What are torticollis and plagiocephaly?

Torticollis is a condition in which a baby’s neck can become tight and shortened on one side, which results in the baby keeping his/her head tilted to one side and often turned to the opposite side. It can sometimes lead to a condition called plagiocephaly, or a misshapen skull. Plagiocephaly usually results in flattening of the skull on the sides or back of the head and can also cause one ear to shift forward and one side of the forehead to push forward.

At PTLC, our early intervention specialist conducts evaluation and treatment of babies with torticollis and plagiocephaly.  Our therapists collaborate with other members of the medical team, such as physical therapists, optometrists, and/or orthopedic physicians, as needed to optimize outcomes.

What are some signs of torticollis and plagiocephaly?

  • Keeps head tilted to one side
  • Strongly prefers turning head to one side over the other
  • Prefers feeding on only one side or facing one direction
  • Difficulty visually tracking a toy to both sides
  • Face seems asymmetrical (one side of cheek is fuller than the other, one eye may appear lower)
  • Flattening on one side or back of head


Photo examples of Torticollis and Plagiocephaly:

Mild torticollis:


Moderate torticollis:


Severe torticollis:

(Images provided courtesy of Cranial Technologies)


Click here to see examples of plagiocephaly.

How do babies get torticollis or plagiocephaly and what does it affect?

Both torticollis and plagiocephaly are much more common now, especially since the introduction of the Back to Sleep campaign to reduce SIDS deaths. Babies spend more time on their backs and in containers (like car seats, baby swings, and bouncy seats) than ever before, putting them at more risk for head flattening and keeping the head turned or tilted to one side.  Tummy time is critical to development, and many babies don’t get enough of it.  Click here for more information on tummy time.

Torticollis affects the entire child and is not just a head and neck problem. It can affect:

  • Vision
  • Sensory awareness of involved side/overall sensory development
  • Gross and fine motor skills
  • Skull shape
  • Facial symmetry

I think my baby may have torticollis and/or plagiocephaly…what do I do?

Early recognition and treatment of these conditions is key to good outcomes. Babies who are diagnosed and provided therapy early (as early as possible in the first year of life) generally need therapy for a shorter duration than those who are diagnosed beyond 6 months.  Speak to your doctor and request a therapy referral if you suspect torticollis and/or plagiocephaly.  If plagiocephaly is recognized and treated early, more intense treatments like helmets are usually not necessary.

How does a therapist evaluate a baby for torticollis/plagiocephaly?

Prior to your baby’s evaluation, you will be contacted for information regarding your baby’s developmental history and the current problems you are noticing.  Our front office will send you various forms; please bring these to your evaluation, or fax/email them prior.

During the evaluation, the therapist will examine your baby’s head, neck, and body alignment without clothing, which makes it easier to see postural/muscular alignment issues.  Head and neck range of motion are examined, as well as overall muscle tone and symmetry of motor skills between the two sides of the body.  Babies with torticollis often learn to use one side of the body more than another, and your therapist will pick up on subtle differences in function between the two sides of the body.  She will also examine skull shape and facial symmetry.  Part of the evaluation consists of an assessment of overall motor skills, with both standardized motor testing and clinical observations, in which the therapist observes skills such as visual tracking, rolling, crawling, standing, etc.

What does therapy for torticollis look like?

Conservative treatment for torticollis involves manual stretching of the tight neck, trunk, or arm muscles involved in torticollis and promoting symmetrical motor skill development (i.e. equal or near equal use of both sides of the body) through play activities and positioning.  It is important that parents learn appropriate, effective stretch techniques to maximize progress.  An assessment of the muscles involved in torticollis is the first step to accomplishing an effective, comprehensive stretching program.

Additional modalities, like kinesiotaping or use of a TOT collar, are sometimes used depending on an individual baby’s needs and rate of progress.

How long will my baby need therapy?

Duration of therapy varies widely from child to child.  Babies who are born with torticollis due to in utero positioning or who have more significant range of motion deficits tend to need therapy longer.  Parent carryover with the recommended stretching regimen is critical for fastest progress, and stretching tends to be much more difficult with older, more mobile babies vs. younger babies who are naturally held more often and who are less resistant to stretching protocols.  Some cases of torticollis are resolved on a consultative basis alone, in which the OT meets with families every few weeks to update a home program; other children benefit from greater intensity treatment (such as once per week) for a year or more.

My baby has plagiocephaly….will he or she need a helmet?

If your baby has plagiocephaly, your therapist will offer advice on positioning strategies to reduce it, which usually involves getting pressure off of the flat spot of baby’s head.  The skull is very malleable in the first year of life, so if caught early, plagiocephaly can often be completely resolved with positioning strategies alone.  The window of opportunity to change skull shape closes between 18-24 months, when the soft spots of the skull fuse completely.  In more severe cases, a helmet may be helpful to achieve a more symmetrical skull shape in a short period of time.  Your therapist can help to determine whether evaluation by an orthotist for a helmet needs is necessary.