Home > What is Infant Reflux > Infant Gastroesophageal Cervical Torticollis, Brachycephaly and Plagiocephaly

Infant Gastroesophageal Cervical Torticollis, Brachycephaly and Plagiocephaly

What to look for:

• Asymmetrical head righting (head turned one way most of the time)
• Asymmetrical head tilt (head tilted to one side most of the time)
• Head tilt
• Shoulder hiking
• Head Abnormalities


Torticollis is a condition in where the head persistently tilts to one side, and the head is usually turned to the opposite side. It is also called “wry neck.” It can be caused by congenital muscular torticollis or it can be an acquired torticollis. Congenital muscular torticollis can be caused by birth trauma or intrauterine position and results in a shortening or tightness of the sternocleidomastoid muscle. Acquired torticollis occurs because of another problem and usually presents in previously normal children. There are many causes of acquired torticollis. Infants with torticollis have a high risk for plagiocephaly. If the torticollis is not treated, facial asymmetry is common. Usually, most infants with muscular torticollis respond well to simple range of motion exercises and postural/positional modifications.

Important: Although torticollis is a relatively common orthopaedic problem in infants, your pediatrician must be made aware your baby’s condition to rule out other serious conditions which can present as torticollis.

Infant with Gastroesophageal torticollis

Usually an infant with true gastroesophageal torticollis has developed the condition largely from maintaining an abnormal position or posture due to comfort. Often, an infant will contort their body to find the most comfortable position that provides them relief. This may involve twisting their body and head in one direction thereby developing unilateral muscle tightness.

They may also develop torticollis and head flattening from the positions a parent may place them in. For example, it is not uncommon for an infant with reflux to sleep upright in a car seat for comfort. Although this position will help with their reflux, it may be difficult for them to keep their head in a neutral position. This will lead to their head tilting or leaning to one side. This excessive leaning to one side can often create muscle tightness and head flattening on that side. Proper positioning is key for infants who prefer to sleep in a more upright position. Your pediatrician or physical therapist will be able to make the appropriate recommendations for positioning.


Positional Brachycephaly refers to a condition where the head is disproportionately wide compared to it’s depth. It is caused by prolonged positioning on the back of the head. The head flattens uniformly, resulting in a head shape that is very wide and short. There can also be increased head height on the back of the head.


Positional or deformational plagiocephaly refers to an asymmetrical shape of the head caused by repeated pressure to one side of the back of the head. Plagiocephaly literally means “oblique head” which is derived from the Greek words “plagio” meaning oblique and “cephale” meaning head. When looked at from above, the head shape has a parallelogram appearance. This shape is characterized by flattening on one side of the back of the head, and a noticeably rounder shape on the other side. When looked at from above the baby’s head, one ear may look more forward than the other. The forehead on the same side as the flattened area may bulge more than the other side (bossing). Asymmetry of facial features may also be noted such as cheekbone prominence, eye orbit shape and/or jaw dysmorphology.

Prevention and Treatment Window

Most of a child’s skull growth occurs during infancy. Skull growth slows and the skull hardens through toddler years. Early prevention and treatment are important. After a child reaches one year of age, the window for treatment quickly closes.

There are several causes of torticollis and many of them are not muscular. Therefore it is important to be screened by your pediatrician prior to seeking treatment and to ensure that you are referred to the appropriate specialist if required.


American Academy of Pediatrics
American Physical Therapy Association
Hospital For Special Surgery
Cranial Technologies
Flathead syndrome

This web site is not intended to make a diagnosis or recommend treatment. If you notice any of the symptoms listed above, see your pediatrician or family doctor right away.