Why Does My Baby Always Turn Their Head to One Side? Head Preference, Torticollis and Plagiocephaly

Many babies develop a favourite direction for looking, feeding or sleeping. You may notice that your baby almost always turns toward the same side, resists looking the other way or develops a flattened area on one part of their head.

An occasional preference is not necessarily a problem. However, a persistent head-turning preference—particularly when accompanied by limited neck movement, a visible head tilt, feeding asymmetry or a developing flat spot—deserves closer attention.

A baby may favour one side because of positioning habits, muscular tightness, restricted movement or physical strain related to their position during pregnancy or birth. In some cases, the preference is associated with congenital muscular torticollis or positional plagiocephaly.

The first step is understanding what you are seeing and whether medical, physiotherapy or supportive manual assessment may be appropriate.

A head preference means that a baby consistently chooses—or appears more comfortable in—one direction.

Parents may notice that their baby:

• Usually looks toward the same side while lying on their back
• Sleeps with the head turned in one direction
• Turns more easily to one side than the other
• Resists or becomes unsettled when encouraged to look the opposite way
• Tilts the head toward one shoulder
• Feeds more comfortably from one breast or in one bottle-feeding position
• Develops a bald patch or flattened area where the head repeatedly rests
• Moves one arm or side of the body more frequently
• Rolls or pivots more easily in one direction
• Has difficulty maintaining a centred head position during tummy time

Very young babies do not have perfectly symmetrical movement. A temporary favourite side can occur without indicating a disorder.

What matters is whether the preference remains persistent, whether the baby appears physically unable or reluctant to turn the other way and whether it is beginning to affect head shape, feeding or movement.

A head-turning preference and torticollis are related, but they are not identical.

Some babies can turn fully in both directions but habitually choose one side because of their environment, how they are carried or where interesting sights and sounds are located.

Congenital muscular torticollis is a specific postural condition usually noticed shortly after birth. It commonly involves tightness or shortening through the sternocleidomastoid muscle on one side of the neck.

A baby with torticollis may:

• Tilt the head toward one shoulder
• Rotate the face in the opposite direction
• Have reduced neck movement
• Resist turning toward one side
• Develop facial or skull asymmetry
• Have difficulty feeding equally on both sides
• Show asymmetrical movement during tummy time or early motor development

Not every tilted head or movement preference is caused by muscular torticollis. Visual, neurological, skeletal and other medical factors can also influence how a baby holds their head.

For this reason, torticollis should not be diagnosed from photographs or home observation alone. A physician, pediatrician or qualified pediatric healthcare provider can assess the baby and determine whether further evaluation or referral is needed.

A young baby’s skull is naturally soft and adaptable. This allows the head to grow quickly and helps it pass through the birth canal.

When a baby rests with the head in the same position for long periods, repeated pressure can gradually produce a flat area.

Positional plagiocephaly describes flattening on one side of the head. The ear and forehead on that side may also appear slightly farther forward.

Brachycephaly describes flattening across the back of the head, often making the head appear wider.

A head-turning preference can contribute to positional plagiocephaly because the baby repeatedly loads the same part of the skull. Once a flat area develops, the head may naturally settle back into that position, reinforcing the preference.

This can become a cycle:

1. Neck tension or movement preference encourages the baby to look toward one side.
2. The same area of the head remains against the mattress, carrier or seat.
3. A flat area gradually develops.
4. The shape of the head makes the preferred position even easier to maintain.

Positional plagiocephaly is different from craniosynostosis, a less common condition in which one or more skull sutures fuse earlier than expected. Craniosynostosis requires medical assessment and specialist care.

A physician can examine the baby’s head shape, skull sutures, neck movement and development to help distinguish positional flattening from other conditions.

Positional plagiocephaly does not restrict brain growth and is generally considered a head-shape concern rather than a brain disorder.

The American Academy of Pediatrics notes that there is no credible evidence that positional plagiocephaly itself causes impaired brain development.

Head asymmetry can still be worth assessing, particularly when it occurs alongside restricted neck movement, torticollis or asymmetrical motor patterns. The goal is to understand why the baby continues to favour one position and whether additional support would be useful.

