Torticollis in Babies: Signs, Treatment and How Long It Lasts

What is congenital muscular torticollis?

One muscle, the sternocleidomastoid, runs from behind the ear down to the breastbone and collarbone. When it is tighter on one side, it pulls the head into a characteristic position: tilted toward the tight side, turned toward the opposite side.⁠^14,15

That combination is the signature. A baby with a tight right sternocleidomastoid tilts right and looks left.⁠¹⁵

Sometimes there is a firm lump in the muscle, a benign fibrous mass also called fibromatosis colli.⁠¹ In a series of 510 babies with one, the mean age when it was found was 24 days, and with an early, prolonged stretching program 90.7% had excellent or good results.⁠¹⁶ It is alarming to find and worth having examined. Babies with a lump tend to be identified earlier but may need longer treatment, and a lump still there at 6 months, or one that grows or changes shape, is a reason to go back to the doctor.⁠¹

What are the signs of torticollis in infants?

• A consistent head tilt toward one shoulder⁠¹
• A strong preference for looking one way, and difficulty turning the other⁠¹
• Feeding more comfortably on one side than the other⁠¹
• Resisting or disliking tummy time, particularly turning the head in one direction⁠¹
• A flat spot developing on one side of the head or face⁠¹
• Facial asymmetry — one eye or cheek appearing slightly different⁠¹
• Reaching mostly with one hand, or rolling only one way⁠¹

A simple check at home: watch which way your baby looks when lying on their back, over several days, and look at your photos. A consistent preference is the thing to mention: the guideline says a parent’s observation, photos included, should prompt a range-of-motion check by a professional.⁠¹

Why does torticollis happen?

Frequently, size and position before birth. Torticollis is more likely in longer babies and after a breech presentation, and in one study of 102 newborns it was linked to the baby being “stuck” in one position for more than six weeks before delivery.⁠^6,7,8

Sometimes birth-related. First births, perineal trauma during delivery, and assisted or difficult deliveries are associated with it.⁠^7,16,17

Sometimes nothing identifiable. No single factor predicts torticollis on its own, and the first-choice treatment is the same.⁠¹

And after birth, position contributes. Lying on the back is associated with a preferred head position, and the guideline suggests limiting time in swings, strollers and other equipment that holds the head against a surface, though that advice has not itself been studied.⁠¹

What else can cause a head tilt?

Most infant torticollis is muscular. Not all of it is, and the distinction changes the treatment entirely: up to 18% of asymmetrical head postures have a nonmuscular cause.⁠¹

Ocular torticollis is a head tilt that compensates for an eye problem, most often a weak eye muscle. In a study of 63 children with an abnormal head posture, the cause was in the eyes in 25, and in two of them tight neck muscles that looked orthopedic were the result of the eye-driven tilt.⁠¹⁸ If a tilt persists despite good therapy, an eye assessment is reasonable to ask about.⁠¹

Reflux-related posturing, called Sandifer syndrome: spasms of the head and neck with back arching, often linked to reflux, which can be mistaken for torticollis or for seizures.⁠^1,19

Acute onset in an older child: a tilt that appears suddenly, particularly with pain, fever or after an illness or injury, is a different clinical picture from congenital muscular torticollis, often due to trauma, infection or, rarely, a tumor, and needs prompt assessment.⁠^1,12

Neurological causes, such as cerebral palsy or, rarely, a tumor in the back of the brain, are less common, and part of why a tilt that is not responding to therapy gets reassessed rather than stretched harder.⁠^1,13 Low muscle tone can also affect head control; see hypotonia.

Spinal differences: bony variations in the neck vertebrae, which imaging shows where there is a specific reason to look.⁠^1,12

The practical rule: a tilt present from the early weeks that responds to therapy is very likely muscular. A tilt that appears suddenly, hurts, or does not respond needs a different look.⁠¹

How is torticollis assessed, and why are the hips checked?

A physical therapist assesses how far the head turns and tilts each way, muscle length and any thickening, head shape and facial symmetry, motor development, and how your baby uses each side.⁠¹

Why should your baby’s hips be checked?

Congenital muscular torticollis is associated with developmental dysplasia of the hip, so a hip examination belongs in a complete assessment.⁠^1,3 If nobody has mentioned your baby's hips, ask.

