…by Holly Putnam Bacasa, PT

Identifying Neck Tightness & Head Flatness in Babies

Do you think your baby is developing some neck tightness because they have a preferred head position, or are you possibly starting to notice a flat spot on your baby’s head?

No worries! There are many things that you can learn to help your baby! As a pediatric Physical Therapist, these are two of the most common things that I initially treat in the babies I evaluate.


Parents and caregivers can use my Turn-Tilt-Top Method (T-T-T) to help identify if your baby has neck tightness and/or head flatness.  A turn and/or tilt preference and flat spots on babies’ heads are the most common concerns I see an an Early Intervention Physical Therapist. Your baby may have or is developing torticollis (which is the medical term for neck tightness), or plagiocephaly (which is the medical term for the most common head flatness).   

The T-T-T Method  can help you decide if you want to consult with your pediatrician and also call for an Early Intervention evaluation.


TORTICOLLIS ( latin word for “twisted neck”) and PLAGIOCEPHALY (head flatness) are two very common diagnoses given to infants these days. I personally have also seen many babies who are also undiagnosed with torticollis and plagiocephaly, although the symptoms are present. This is why it’s important for YOU to not miss it- and to take your window of opportunity to do something about it!

Over the past 10 years, I have evaluated thousands of babies, and it seems that easily 66-75% of them have had torticollis and/or plagiocephaly.  The crazy part is that it is preventable! With some coaching and commitment, it is also treatable!

All you have to do is use your observation skills- I will teach you! Watch and observe……


…by  PT Holly….. quick lesson, I promise! I am a big believer that your understanding of simple neck anatomy will make a difference in how you are able to help your baby.

  • The major neck mover is the Sternocleidomastoid Muscle (SCM). Yes, it’s a long name and you don’t have to remember it.  It’s job is to  TURN AND TILT the neck.
  • There is a RIGHT SCM and a LEFT SCM.
  • The confusing part, is that the RIGHT SCM’s job is to TURN THE HEAD LEFT & TILT THE HEAD RIGHT, and the LEFT SCM’s job is to TURN THE HEAD RIGHT & TILT THE HEAD LEFT.
  • When the RIGHT SCM & the LEFT SCM work at the same time, their job is to flex the neck– tucking the chin toward the chest.
  • The SCM starts by attaching at the base of the bone behind your ear.
  • The muscle then splits, such that it looks like an upside down “V”, and one split connects to the collar bone and the other split connects to the breast bone.
  • Since the muscle splits, it has the two functions- to TURN AND TILT the neck.
  • If you put your fingers there and turn your neck, you will feel it working, and if you look in the mirror you can see it working.  You can also see and feel it when you tilt your head to the side.


T=TURN- chin turns toward and just over-top of shoulder

“My baby is turning their head more to one side.” This is the most common report I hear from a parent.  Because the SCM turns and tilts the neck, the parents don’t often realize there is also an imbalance with their baby’s neck tilting. Turning to one side can easily become a habit and a preference. Babies are smart and will take the path of least resistance!

So, we want your baby’s head and neck to turn freely to both directions– whether you are turning it for them, gravity causes it to turn or they are gaining strength and learning how to turn it themselves.  This is a good thing!

When I say freely, I mean that your baby’s neck should turn so that their chin can turn over-top of their right shoulder and then also their left shouldera 90° turn.

At first, they depend on you to position their head and then they gain strength and learn to control it themselves. This turning action is first observed when they lay on their backs and when they play or rest on their tummy in a supervised way.




Questions to help you identify a persistent TURN (or lack of turn)…


  1. When your baby sleeps on their back, is their head usually turned more to one side?
  2. When your baby sleeps on their back, does their head stay still and centered, not turning at all?
  3. When your baby rests on their tummy with supervision, is their head usually turned more to one side?
  4. Is your baby developing a flat spot on the back of their head  on the same side that they prefer to turn?
  5. Does your baby seem to move their eyes more than their head when they turn to one direction, such that you will see their eyes working harder because turning their neck is even harder? Does you baby seem to compensate for their lack of turn by hinging at the back corner of their neck when turning to the harder side, rather than turning their chin over their shoulder? Check out this baby girl in this photo to see her eyes pulling to the right and how she “hinges” at the back corner of her neck to help her turn more to the right.     
  6. Does your baby seem to be favoring (looking at it more, mouthing it more, grasping with it more) the same hand that their head is mostly turned toward?
  7. Does your baby prefer to be nursed on one side more than the other?
  8. Does your baby prefer to be held chest to chest over your left shoulder and not your right shoulder, or vice versa?


