GP FAQ Torticollis and plagiocephaly

Case: A 6 month old baby (born at 32 weeks gestation) was seen in clinic due to torticollis and preferentially looking to the left side. This was causing him to develop plagiocephaly on that side.

What is plagiocephaly?

Plagiocephaly is also known as flat head syndrome.  The head is usually flattened on one side causing the head to appear asymmetrical.

What is brachycephaly?

Brachycephaly is when the back of the head becomes flattened. 

What is torticollis?

Torticollis in infants is due to tightened muscles in one side of the neck. 

Parents may notice that their baby’s head tilts to one side or that there is reduced range of motion in the neck.  They may also report asymmetry in baby’s head or neck or may notice that breastfed babies may prefer feeding on one side over the other.

Did you know?

Torticollis is often due to the positioning of the baby in the womb.  If it is present when a baby is born it can lead to the development of plagiocephaly or brachycephaly.

Management of torticollis:

Usually torticollis will gradually resolve without treatment as a baby develops more head control.  Conservative treatment is centred around lengthening the short/tight sternocleidomastoid muscle. In mild cases no active treatment may be needed.  However, early recognition of plagiocephaly can improve the chance of fully correcting it.

Advise parents to:

  • Encourage tummy time
  • Turn the cot around so the baby has to turn its head to see mum/dad.  If it is not possible to turn the cot, perhaps altering the position of toys and mobiles may help encourage the baby to turn their head
  • Check position of car seats and buggies

If severe, consider referral for physiotherapy

The NHS choices website has helpful information for parents:

Other helpful resources:

Great Ormond Street Hospital, Plagiocephaly:

Boston Children’s hospital guidelines on plagiocephaly.