It is worth knowing what the association actually amounts to, because the figure often quoted is too high. Across the older literature the reported correlation ranges from 2% to 29%, most of it predating routine ultrasound.⁠³ In a series of 292 infants with torticollis, 16 had hip dysplasia, and the rate needing treatment was 4.5%, which the authors noted is lower than the commonly accepted 20%.⁠² The 2018 guideline gives a range of 2.5% to 17%, depending on how cases were counted.⁠⁶

Every one of those 16 was picked up by the clinical hip examination.⁠² On that basis the authors concluded that a baby with torticollis does not need routine hip imaging when the clinical examination is normal. So the thing to make sure of is that the hips are examined — not that your baby is sent for a scan.

How do you get started with torticollis treatment?

Under three in the US, a parent can refer their own child to early intervention — no doctor's referral, no diagnosis needed — and the evaluation is free; some states charge sliding fees for services.⁠⁴ Search for your state's early intervention program.

Your pediatrician can also refer directly to physical therapy, which the guideline recommends as soon as an asymmetry is noticed, and in states with direct access you can go straight to a pediatric physical therapist.⁠¹

RelatedFlat head syndrome (plagiocephaly)Find a physical therapistMilestones and red flags

Does torticollis cause a flat head?

Torticollis and a flat head often go together: in one series, 90.1% of babies with torticollis had some craniofacial asymmetry when first seen.⁠⁶ The link can run both ways. A baby who cannot turn easily may rest on the same part of the skull, and a flattened skull can in turn hold the head in one position; the guideline notes that it is unclear which comes first.⁠¹

Physical therapy helps the head shape too. A Congress of Neurological Surgeons guideline found physical therapy significantly more effective than repositioning advice alone for positional plagiocephaly.⁠²⁰

What helps: varied positioning when awake · plenty of supervised tummy time · alternating which end of the crib you approach from, and which arm you feed with · less time in seats, swings, and carriers.⁠^1,21 Repositioning advice on its own brings some correction in virtually all babies with a flat head.⁠²²

Helmet therapy is considered for some babies. The guideline suggests asking the primary care provider about a helmet when the skull asymmetry is moderate or severe,⁠¹ and a Congress of Neurological Surgeons review found that helmets correct head shape more, and faster, than conservative care, especially for severe flattening and when started at the right point in infancy.⁠²⁴ It is a conversation with your pediatrician.

Who treats torticollis, and what does treatment involve?

A pediatric physical therapist treats congenital muscular torticollis, and the guideline recommends referral to one, along with the baby’s primary care provider, as soon as an asymmetry is noticed. Physical therapy is the first-choice treatment, and its components are consistent:⁠^1,15

• Gentle lengthening of the tight muscle, taught to parents and done at home.⁠¹
• Active turning — encouraging your baby to look toward the harder side using toys, voices, faces, and light.⁠¹
• Strengthening the weaker side, so the head holds in the middle rather than only reaching it passively.⁠¹
• Positioning through the day — how you carry, feed, play, and lay your baby down.⁠¹
• Tummy time, progressed gradually.⁠¹

A therapist teaches you and checks the technique. Most of the treatment happens at home, in short sessions through the day.⁠¹

Do the stretches as shown, not harder. The guideline calls for gentle, sustained, pain-free stretches, stopped if the baby resists or if breathing or color seems to change. If it seems painful, stop and tell your therapist.⁠¹

On chiropractic care: the physical therapy guideline does not recommend cervical manipulation for babies with torticollis; a small trial found no added benefit, and manipulation in infants may carry higher risks of apnea and possible death.⁠¹ A review of published reports found serious harms from manual therapy in children rare: 15 serious events, including three deaths, none of them under chiropractic care, and most in children with an underlying condition.⁠²⁵ Discuss any manual treatment for a baby with your pediatrician first.

When therapy is not enough. The guideline suggests going back to the baby’s doctor if the asymmetry has not started to improve after 4 to 6 weeks of comprehensive treatment, or stalls after 6 months. The two options then discussed are botulinum toxin injections, which are off-label in infants, and surgery to release the tight muscle.⁠¹ A meta-analysis of 411 patients, mostly from case series, found botulinum toxin effective in 84%, with 9% going on to surgery and adverse reactions in 1%.⁠¹¹ In a prospective series of 821 babies treated with stretching before age one, 8% of those with a lump in the muscle needed surgery, against 3% with a tight muscle and none with postural torticollis.⁠²⁶

What can parents do at home for torticollis?