Parents sometimes try to correct a flat spot by placing a baby on their side or stomach to sleep. This is not recommended.

Babies should continue to be placed on their backs for every sleep unless their physician has provided different instructions for a specific medical reason.

Do not use pillows, wedges, sleep positioners or rolled blankets to hold a baby’s head in place. These products can create a suffocation or entrapment risk.

Head-position variety should instead be encouraged through supervised awake activity, carrying, feeding and changes to the baby’s environment.

The Canadian Paediatric Society recommends supervised tummy time while babies are awake and alternating their orientation in the crib so interesting sights encourage them to look in different directions—while they remain safely positioned on their back.

Small changes throughout the day can give a baby more opportunities to look, reach and move in both directions.

Depending on your baby’s age and abilities, you may try:

• Offering short, frequent periods of supervised tummy time while the baby is awake
• Alternating the arm used for carrying and feeding
• Positioning toys, faces or other interesting objects on the less-preferred side during awake time
• Changing which end of the crib the baby’s head faces while continuing to place them on their back
• Encouraging floor play that allows the baby to move freely
• Holding the baby upright to reduce time spent with the head against a flat surface
• Limiting unnecessary awake time in car seats, swings and reclined baby equipment
• Changing where you sit or stand during interaction so the baby looks in different directions
• Noticing whether feeding, reaching or rolling consistently occurs toward one side

These strategies should feel comfortable and should not involve forcing the baby’s head through resistance.

Do not begin aggressive neck stretching based on an online video. If your baby has suspected torticollis or restricted movement, a pediatric physiotherapist or other appropriately trained healthcare provider can demonstrate movements suited to your baby’s presentation.

Consider speaking with your baby’s physician or pediatrician when:

• The baby almost always turns toward one side
• The head remains tilted toward one shoulder
• Turning in the opposite direction appears physically limited
• The baby cries, arches or strongly resists when the head is moved
• A flat area is developing or becoming more noticeable
• The ears, forehead or facial features appear increasingly asymmetrical

• Feeding is consistently more difficult in one position
• Tummy time remains very difficult because of head or neck positioning
• Rolling, reaching or other movements appear consistently one-sided
• The head shape appeared unusual at birth
• You notice a prominent ridge or unusual shape through the skull
• Positioning changes are not improving the preference
• You have concerns about development, muscle tone, vision or movement

A sudden head tilt in a baby who previously moved normally should also be medically assessed, particularly when accompanied by fever, vomiting, unusual sleepiness, pain, weakness, abnormal eye movements, recent illness or an injury.

The appropriate care pathway depends on what is contributing to the preference.

A physician can examine the baby’s head shape, neck, eyes, neurological function and development. They can identify whether the presentation appears positional or whether testing or specialist referral is required.

Medical assessment is especially important when the skull shape is unusual, symptoms appeared suddenly or the baby has other health or developmental concerns.

Physiotherapy is commonly recommended for congenital muscular torticollis. Treatment may include caregiver education, positioning, stretching, strengthening and activities that encourage symmetrical movement.

A 2024 clinical practice guideline provides evidence-based recommendations for the identification, referral and physiotherapy management of infants with congenital muscular torticollis.

A pediatric-focused Osteopathic Manual Practitioner assesses how the baby’s head, neck and body move together.

The practitioner may consider:

• Active and passive neck movement
• Muscular and fascial tension around the neck and shoulders
• Jaw and cranial-base mechanics
• Upper-back, rib-cage and shoulder-girdle mobility
• Pelvic and whole-body movement patterns
• Feeding positions and side preferences
• Pregnancy and birth history
• Early positioning and movement habits

Osteopathic care may be used alongside medical monitoring, pediatric physiotherapy, repositioning strategies or other recommended treatment.

These roles do not have to compete. A baby may benefit from more than one form of assessment when different providers are addressing different parts of the presentation.

To learn more about pediatric osteopathy, visit our service page Expert Pediatric Osteopathy Services for Babies in Toronto

A pediatric osteopathic appointment begins with a detailed discussion of what the parents have noticed.

