Have you ever noticed your baby consistently turning their head to one side, or a flattening developing on one part of their head—and wondered if it’s something they’ll simply “grow out of”?
I remember a young couple who came into a paediatric physiotherapy clinic visibly anxious. Their three‑month‑old son had a noticeably flattened area on the right side of his head and seemed uncomfortable turning left. They had been told by well‑meaning relatives to “wait it out.” Yet their parental instinct said otherwise. They were right to trust it.
Plagiocephaly and torticollis are common, but they are not conditions to ignore. When addressed early—particularly through evidence‑based physiotherapy—outcomes are overwhelmingly positive. In this article, I draw on clinical evidence, expert insights, and real‑world practice to explain how physiotherapy plays a decisive role in correcting both conditions safely and effectively.
Understanding Plagiocephaly and Torticollis
Although often discussed together, plagiocephaly and torticollis are distinct conditions that frequently coexist.
What is Plagiocephaly?
Plagiocephaly, commonly referred to as positional plagiocephaly, describes an asymmetrical flattening of an infant’s skull. It most often develops when a baby spends prolonged time lying in the same position, particularly during sleep.
According to the American Academy of Pediatrics, positional plagiocephaly affects up to 20–30% of infants in the first year of life, with prevalence peaking around 4 months of age. The rise coincided with the widely endorsed “Back to Sleep” campaign, which successfully reduced sudden infant death syndrome (SIDS), but inadvertently increased time spent supine.
Importantly, plagiocephaly is not a disorder of brain growth. However, untreated moderate to severe cases may be associated with facial asymmetry, jaw alignment issues, and later functional or psychosocial concerns.
What is Torticollis?
Torticollis—most commonly congenital muscular torticollis—occurs when the sternocleidomastoid muscle (SCM) in the neck is shortened or tight. This causes the baby’s head to tilt to one side and rotate to the opposite side.
A large cohort study published in Pediatrics estimates torticollis occurs in 0.3–2% of newborns, though milder cases are likely under‑reported. Left untreated, torticollis restricts neck mobility, reinforcing positional preference and significantly increasing the risk of plagiocephaly.
In clinical reality, the two conditions form a feedback loop: torticollis limits movement, limited movement causes skull flattening, and skull asymmetry further encourages positional bias.
Why Physiotherapy Is the Gold Standard of Care
Many parents ask whether repositioning alone is enough. The honest answer: sometimes—but often not.
Physiotherapy is widely recognised as first‑line, conservative management for both plagiocephaly and torticollis. A 2016 systematic review in Physical Therapy Journal concluded that early physiotherapy leads to faster resolution, improved symmetry, and reduced need for helmet therapy.
The Critical Importance of Early Intervention
Timing matters. Infants’ skulls are most malleable in the first 6 months of life, and neuro‑muscular patterns are still forming.
Dr Anne‑Marie Bérard, a paediatric physiotherapist and contributor to the Canadian Paediatric Society, explains:
“When treatment begins before four months, we often see dramatic improvements within weeks. Delayed referral reduces flexibility—both physically and neurologically.”
This aligns with real‑world clinical outcomes: early physiotherapy is simpler, gentler, and more effective.
How Physiotherapy Treats Torticollis
Physiotherapy for torticollis is highly individualised and family‑centred.
Comprehensive Assessment
A paediatric physiotherapist evaluates:
- Active and passive neck range of motion
- Head tilt and rotation preference
- Muscle tone and symmetry
- Developmental milestones
- Feeding posture and sleep positioning
This assessment ensures that treatment addresses function, not just muscle length.
Gentle Stretching and Muscle Lengthening
Targeted stretching of the affected SCM muscle is a cornerstone of care. Contrary to common fears, these techniques are gentle and safe when taught correctly.
In practice, parents are shown how to incorporate stretches into daily routines—during nappy changes or after baths—making therapy sustainable rather than stressful.