The guideline recommends doing the home program frequently through each day, and a caregiver’s ability to do it often is one of the factors linked to full resolution.⁠¹

• Alternate feeding sides, whether breast or bottle⁠¹
• Change which end of the crib you approach from, so your baby turns both ways to see you⁠¹
• Position toys and interest on the harder side⁠¹
• Carry in varied positions⁠¹
• Supervised tummy time, little and often: two or three short sessions a day from birth, building to 15 to 30 minutes a day by 7 weeks⁠¹
• Leave towel rolls and positioning devices out of the car seat; they can become a suffocation hazard⁠¹
• Reduce time in seats and swings when awake⁠¹

Consistency matters. Babies with torticollis who spent time on their tummy at least three times a day had higher motor scores, and in that study the risk of delayed milestones was tied more strongly to little or no awake tummy time than to torticollis itself.⁠²⁷

How long does torticollis last in babies?

Most infants with congenital muscular torticollis improve substantially with physical therapy: when therapy starts before 3 months of age, 98% to 100% respond within six months, though full resolution can take longer. The evidence that starting earlier means a shorter course and a better result is strong.⁠¹

Babies who start in the first few months typically need a shorter course than those who start later. More severe restriction, a lump in the muscle and later starts take longer; in one study, treatment lasted 3 months on average for mild early cases, 5 for moderate and 6 for severe.⁠¹

The guideline reports a study of 980 children by Petronic and colleagues that gives results by the age treatment started. A good outcome there means no remaining head tilt and full passive neck rotation, not simply improvement.⁠^1,5

Read the two columns together. Starting later does not only make treatment longer; it makes a complete result less likely, and the drop is steep: from 99% before one month to 19% at 6 to 12 months. That is the whole argument for not waiting to see whether a head tilt settles on its own, and the guideline does not expect it to.⁠^1,5

These are figures for a group, not a forecast for one baby. Severity, how consistently the home program is done, and any other conditions all move it, and your therapist's estimate for your child is better than a table.⁠¹

Direct therapy stops when five things are true: neck range within 5 degrees of the other side, symmetrical movement, age-appropriate motor development, no visible head tilt, and parents who know what to watch for. The guideline then recommends a recheck 3 to 12 months later, or when the child starts walking.⁠¹

Does torticollis cause developmental delays?

Torticollis is linked to early motor delays. Babies with torticollis had lower motor scores than healthy babies at 2 and 6 months and reached early milestones later until about 10 months, though time spent on the tummy mattered more than the torticollis.⁠²⁷ In another study, 35% of 101 babies had suspect or abnormal gross motor skills when first seen.⁠⁹

What can be affected: rolling, often only one way · reaching and using both hands · tummy time tolerance, and the strength it builds · feeding.⁠¹

Treated torticollis usually does not cause lasting delay. Of 83 babies followed after physical therapy, 75 had normal gross motor skills at about one year, and early cognitive development was not affected.⁠^6,9 At 3.5 to 5 years, children who had torticollis as babies were at no higher risk of motor delay.⁠¹⁰ One longer follow-up of 68 children aged 7 to 9 found that 44.1% had a current or past developmental delay or disorder, including language impairment, ADHD, coordination disorder and autism, so the guideline suggests a recheck when a child starts school if a parent or teacher has concerns.⁠^1,28

RelatedDelayed motor milestonesMilestones and red flags

Can adults get torticollis?

Adults can develop torticollis too, and it is usually a different condition entirely.⁠¹⁴

Cervical dystonia is a neurological movement disorder in which the neck muscles turn or pull the head in one direction, most often starting in midlife. It is managed rather than cured, with botulinum toxin injections often the most effective treatment, alongside medicines, physical therapy and sometimes surgery.⁠²⁹ It has little in common with the infant condition beyond the word.

Acute wry neck, a sudden painful twist of the neck, is different again. Torticollis of some kind is common: an estimated 90% of people have at least one episode in their lives.⁠¹⁴

RelatedNeck pain in adultsBaby development: the first year

Frequently asked questions

Where can you find a therapist who treats torticollis?

Torticollis is usually treated by a pediatric physical therapist.⁠¹ 306 clinics in the DrSensory directory name torticollis among the conditions they treat — 281 physical therapy, 23 occupational therapy and 2 speech therapy clinics, across 47 states and the District of Columbia. They are grouped by state below.