T=TILT- ear tilts toward a shoulder

Once in a while, I do have a parent that will report on just noticing that their baby is tilting more to one direction. True confession- that was me-my fourth baby! Yes- my baby!

Because the job of the SCM is to turn and tilt the neck, these babies, who prefer their tilt, most likely have an imbalance with their neck turning as well.

So we want your baby’s neck to tilt comfortably to both directions– whether you are tilting it for them, gravity causes it to tilt or they are gaining strength and learning how to control their tilt themselves.  At first a baby’s neck is flexible enough that their ear can actually touch their shoulder when you tilt it. Looking at the space between the baby’s ear and their shoulder is a great way to identify a tilt. One ear will be closer to the same shoulder on the side they tilt toward and the opposite ear will be farther away from the other shoulder.

Questions to help you identify a persistent TILT….

  1. When your baby travels in their car seat, does their head always fall/tilt to the same side?
  2. When your baby lays on their back and sleeps, does their head seem to tilt to the same side, such that one of their ears is closer to one of their shoulders and the other side has more space between the ear and the shoulder?
  3. When your baby lays on their back does their whole body tend to curve in one direction or another? Does it look like they make a “C” shape with their body?
  4. Does one side of your baby’s neck have more skin creases?
  5. Is one side of your baby’s neck harder to clean?
  6. Does one side of their neck look like it has pink shiny skin when you open up the skin creases?
  7. Does one side of your baby’s neck collect some formula or breast milk once in a while or get dirtier than the other side?
  8. Has your baby been diagnosed with a yeast infection on one side of their neck?
  9. Does it seem like your baby is favoring one hand more than the other?
  10. Does one of your baby’s eyes look bigger?
  11. Does one side of your baby’s face look less full in the cheek and jaw area than the other side?

T=TOP – Look over TOP of your baby’s head to check out their head shape. 

Use the ” bird’s eye view” approach so you are looking down over-top your baby’s head, not just from behind.  Ideally your baby’s head is round and symmetrical. Its shape is especially vulnerable in the first few months of life. The flattened head shape, called “plagiocephaly” is asymmetric flatness that is noticed on the  back of one side of the head. The flattened head shape, called “brachiocephaly” is symmetric flatness across the back of the head.


No worries- this is correctable, and more correctable the earlier it’s noticed. And, please know this is not interfering with brain development. It however can interfere with physical development and can affect functional cosmetics, such as helmet and eyeglass wear. Positioning helmets are an option for infants 6 months and older to assist with changing the head shape, if needed.

Early detection of any type of head flattening in an infant creates an earlier opportunity to make a change and avoid needing a helmet.

Questions to help you identify HEAD FLATNESS…

  1. Is your baby developing a flat spot on the back of the left or right side of their head when you look down over-top of it, using the “bird’s eye view” approach?
  2. Is your baby developing flatness straight across the back of their head?
  3. Is one of your baby’s ears aligned forward compared to the other one when you look down over-top of their head using the “bird’s eye view” approach?
  4. Does one of your baby’s eyes look bigger?
  5. Does one side of your baby’s forehead seem to bulge compared to the other side?
  6. Do you think that the shape of your baby’s head causes it to always fall to the same side?

If you answered YES to any of the above questions….

…then don’t hesitate to take charge! Change it up! Turn them the other way, tilt them the other way and reposition them to help their head shape. I get it- easier said than done. I promise you, that once you make some small changes they will lead to big improvements!

Check out my other blogs about neck tightness and head flatness to learn more about how they happen in the first place and what to do to prevent them!

So did you answer YES? This is your baby’s neck and head and you are already overwhelmed just being a parent to take this on without some coaching. If you have any concerns about your baby’s neck tightness or head shape/head flatness, please call your pediatrician and your county’s Service Coordination Unit for Early Intervention services to get some help. It will be worth it! I promise! 

Here is the link….https://www.cdc.gov/ncbddd/actearly/parents/state-text.html

Watch for future blogs to include easy ideas to stretch and strengthen your baby’s neck and great tricks to improve their headshape!