Head Shape Concerns? Turn Preference?

Have you been worried about your child’s head shape? Do you see them looking in one direction more than the other? It’s quite common for newborns to prefer to look to one side more than the other, though that doesn’t mean it’s normal! Babies spend a long time in tight quarters, and babies that didn’t do a lot of moving as they grew, typically come out a bit tight in one way or another. The most noticeable aspect of this is generally a turn preference or head tilt, though it’s almost always involving the whole body, not just the neck. 

Let’s go over some definitions first so we’re all on the same page. Torticollis is a condition diagnosed as a tight or shortened sternocleidomastoid (SCM) muscle causing the neck to tilt and turn, and there are rare occasions where this can be the case, usually due to birth trauma and/or positioning, though could also be due to vision, viral infection, injury, or vigorous movement. 

Typically, when I see a baby with any level of persistent turn or tilt asymmetry, I consider them a Torticollis case, though my focus in treatment is rarely on the SCM and more directed at how the hips, pelvic floor, diaphragm, intercostal muscles, shoulders, cervical spine, and cranial bones all relate to each other. Looking at the full body is a must in these cases. 

The next thing we need to identify is plagiocephaly. Plagiocephaly is one of 3 main cranial shapes. Plagiocephaly is one side flattening, Brachycephaly is flattening of the back of the head, and Scaphocephaly is a long narrow head shape.

It is rare to have any level of torticollis without some level of cranial molding since the beginning of the Back to Sleep campaign (now Safe to Sleep) that started in 1994. Prior to this, babies were usually placed to sleep on their bellies. Since 1994 the rate of SIDS has decreased, though those statistics are also generally lumped together with suffocation so it’s difficult to determine the true number of SIDS cases each year. There are also cultural and genetic factors at play in SIDS rather than just sleeping position, this is more about sleep environment and new research has begun pointing us in the direction of understanding differences in blood enzymes. This means that true SIDS is very unlikely in a safe sleep environment with a healthy infant, though of course more research is needed as this is only based on one study. 

Focusing on the Safe Sleep 7 is a great way to practice safe sleep while bedsharing/cosleeping, which the majority of parent will do even if they don’t plan on it, so knowing how to do it safely before those middle of the night wake ups is super important. 

1. No one in the house smokes - secondhand smoke affects infants’ breathing

2. Breastfeeding parent must be sober as well as partner if they are in the same bed - this applies to medications that may cause drowsiness as well

3. Baby is breastfed - breastfed babies are at a lower risk of SIDS, and breastfeeding parents are hormonally in sync with their babies

4. Baby is healthy and full term - premature babies or those that are sick may not rouse as easily if needed

5. Baby is on their back

6. Baby is lightly dressed and not swaddled - this avoids overheating and allows baby to adjust their body as needed

7. Baby and parent are on a safe sleep surface - flat, no pillows or blankets near baby, no stuffed animals, no pets, no older siblings near infant

Head shape concerns are typically due to in-utero positioning and/or consistent force on one part of the skull from positioning in the first few months of life. Baby’s skull has not fully formed and is malleable to accommodate the birth process, though this means that positioning with their head turned to the same side for prolonged periods on firm surfaces can lead to impact on the skull shape. Here are some things to consider:

• Limit container time - bouncers, swings, dock-a-tots, etc

• Use a baby carrier or bassinet attachment for the stroller rather than the car seat

• Alternate sides for feedings, even when bottle feeding

• Alternate which side you carry baby on

• Rotisserie baby play - baby spending time on back, belly, right side, and left side during floor play activities

• Help baby turn their head to non-preferred side when sleeping or alternate which way they turn their head when sleeping

• Look through your camera roll with the intention of looking for a head turn preference and adjust to help baby turn the other way during play

• Reach out for a functional evaluation if you have concerns!

For babies 3 months and under with cranial molding/asymmetry, mindful positioning can be very helpful, and positioning and therapy can be effective in correcting head shape. Babies aged 4-6 months have skulls that are becoming a bit firmer, but positioning and therapy can still be helpful depending on severity and consistency of treatment. For babies 5 months and up therapy and a cranial helmet are recommended for correction. 

With any head shape concerns, I always recommend getting digital head measurements with a reputable orthotist around 5 months because even mild plagiocephaly can lead to vision and jaw challenges with age. I’d much rather have a baby with a helmet for the short term than long term impact.

If you have concerns about your baby’s head shape, please reach out to your local OT or PT that specializes in this area, the sooner we address it the better our outcomes are!