Each clinic appears here because its own listing names torticollis among the conditions it treats. A listing is not an endorsement or a referral, and inclusion does not mean we have verified a clinic’s credentials, licensure or insurance — check those directly. Browse all physical therapy clinics.

RelatedPhysical therapy

Sources

1. Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical therapy management of congenital muscular torticollis: a 2024 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatric Physical Therapy. 2024;36(4):370–421. PMID 39356257. Checked October 11, 2026.
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   Free full text on the publisher’s Ovid site. “CMT is a condition evident shortly after birth, affecting 3.9% to 16% of newborns.” “An SCM mass is a benign fibrotic mass or enlargement of the SCM and is synonymous with fibromatosis colli or tumor.” “up to 18% of cases of asymmetrical head and neck posturing may be due to nonmuscular causes, eg, cerebral palsy, visual impairments, scoliosis, gastroesophageal reflux disorder (GERD), and acute respiratory distress”. “Infants diagnosed with CMT are not expected to spontaneously resolve or resolve with 1-2 sessions of parent/caregiver training on neck stretching; therefore, immediate referral to physical therapy is recommended”. Action Statement 3: refer infants with “postural preference, reduced cervical ROM, an SCM mass, and/or craniofacial asymmetry to their primary care provider, and a PT with expertise in infants as soon as the asymmetry is noted.” Prognosis: “If an infant diagnosed with CMT begins physical therapy intervention before 1 month of age, the prognosis for good clinical outcomes (no head tilt, full passive cervical rotation) is 99% with 1.5 months of physical therapy”, declining to 89% from 1 to 3 months, 62% from 3 to 6 months and 19% from 6 to 12 months (Petronic et al); “if intervention is initiated before 3 months of age, 98% to 100% of infants will respond to physical therapy intervention within a 6-month period of time, though full resolution may require longer durations.” Knudsen et al: “average treatment durations of 3 months for Grade 1, 5 months for Grade 2, and 6 months for Grade 3”. Referral to the primary care provider for a history of acute onset torticollis, “which is usually associated with trauma or acute illness”, late onset at 6 months or older, or “an SCM mass at 6 months or older, or an SCM mass that changes shape and location or increases in size at any age.” Hips: “DDH has been associated with CMT, so screening for DDH is recommended”. Head shape: “Although CMT is associated with CD, it is unclear how or whether they are causally related.” Eating: “As many as 44% of infants with CMT may have an eating preference to one side”. “Stretching interventions should not be painful; stretches should be stopped if the infant resists or there are perceived changes in breathing or circulation.” “placing towel rolls or other positioning devices in the car seat is not recommended since they can become a suffocation hazard”. “the GDG does not recommend cervical manipulation as an intervention for infants with CMT”, which “may be associated with higher risks of apnea and possible death.” Consult when asymmetries “are not starting to resolve after 4 to 6 weeks of comprehensive intervention, or after 6 months of intervention with a plateau”; botulinum toxin “is considered off-label for infants”; “Surgical management of the SCM is the more traditional alternative for managing recalcitrant CMT.” Of cervical manipulation, a small trial found “no differences between the groups”. Discontinue direct services at “cervical PROM within 5° of the non-affected side, symmetrical active movement patterns, age-appropriate motor development, no visible head tilt, and the parents/caregivers understand what to monitor”, then reassess “3 to 12 months following discontinuation ... OR when the child initiates walking.”
2. Minihane KP, Grayhack JJ, Simmons TD, Seshadri R, Wysocki RW, Sarwark JF. Developmental dysplasia of the hip in infants with congenital muscular torticollis. American Journal of Orthopedics. 2008;37(9):E155–E158. PMID 18982188. Checked October 11, 2026.
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   “We reviewed the cases of 292 patients with the diagnosis of CMT, 16 of whom were found to have DDH. Each patient with DDH had an abnormal clinical hip examination. Our study results demonstrate that, despite the association of these disorders, an infant presenting with CMT does not require routine hip imaging in light of a normal clinical hip examination. The coexistence rate for CMT and DDH requiring treatment is 4.5%, which is lower than the commonly accepted 20%.”
3. von Heideken J, Green DW, Burke SW, Sindle K, Denneen J, Haglund-Akerlind Y, et al. The relationship between developmental dysplasia of the hip and congenital muscular torticollis. Journal of Pediatric Orthopaedics. 2006;26(6):805–808. PMID 17065952. Checked October 11, 2026.
