Why does my baby always look to one side? Practical tips to help with Torticollis and Plagiocephaly

Have you noticed that your baby spends a lot of time looking one way more than the other? If so, you are not alone! This is very common in young babies, however, just because it is common doesn’t mean it should be left unchecked – it is something that needs help to be corrected. The good news is that with a little help, it can normally be sorted very quickly.

 Babies tend to have a preference to look to one side due to one or both of the following reasons:

1 – Tightness in the muscles on one side of their neck. The medical term for this is Torticollis.

2 – An asymmetry of their head shape. The medical term for this is Plagiocephaly.

What causes torticollis and plagiocephaly?

Both of these can be caused by a number of reasons and often one can then lead to the other. Torticollis can sometimes be due to baby’s position within the womb, or injury to the neck muscles at birth. If, at birth, a baby has tightness in one side of their neck, they will keep their head tilted to that side. Babies’ heads are big and heavy and their neck muscles are weak, meaning they struggle to overcome that tightness and turn or tilt their head in the opposite direction. This then puts more pressure through the same part of their head when they are lying on their back.

As babies’ skulls have not fused and are soft and malleable, this can result in a flat spot and asymmetry of their head shape (plagiocephaly). Once the asymmetry is there, it is then even harder for baby to move their head in the opposite direction, as they have a little flat area which their head naturally wants to rest on.

Sometimes the plagiocephaly can come first. This is common in premature babies or babies that spend time in special care. Staying in one position for too long (often common when babies are in hospital), combined with their large head, weak neck and malleable skull, can then lead to a flat spot and asymmetry. This can then lead to a torticollis, as babies will rest their head on the flat spot keeping their head turned to that side and therefore shortening the neck muscles on one side.

 There are 3 main signs to look out for in your child:

 1 – Do they have an asymmetrical head shape? Or is there a part of their head that looks flat? (Check this only after two weeks post birth, as babies’ heads can be all sorts of strange shapes immediately after birth!)

 2 – Do they keep their head turned to one side most of the time?

 3 – Do they keep their head tilted to one side most of the time? (Is their ear closer to their shoulder on one side more than the other?)

If you are noticing one or more of these three things, you should speak to a healthcare professional. It is likely they will refer you to see a paediatric physiotherapist to get personal tailored advice for your baby. Treatment works best when it is started early so it’s best to highlight your concerns straight away rather than ‘wait and see’.

What can you do to help?

The main thing to do initially is get the ball rolling to see a healthcare professional. They will be able to assess your baby and work out exactly what tailored advice you will need. However, whilst you are waiting for this there are a few things you can start doing.

Disclaimer: The following advice is general advice around how you can help your baby turn their head to both directions and promote symmetry. However, this advice is not personal to your baby and you should still seek professional medical advice if you have any concerns.

Alternate positions regularly

Avoid spending too much time in any one position. Little and often is key! Remember, even if you have had a busy day moving around (for example, gone from home, to the car, to the shops, to the car, to a friend’s house, to the car and home again), if baby has stayed in their car seat travel system throughout, then they have not moved or changed position!

Lots of little and often awake tummy time

Even just a few seconds at a time can be enough, as long as long it is repeated regularly throughout the day. Tummy time can be done in a variety of ways. It doesn’t have to be on the floor. Lying on your chest if you are reclined back counts too!

Side lying play

An alternative awake lying position is on their side. This is a lovely position to lay down next to them and have a chat or sing. Their hands will naturally be more together making it easier for them to play with their hands.

Minimise awake time spent in containers or lying on their back

Babies still need to follow the back to sleep advice, but when they are awake and supervised by an adult, try to minimise the amount of time spent in containers. Things like baby bouncers, car seats etc… lying on their back to play is an important position but like all positions, should be alternated regularly. When lying on their back awake, try to encourage head turning away from their preferred side to minimise pressure going through the flattened area and put more pressure through the other side of their head.

Encourage baby to look to the non-preferred side

Adapt the environment or baby’s position within the environment, to encourage looking to the non-preferred side. Always ask yourself, ‘Where is their head and what can I do to change it?’ For example, you might present toys and people from their least preferred side and hang toys on the non-preferred side on the play mat. 

Tracking exercises

Show visually stimulating, slow moving toys or vision flash cards in a rainbow arc shape approximately 30cm away. Start on the preferred side and move slowly to the non preferred side, encouraging baby to turn their head and track the toy or card with their eyes. Watch to see if they can turn their head to both sides without lifting their shoulders and body off the floor (check out our vision flashcards on our Bloss products page for this activity)

Other ways to help:

• Switch sides for feeding, even if bottle feeding.
• Encourage baby to reach for toys in midline and either side with both hands.
• Alternate which side you hang toys on the pram/car seat.
• Your physiotherapist may also recommend some gentle stretches to help lengthen their neck muscles.

You may have seen babies wearing helmets – this can be a method used to help regain a symmetrical head shape. This is usually paid for privately rather than available on the NHS. In most cases, if the head asymmetry is detected early and the treatment/advice is followed well, most babies’ head shapes will improve significantly without the need for a helmet. However, this is an option if needed. 

Remember don’t be afraid to ask for help. Your Physiotherapist would rather see you early and prevent a problem!