness, or other new neurological symptoms. In an emergency call 000.

How Little Strides can support your family

At Little Strides Physiotherapy, we take time to understand your baby’s movement, daily routines and your family’s priorities. We work with you to make the plan practical, gentle and developmentally appropriate, and liaise with your GP or other health professionals when needed.

To ask about an appointment: Call 0411 876 851 or visit littlestrides.com.au. Little Strides is at 426 Princes Hwy, Narre Warren VIC 3805.

Download the torticollis in babies handout (PDF)

Further information and references

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Explore Little Strides physiotherapy in Narre Warren. Selected appointments are available in Nunawading. View appointment and booking information or ask us about your needs.

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