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   “Multiple studies report a correlation between congenital muscular torticollis (CMT) and developmental dysplasia of the hip (DDH) at a rate between 2% and 29%. Most of these studies were completed before the routine use of hip ultrasound.” “among the patients with CMT, there was a 12.5% coexistence of DDH”; “Our results confirm that patients with CMT should be screened for DDH”.
4. Individuals with Disabilities Education Act, Part C regulations, 34 CFR Part 303 (eCFR). Parents are primary referral sources: §303.303(c). Checked October 11, 2026.
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   Evaluation and assessment, service coordination and the IFSP “must be carried out at public expense, and for which no fees may be charged to parents”; a State may set a “schedule of sliding or cost participation fees that may be charged to the parent for early intervention services,” and a family the State finds unable to pay receives all Part C services at no cost: §303.521.
5. Petronic I, Brdar R, Cirovic D, et al. Congenital muscular torticollis in children: distribution, treatment duration and outcome. European Journal of Physical and Rehabilitation Medicine. 2010;46(2):153–157. PMID 20485220. Checked October 11, 2026.
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   980 children with congenital muscular torticollis treated in Belgrade: “In group of children less than one month of life median duration of physical therapy was 1.5+/-0.3 months, in group above one to 3 months of life 5.9+/-0.6, in group above 3 to 6 months 7.2+/-0.6, in group above 6 to 12 months 9.8+/-0.6 and in group of children above 12 months of life 10.3+/-0.8 months.” “Younger children have lower treatment duration and better treatment outcome.”
6. Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatric Physical Therapy. 2018;30(4):240–290. PMID 30277962. Checked October 11, 2026.
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   “Congenital muscular torticollis may be present at birth when selected morphologic and birth history variables converge, such as in longer babies, breech presentation and/or the use of forceps during delivery”. “The incidence of DDH with CMT ranges from 2.5% - 17% depending on inclusion criteria”. “Cheng et al reported a 90.1% prevalence of craniofacial asymmetry in children with CMT at initial evaluation.” “Infants with CMT have a higher prevalence of gross motor delay at 2 and 6 months of age. The motor delay of most infants undergoing PT for CMT resolves by 8–15 months”.
7. Chen MM, Chang HC, Hsieh CF, Yen MF, Chen TH. Predictive model for congenital muscular torticollis: analysis of 1021 infants with sonography. Archives of Physical Medicine and Rehabilitation. 2005;86(11):2199–2203. PMID 16271571. Checked October 11, 2026.
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   “Forty of 1021 infants were diagnosed with CMT using ultrasonography, yielding an overall incidence of 3.92%. Birth body length ..., facial asymmetry ..., plagiocephaly ..., perineal trauma during delivery ..., and primiparity ... were significant correlates.”
8. Stellwagen L, Hubbard E, Chambers C, Jones KL. Torticollis, facial asymmetry and plagiocephaly in normal newborns. Archives of Disease in Childhood. 2008;93(10):827–831. PMID 18381343. Checked October 11, 2026.
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   102 healthy newborns examined during the birth stay: “torticollis (16%) ... Torticollis was associated with maternal report of the fetus being ‘stuck’ in one intrauterine position for more than 6 weeks before delivery.”
9. Schertz M, Zuk L, Zin S, Nadam L, Schwartz D, Bienkowski RS. Motor and cognitive development at one-year follow-up in infants with torticollis. Early Human Development. 2008;84(1):9–14. PMID 17363197. Checked October 11, 2026.
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   “At presentation, 35 (35%) of the 101 infants had suspect or abnormal GM function.” “Follow-up assessment of 83 participants, mean age 12.8 (SD 3.6) months, showed 75 had normal GM function”. “Infants with torticollis are at increased risk for early GM delay but most normalize by one year. Torticollis is not associated with delays in early cognitive function.”
10. Öhman A, Beckung E. Children who had congenital torticollis as infants are not at higher risk for a delay in motor development at preschool age. PM&R. 2013;5(10):850–855. PMID 23702351. Checked October 11, 2026.
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    Follow-up at 3.5 to 5 years with the Movement Assessment Battery for Children: “Children who had CMT as infants were not at higher risk for a delay in motor development at preschool age.”
11. Qiu X, Cui Z, Tang G, Deng H, Xiong Z, Han S, Tang S. The effectiveness and safety of botulinum toxin injections for the treatment of congenital muscular torticollis. Journal of Craniofacial Surgery. 2020;31(8):2160–2166. PMID 33136847. Checked October 11, 2026.
