What is Torticollis?
Torticollis is a fairly common condition in infants where the neck muscles (often the sternocleidomastoid- “SCM” muscle) become tight, leading many babies to consistently prefer turning or tilting their head to one side. Parents often first notice it during feeding, sleeping, tummy time, or in photos- when baby seems to always look the same direction.
While a mild head preference can sometimes be normal early on, a persistent preference may contribute to movement asymmetries, feeding challenges, delayed motor milestones, retained reflexes and head shape flattening (plagiocephaly).
The great news: early pediatric physical therapy is highly effective and often leads to excellent outcomes.
What Causes Head Preference or Torticollis?
There are several reasons an infant may develop torticollis or a strong side preference, including:
Positioning in the womb
Birth positioning or delivery factors
NICU stays requiring prolonged positioning
Preference developed from sleeping or feeding positions
Neck and trunk muscle tightness
Reflux or discomfort that leads babies to avoid one side
Since babies often spend so much time on their backs early in life, a strong side preference can quickly impact both head shape and movement patterns.
What Are Common Signs?
You may notice one or more of the following:
Always looking or rolling to one side
Difficulty turning the head equally both directions
Flattening on one side of the head
One shoulder appearing higher
Asymmetrical ear positioning
Trouble with tummy time
Feeding better on one side
Preference using one arm/side more than the other
Delayed rolling or other motor milestones
Many families are told to “wait and see,” but earlier treatment is often easier and more effective.
How Does Physical Therapy Help?
Pediatric physical therapy works to improve:
Neck flexibility and strength
Symmetrical movement patterns
Tummy time tolerance
Positioning strategies
Developmental motor skills
Head shape and mild facial asymmetry management
Our approach is play-based, gentle, and individualized to your baby and your family. Parent education is also a big part of treatment, so you feel confident using the strategies at home as part of everyday routines.
Simple Ways to Encourage Symmetry at Home
Small, consistent changes can make a big difference. Consider trying:
Alternate feeding positions
Encourage your baby to look both directions during play
Switch crib, diaper changing and carrying positions
Increase supervised tummy time
Limit prolonged time in swings, containers, and car seats when possible
Use toys and interaction to promote active head turning
When Should You Seek an Evaluation?
It may be helpful to request an evaluation if your baby:
Consistently prefers one side
Has noticeable head flattening
Struggles with tummy time
Seems stiff through the neck or body
Early assessment helps address concerns before movement patterns become more ingrained and supports more symmetrical development as your baby grows.
As always, feel free to reach out with questions. I’m always happy to discuss whether an evaluation or consultation may be appropriate.
Dr. Maddie Pessel, PT, DPT, CSCS
