A head tilted to one side is a condition where the head consistently leans instead of remaining upright. This persistent leaning can sometimes be subtle and might go unnoticed until observed in photographs or during virtual interactions. While it can affect individuals of any age, it is a commonly observed condition in infants, often causing concern for parents and caregivers.
Understanding Head Tilt
Known as torticollis, from Latin for “twisted neck”, this condition manifests as an abnormal, asymmetrical head or neck position, where the head typically tilts to one side while the chin rotates toward the opposite shoulder. This postural imbalance can be present from birth (congenital torticollis) or develop later (acquired torticollis).
Primary Causes of Head Tilt
Head tilt can stem from causes present at birth or those that develop later. Congenital muscular torticollis (CMT) is the most common form observed in infants. It often results from tightness or shortening of the sternocleidomastoid (SCM) muscle, a neck muscle connecting the skull to the collarbone and breastbone. This muscular shortening can be linked to the baby’s position in the womb, particularly in crowded conditions or breech presentations, or sometimes due to birth trauma. In some instances, a small, painless lump of fibrous tissue may be felt in the SCM muscle, which usually resolves within about six months.
Acquired head tilt can emerge at any age. Positional preference, where an infant consistently holds their head in one direction, can contribute to this condition. Ocular torticollis occurs when vision problems, such as strabismus (crossed eyes), cause the individual to tilt their head to achieve clearer vision and avoid double vision. Sandifer syndrome, a rare condition, involves head tilting and arching as a response to discomfort from gastroesophageal reflux disease (GERD). Less common causes include mild viral infections, minor head/neck trauma, neurological conditions (tumors, stroke), or medication reactions.
Identifying and Diagnosing Head Tilt
A head tilt is often first noticed by parents or caregivers who observe their child consistently holding their head to one side, showing limited neck movement, or preferring to look in a single direction. A healthcare professional performs a physical examination to assess neck range of motion and identify stiffness or swelling. During this examination, the presence of a small, pea-sized lump in the sternocleidomastoid muscle might be detected, which is a common finding in congenital muscular torticollis.
While clinical examination is often sufficient, imaging studies may be considered in some cases. X-rays, CT scans, or MRI of the head and neck can rule out other underlying causes, especially in acquired or atypical torticollis. These diagnostic tools help differentiate muscular issues from more complex conditions involving the bones, nerves, or other structures of the neck.
Management and Treatment Options
Physical therapy (PT) is a primary and often very effective treatment for congenital muscular torticollis, especially when started early. A physical therapist guides parents through gentle neck stretches to lengthen the tightened sternocleidomastoid muscle and strengthening exercises for opposing neck muscles. These exercises may involve passive range-of-motion movements, where the therapist gently moves the baby’s head, and active exercises that encourage the baby to move their head independently through play.
Home exercises and positional management are important treatment components. Parents are often taught specific stretches to perform multiple times a day, such as gently bringing the ear towards the shoulder on the unaffected side to stretch the tight muscle. Positional changes during daily activities, like placing toys to encourage turning the head to the less favored side during playtime or strategically positioning the baby in the crib to encourage turning away from a wall, help promote symmetrical neck movement. Tummy time also strengthens neck and shoulder muscles.
For acquired torticollis, treatment focuses on addressing the underlying cause, which could involve medication for reflux or addressing vision problems. Surgery for congenital muscular torticollis is rare, considered only if physical therapy doesn’t yield sufficient improvement after an extended period (generally six months).
When to Consult a Professional and Prognosis
Consult a pediatrician if a head tilt is noticed at any age, or if there’s limited neck movement, a palpable neck lump, or developmental concerns. Urgent medical attention is recommended if the head tilt appears after injury, or with symptoms like fever, increased drooling, difficulty swallowing, or changes in vision/limb mobility, as these may indicate a serious underlying condition.
Prognosis for most congenital muscular torticollis cases is favorable with early, consistent physical therapy. Many infants show significant improvement, often resolving fully within the first year. If left untreated, however, torticollis can lead to complications such as facial asymmetry or flattening of the head. For acquired torticollis, the outcome depends on the specific cause, with many cases resolving once the underlying issue is addressed.