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    Ten studies, 411 patients: “the overall effective rate of botulinum toxin for congenital muscular torticollis was 84% (95% confidence interval [CI] 67%-96%). After botulinum toxin treatment, the conversion rate to surgery was 9% (95% CI 4%-22%), and the adverse reaction rate was 1% (95% CI 0%-3%).” Nine of the ten studies were cases or case series.
12. Haque S, Bilal Shafi BB, Kaleem M. Imaging of torticollis in children. RadioGraphics. 2012;32(2):557–571. PMID 22411949. Checked October 11, 2026.
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    “Congenital torticollis, seen in neonates and infants, usually results from craniocervical vertebral anomalies or muscular causes, although ocular abnormalities such as congenital paralytic squint (strabismus) and congenital nystagmus should also be considered. Acquired torticollis, seen in older children and adolescents, is often secondary to trauma, infection, or tumors.”
13. Tumturk A, Kaya Ozcora G, Kacar Bayram A, et al. Torticollis in children: an alert symptom not to be turned away. Child’s Nervous System. 2015;31(9):1461–1470. PMID 26043711. Checked October 11, 2026.
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    Twenty children with torticollis, among them cerebellar tumors, vertebral anomalies, Sandifer syndrome and a retropharyngeal abscess: “Various underlying disorders from relatively benign to life-threatening conditions may present with torticollis.” “Imaging must be performed for ruling out underlying life-threatening diseases in children with torticollis, particularly, if acquired neurological symptoms exist.”
14. Cunha B, Tadi P, Bragg BN. Torticollis. StatPearls. StatPearls Publishing; updated August 8, 2023. PMID 30969679. Checked October 11, 2026.
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    The sternocleidomastoid has “insertions on the sternum (sternum furcula), clavicle (medial aspect), occipital region (lateral neckline), and mastoid”, and its action is “to perform contralateral rotation, ipsilateral inclination, and flexion of the head.” “Torticollis is a common diagnosis, and estimates are that 90% of people will exhibit at least one episode of torticollis throughout their lives.”
15. Gundrathi J, Cunha B, Tiwari V, Mendez MD. Congenital torticollis. StatPearls. StatPearls Publishing; updated March 20, 2024. PMID 31747185. Checked October 11, 2026.
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    “Torticollis refers to a contracture or fibrosis of the sternocleidomastoid muscle on 1 side, resulting in an ipsilateral inclination and contralateral rotation of the face and chin.” “Physical therapy is the cornerstone of torticollis treatment, whether congenital or acquired.”
16. Cheng JC, Tang SP, Chen TM. Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases. Journal of Pediatrics. 1999;134(6):712–716. PMID 10356139. Checked October 11, 2026.
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    “The mean age of presentation was day 24, with most (92.7%) presenting before the age of 3 months. There was a high correlation with breech presentation and assisted delivery.” “With an early and prolonged manual stretching program, 90.7% had excellent and good overall results.”
17. Cheng JC, Tang SP, Chen TM, Wong MW, Wong EM. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants: a study of 1,086 cases. Journal of Pediatric Surgery. 2000;35(7):1091–1096. PMID 10917303. Checked October 11, 2026.
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    “The SMT group was found to present earlier within the first 3 months and was associated with higher incidence of breech presentation (19.5%), difficult labor (56%), and hip dysplasia (6.81%).”
18. Nucci P, Kushner BJ, Serafino M, Orzalesi N. A multi-disciplinary study of the ocular, orthopedic, and neurologic causes of abnormal head postures in children. American Journal of Ophthalmology. 2005;140(1):65–68. PMID 16038652. Checked October 11, 2026.
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    “In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5.” “The most common ocular cause was superior oblique muscle palsy”. “In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior oblique muscle palsy.”
19. Patil S, Tas V. Sandifer syndrome. StatPearls. StatPearls Publishing; updated June 20, 2023. PMID 32644332. “Sandifer syndrome (SS) is a type of movement disorder that constitutes paroxysmal spasms of head, neck, and back arching but spares the limbs. SS is often associated with gastroesophageal reflux (GERD) in children.” Checked October 11, 2026.
20. Baird LC, Klimo P, Flannery AM, et al. Congress of Neurological Surgeons systematic review and evidence-based guideline for the management of patients with positional plagiocephaly: the role of physical therapy. Neurosurgery. 2016;79(5):E630–E631. PMID 27776088. “physical therapy is significantly more effective than repositioning education as a treatment for positional plagiocephaly.” Checked October 11, 2026.
21. Hewitt L, Kerr E, Stanley RM, Okely AD. Tummy time and infant health outcomes: a systematic review. Pediatrics. 2020;145(6):e20192168. PMID 32371428. Checked October 11, 2026.