This may include:

• Which direction the baby prefers
• Whether the preference occurs during sleep, feeding or play
• When the pattern first became noticeable
• Whether the baby can turn fully in both directions
• Whether a flat spot has developed
• Pregnancy and birth history
• Feeding, digestion and sleep patterns
• Previous medical or physiotherapy assessments
• Current home exercises or positioning recommendations

The osteopathic assessment looks for physical restrictions or tension patterns that may be contributing to the baby’s preferred position.

Treatment is gentle and adapted to the baby. Depending on the assessment, it may include:

• Soft-tissue and myofascial techniques
• Gentle joint mobilization
• Balanced ligamentous tension techniques
• Cranial osteopathic techniques
• Work around the neck, shoulders, jaw, upper back, ribs or pelvis
• Positioning and movement recommendations for home

The goal is to improve comfortable mobility, reduce physical restriction and support the baby’s ability to move more freely in both directions.

Treatment is not forceful, and the practitioner is not attempting to push the baby’s skull into shape. Any change in head shape occurs gradually as the baby grows, moves more freely and distributes pressure more evenly.

Research into osteopathic and pediatric manual treatment for positional plagiocephaly is developing.

A 2022 randomized controlled trial involved 96 infants with nonsynostotic plagiocephaly. Both groups received repositioning advice. One group also received six osteopathic manipulative therapy sessions, while the comparison group received light-touch therapy.

A greater proportion of infants in the osteopathic group reached the study’s target measurement for reduced cranial asymmetry at the end of treatment and at the one-year follow-up.

A smaller 2021 randomized trial compared caregiver education alone with caregiver education plus pediatric integrative manual therapy. The manual-therapy group experienced a greater reduction in cranial asymmetry over ten weeks.

Not every study has found a clear benefit. A 2025 randomized trial examined whether early osteopathic treatment could prevent plagiocephaly or brachycephaly in newborns considered at risk. It found no statistically significant difference between treatment and standard advice alone. However, the trial ended early because of recruitment and follow-up difficulties and did not reach its planned sample size.

These studies suggest that manual and osteopathic care may have a role in managing existing positional asymmetry, particularly when combined with caregiver education and repositioning. They do not establish that osteopathy will prevent or correct every case.

Treatment decisions should consider the baby’s age, presentation, medical assessment and the recommendations of the professionals involved in their care.

At Excelsior Integrative, pediatric osteopathy is provided by Ceb’sile Ndlangamandla, BA Kin., DOMP.

The appointment is calm, unhurried and adapted to the baby’s comfort.

Parents remain involved throughout the session. Treatment may take place while the baby is lying on the table, being held, feeding or moving naturally. If the baby becomes hungry, tired or unsettled, the appointment can be paused or adjusted.

Parents can ask questions throughout the visit and may receive individualized home-care suggestions when appropriate.

If your baby consistently turns their head toward one side, has difficulty moving comfortably in both directions or is developing a positional flat spot, an individualized assessment may help clarify what is contributing to the pattern.

Learn more about pediatric osteopathy at Excelsior Integrative or book a pediatric osteopathy appointment with Ceb’sile Ndlangamandla, DOMP.

Our clinic is located near Yonge and Eglinton in Midtown Toronto.

1. Canadian Paediatric Society. Preventing flat heads in babies who sleep on their backs.
2. American Academy of Pediatrics. Differentiating infant head-shape abnormalities.
3. Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline. Pediatric Physical Therapy. 2024;36(4):370–421.
4. Bagagiolo D, et al. A Randomized Controlled Trial of Osteopathic Manipulative Therapy to Reduce Cranial Asymmetries in Young Infants With Nonsynostotic Plagiocephaly. American Journal of Perinatology. 2022.
5. Pastor-Pons I, et al. Efficacy of Pediatric Integrative Manual Therapy in Positional Plagiocephaly: A Randomized Controlled Trial. Italian Journal of Pediatrics. 2021;47:132.
6. Genelot C, et al. Early Osteopathic Manipulative Treatment to Prevent Cranial Positional Deformities: A Randomized Controlled Trial. Archives de Pédiatrie. 2025;32(3):203–209.