Strengthening and Motor Re‑education
Stretching alone is insufficient. Physiotherapy also focuses on:
- Strengthening the weaker neck muscles
- Encouraging symmetrical head control
- Promoting midline orientation
A randomised controlled trial in Developmental Medicine & Child Neurology demonstrated that combining stretching with active strengthening led to significantly faster resolution compared to stretching alone.
How Physiotherapy Corrects Plagiocephaly
While helmets often dominate online discussions, physiotherapy remains foundational.
Repositioning With Purpose
Parents are guided to vary positions consciously throughout the day—during sleep, play, and feeding.
For example, one family I worked with noticed improvement simply by alternating cot orientation, encouraging their baby to turn towards light and sound on the non‑flattened side.
Tummy Time That Actually Works
“Tummy time” is often recommended but poorly executed. Effective physiotherapy transforms it from a chore into a developmental tool.
Rather than static prone lying, therapists encourage:
- Prone play on a parent’s chest
- Short, frequent sessions
- Use of toys to encourage rotation
Research in Archives of Pediatrics & Adolescent Medicine shows infants with increased supervised tummy time have significantly lower rates of plagiocephaly.
When Helmet Therapy Is Considered
In moderate to severe cases unresponsive to conservative care, cranial orthoses may be discussed. Notably, physiotherapy remains essential even when helmets are used, as untreated torticollis reduces helmet effectiveness.
Real‑World Outcomes: What Parents Can Expect
With consistent physiotherapy and parental engagement:
- Neck range of motion often improves within 2–4 weeks
- Head shape changes are visible within 6–8 weeks
- Most infants achieve near‑normal symmetry by 12 months
Long‑term follow‑up studies confirm that early‑treated infants show no functional or cognitive disadvantage later in childhood.
Practical, Actionable Steps You Can Start Today
If you suspect plagiocephaly or torticollis:
- Observe your baby’s head preference during sleep and play.
- Increase tummy time, aiming for a total of 30–60 minutes daily in short bursts.
- Alternate feeding sides and carrying positions.
- Seek early assessment from a paediatric physiotherapist—do not wait for routine check‑ups.
- Be consistent, not perfect. Small daily actions compound into meaningful change.
How Cure on Call Supports Infants and Families
At Cure on Call, we provide specialised physiotherapy for plagiocephaly and torticollis through accessible, parent‑centred care. Our licensed physiotherapists deliver evidence‑based assessments, personalised home programmes, and ongoing guidance—either in‑clinic or via structured tele‑physiotherapy where appropriate. By empowering parents with knowledge and practical skills, Cure on Call ensures timely intervention, reduced anxiety, and optimal developmental outcomes for every child.
Frequently Asked Questions (FAQ)
Can plagiocephaly correct itself without treatment?
Mild cases may improve with repositioning, but physiotherapy significantly accelerates correction and prevents progression—especially when torticollis is present.
Is physiotherapy safe for newborns?
Yes. Paediatric physiotherapy uses gentle, developmentally appropriate techniques supported by decades of clinical research.
How long does treatment usually take?
Most infants require several weeks to a few months, depending on severity and age at referral.
Will my baby need a helmet?
Many do not. Early physiotherapy reduces the likelihood of helmet therapy, which is typically reserved for persistent moderate to severe cases.
Does plagiocephaly affect brain development?
Current evidence confirms positional plagiocephaly does not impair brain growth or intelligence.
Final Thoughts: Trust Early, Informed Action
Plagiocephaly and torticollis can feel overwhelming—but they are among the most treatable conditions in early childhood when addressed promptly. Physiotherapy does more than correct shape or movement; it supports healthy development, reassures parents, and restores confidence.
If you’ve navigated this journey, I invite you to share your experience. What worked for your child? What questions remain? Meaningful conversations help other parents take that crucial first step.
Read Also: How Physiotherapy Can Help with Sports Concussions