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    Sixteen studies, 4,237 infants: “Tummy time was positively associated with gross motor and total development, a reduction in the BMI-z score, prevention of brachycephaly, and the ability to move while prone, supine, crawling, and rolling.”
22. Klimo P, Lingo PR, Baird LC, et al. Congress of Neurological Surgeons systematic review and evidence-based guideline on the management of patients with positional plagiocephaly: the role of repositioning. Neurosurgery. 2016;79(5):E627–E629. PMID 27776087. “repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly.” Checked October 11, 2026.
23. Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and Committee on Fetus and Newborn. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 2022;150(1):e2022057990. PMID 35726558. Checked October 11, 2026.
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    “The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating.”
24. Tamber MS, Nikas D, Beier A, et al. Congress of Neurological Surgeons systematic review and evidence-based guideline on the role of cranial molding orthosis (helmet) therapy for patients with positional plagiocephaly. Neurosurgery. 2016;79(5):E632–E633. PMID 27776089. Checked October 11, 2026.
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    “There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy.”
25. Todd AJ, Carroll MT, Robinson A, Mitchell EKL. Adverse events due to chiropractic and other manual therapies for infants and children: a review of the literature. Journal of Manipulative and Physiological Therapeutics. 2015;38(9):699–712. PMID 25439034. Checked October 11, 2026.
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    “A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist)”; “Underlying preexisting pathology was identified in a majority of the cases.” “Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare.”
26. Cheng JC, Wong MW, Tang SP, Chen TM, Shum SL, Wong EM. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants: a prospective study of eight hundred and twenty-one cases. Journal of Bone and Joint Surgery, American Volume. 2001;83(5):679–687. PMID 11379737. Checked October 11, 2026.
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    821 infants seen before age one and treated with manual stretching: “subsequent surgical treatment was required by 8% (thirty-four) of the 452 patients in the sternomastoid tumor group compared with 3% (eight) of the 276 patients in the muscular torticollis group and 0% (none) of the ninety-three patients in the postural torticollis group.” “controlled manual stretching is safe and effective in the treatment of congenital muscular torticollis when a patient is seen before the age of one year.”
27. Ohman A, Nilsson S, Lagerkvist AL, Beckung E. Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants? Developmental Medicine and Child Neurology. 2009;51(7):545–550. PMID 19191832. Checked October 11, 2026.
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    82 infants with torticollis and 40 healthy infants: “infants in the CMT group had a significantly lower AIMS score than the control group at 2 months (p=0.03) and 6 months of age (p=0.05). Infants who spent at least three occasions daily in a prone position when awake had significantly higher AIMS scores”; “the risk of delay seems to be more strongly associated with little or no time prone when awake than with CMT.”
28. Schertz M, Zuk L, Green D. Long-term neurodevelopmental follow-up of children with congenital muscular torticollis. Journal of Child Neurology. 2013;28(10):1215–1221. PMID 22952314. Checked October 11, 2026.
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    68 children aged 7 to 9: “30/68 (44.1%) children of the total sample demonstrated a developmental delay/disorder, currently (22/68) or previously (8/68)”, the disorders including “attention-deficit hyperactivity disorder (ADHD), developmental coordination disorder, language impairment, autistic spectrum disorder”. “Our findings suggest congenital muscular torticollis to be a significant risk factor for later neurodevelopmental conditions”.
29. National Institute of Neurological Disorders and Stroke. Dystonia. Checked October 11, 2026.
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    “Cervical dystonia is the most common focal dystonia. It affects a person’s neck muscles, causing their head to turn or pull in a specific direction.” “for most people, it first happens in midlife.” “Few treatments can stop dystonia or keep it from getting worse. But treatments such as botulinum toxin injections, medicines, surgery, and physical therapy can help manage specific dystonia symptoms.” “Botulinum toxin injections are often the most effective treatment for focal dystonia”.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. A head tilt in a baby should be assessed by a qualified healthcare professional, who can tell you what is causing it and what will help. Always consult your pediatrician or therapist about your own child.