Plagiocephaly and Torticollis: What Parents Need to Know

Key Takeaways:

• Plagiocephaly is a flat spot on the head that can occur from positioning in the womb or repeated pressure on the same spot of the head after birth.

• Torticollis occurs when a muscle is tight in the neck causing infants to tilt their head to one side and rotate (usually to the opposite side). Torticollis can cause plagiocephaly.

• After birth, torticollis and plagiocephaly can be prevented with tummy time during awake periods, floor time, and frequent position changes. The primary treatment for these conditions is physical therapy. A cranial helmet may be indicated for plagiocephaly.

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As a pediatric physical therapist, I frequently work with infants who have head shape asymmetries and neck tightness. Two terms parents often hear early on are plagiocephaly and torticollis. While these words can sound intimidating, the good news is that both conditions are common, manageable, and highly treatable, especially when addressed early.

What Is Plagiocephaly?

Plagiocephaly refers to a flattening on one area of a baby’s head. The most common type seen today is positional plagiocephaly, meaning the head shape changes due to repeated pressure on the same spot.

Common Signs of Plagiocephaly

• Flattening on the back or side of the head

• One ear appearing shifted forward

• Facial asymmetry (one cheek or forehead more prominent)

• Preference for turning the head to one side

Because an infant’s skull is soft and rapidly growing, it can mold easily—especially during the first few months of life. After about 18 months old, the head shape is unable to change with positioning and helmet therapy, so early intervention is crucial.

What Is Torticollis?

Torticollis occurs when a neck muscle (most often the sternocleidomastoid) becomes tight or shortened, causing a baby to:

• Tilt their head to one side

• Rotate their head more easily in one direction than the other (usually the opposite side of their tilt)

Torticollis may be present at birth or develop over time.

Common Signs of Torticollis

• Consistent head tilt

• Difficulty turning the head both ways

• Preference for looking in one direction

• Flattening of the head on one side

How Are Plagiocephaly and Torticollis Connected?

These two conditions often occur together.

• A baby with torticollis may consistently rest their head in the same position, increasing pressure on one area of the skull.

• A baby with plagiocephaly may develop neck tightness due to limited head movement.

This cycle is why early screening and intervention are so important.

Common Causes

Several factors can contribute to plagiocephaly and torticollis, including:

• Positioning in the womb, especially with limited space

• Prolonged time on the back without position changes

• Limited tummy time

• Bottle-feeding or holding on the same side consistently

• Extended time in car seats, swings, or bouncers

• Birth factors, such as assisted deliveries or multiple births

It’s important to note that back sleeping is still essential for reducing the risk of SIDS. The goal is not to change sleep positioning, but to focus on alignment and tummy time while awake.

Prevention Strategies Parents Can Use at Home

Many simple strategies can significantly reduce the risk of developing or worsening these conditions.

Encourage Tummy Time

• Aim for multiple short sessions throughout the day

• Start early and build gradually (can start chest to chest and slowly recline to flat position- especially helpful for babies with reflux)

• Get down on the floor to engage your baby

Vary Positions Throughout the Day

• Alternate the direction your baby faces in the crib

• Switch arms when feeding

• Change the side you carry your baby on

Limit Time in Containers

• Reduce prolonged time in car seats, swings, and bouncers when not necessary

Promote Active Head Turning

• Place toys, mirrors, or people on your baby’s less preferred side

• Encourage looking both ways during play

Common Treatments

Pediatric Physical Therapy

Physical therapy is the primary treatment for torticollis and often helps improve head shape as well.

PT treatment may include:

• Gentle stretching of tight neck muscles

• Strengthening exercises

• Positioning strategies

• Parent education and home exercise programs

• Monitoring head shape and movement milestones

Early physical therapy often leads to faster and more complete improvement.

Helmet Therapy (When Needed)

In some cases of moderate to severe plagiocephaly, a cranial orthosis (helmet) may be recommended.

• Helmets guide skull growth, they do not squeeze or reshape forcefully

• Most effective when started between 4–7 months of age

• Always used in combination with repositioning and/or therapy

• Helmets cannot be used after 18 months of age

Not all babies need a helmet, and many improve with therapy and positioning alone.

When Should Parents Seek Help?

Consider reaching out to your pediatrician or a pediatric physical therapist if you notice:

• Persistent head tilt or head turning preference

• Flattening that does not improve with repositioning

• Delays in head control, rolling, or symmetry in movement

A Reassuring Final Note

Plagiocephaly and torticollis are very common, and parents are not to blame. With early identification, education, and appropriate intervention, most babies go on to develop normal head shape, full neck motion, and strong motor skills.

If you have concerns, a pediatric physical therapist can evaluate your baby’s movement, head shape, and positioning.