Look Both Ways Before Crossing the Crib: Prevention of Head Flattening and Torticollis

What is Torticollis?

Congenital Muscular Torticollis or CMT is a condition in which muscles in the neck become tight. A child may be born with or acquire it a few months after birth. This typically causes the children to favor looking to one direction while tilting their heads towards their shoulder in the opposite direction of the head turn.

Sometimes, the tightness in the muscles is a result of a strong preference an infant has to position his head in one direction. Sometimes the preference develops from a pre-existing tightness, such as from tight positioning in the womb.

No matter what the cause, Torticollis is treated similarly. If left untreated, it can lead to developmental delay as well as cosmetic deformities which are often preventable with the suggestions listed below.

Is my Child at Risk for Torticollis and Head Flattening?

Yes, all children are at risk. This has become more prevalent with the American Acadamy of Pediatrics suggestion that children sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS). This positioning is important but places weight on the back and side of infants’ heads during sleep. Over time, this pressure can lead to flatness in the head if positioning is not frequently changed.

How Do I Know if my Child has Torticollis?

Baby on backDoes your child only turn his head to one direction? Children begin actively turning their heads to locate noises by three months of age.

The major sign that parents and physicians notice first is a head-turning preference. If you approach your child from the side, will he turn his head symmetrically to follow you?

If you notice that your child is favoring looking to one direction, you should contact your child’s pediatrician. Your physician can determine if your child has torticollis and if a referral is appropriate to Physical Therapy for stretches and gross motor activities or to an Orthopedic Surgeon for further testing.

Generally, the earlier that a Torticollis diagnosis is made, the sooner rehabilitation can start to improve your child’s range of motion, strength, and gross motor skills.

Why Does Head Flattening Occur?

Head Flattening occurs as a deformity to the shape of the skull due to constant pressure on one spot of the child’s head.

  • Plagiocephaly is characterized as a flattening on one side of the head and is commonly associated with Torticollis, but can occur in isolation. This type of head flattening occurs when children place frequent pressure on the side they turn their heads to and since infants’ heads are very moldable during the first year of life.

  • Some children will present with flattening uniformly on the back of the head; this is due to frequent positioning on their back without a Torticollis or head turn preference.

Ways to Prevent Torticollis

Although Torticollis is not always preventable, early detection significantly improves outcomes. Often it is preventable just by knowing to look out for a head turning preference before it becomes too much of a habit. Mindfully positioning your child to look in both directions during sleep and awake time will help as well.

Ways to Avoid Head Flattening

The best way of preventing head flattening is re-positioning.

  • Never allow your children to sleep only to one side.

  • Try not to let children nap in their car seats after you return home.

  • Limit the amount of time your children are on their backs when awake such as in reclined swings or bouncy seats.

Easy ways to re-position your children

  • alternating which end of the crib you lay them in

  • alternating their position on the changing table

  • switching which arm you carry them in.

Currently, the Academy of Pediatrics advocates the Back to Sleep Program to reduce the incidence of SIDS when children are sleeping. When children are awake, it is important to promote supervised tummy time. You can also position them lying on their sides with toys in front of them. Children may only tolerate this position for small increments of time.

Ways to Increase Tolerance to Tummy Time:

    tumy time

  • Recline on your back on a couch or chair and lay your baby on your stomach while singing and talking to him.

  • Place babies on their tummy over a rolled receiving blanket or Boppy pillow to allow them the opportunity to practice holding their head up on an inclined surface.

  • Increase tummy time in small increments, but be consistent.


If you notice that your child has a preference to look in one direction or has a flattening in the back or one side of his head, contact your child’s primary physician. The earlier these conditions are detected the faster an intervention can occur to improve your child’s well-being.


This article was created by Physical Therapist Brigitte Filipczak, MSPT and Alyson Etter, DPT from St. Christopher’s Pediatric Outpatient Therapy Services in Abington, PA. It was prepared as a guideline to promote motor development and prevent Torticollis and Plagiocephaly. For questions or information about available therapy services, you can reach the therapy department at (215) 884-1128.



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