WRITTEN BY SALLY HILLS-DAVIS, CHILDRENS OCCUPATIONAL THERAPIST AND KIRSTY BROCKLEHURST, CHILDRENS PHYSIOTHERAPIST. FOUNDERS OF THE PRACTICAL CHILD.
Have you noticed that your baby spends a lot of time only looking one way or keeping their head to one side? If so you are not alone! This is very common in young babies, however just because it is common doesn’t mean it can be left unchecked, It is something that needs help to be corrected. But the good news is that with a little help it can normally be fully sorted very quickly.
Why does my baby only look one way?
Babies tend to have a preference to look to one side due to either, or a combination of the following two reasons.
1 - Tightness in the muscles on one side of their neck. The medical term for this is Torticollis
2 - An asymmetry of their head shape. The medical term for this is Plagiocephaly.
What causes my baby to only look one way?
Both of these can be caused by a number of reasons and often one can then lead to the other!
Take tightness of the neck muscles (torticollis) to start with. This can sometimes be due to babies position within the womb, or injury to the neck muscles at birth. If at birth a baby has tightness in one side of their neck they will keep their head tilted to that side. Babies heads are big and heavy and their neck muscles are weak, meaning they struggle to overcome that tightness and keep their head to one side.
This then puts more pressure through the same part of their head when they are lying on their back. As babies skulls have not fused and are soft and malleable this can result in a flat spot and asymmetry of their head shape (Plagiocephaly sometimes referred to as flat head syndrome). Once the asymmetry is there it is then even harder for baby to move their head in the opposite direction as they have a little flat area which their head naturally wants to rest on.
Sometimes the Plagiocephaly (flat head) can come first. This is common in premature babies or babies that spend time in special care. Staying in one position for too long (often common when babies are in hospital) combined with their large head, weak neck and malleable skull as described previously can then lead to a flat spot and asymmetry of their head shape and a 'flat head'. this can lead to a torticollis as babies will rest their head on the flat spot keeping their head to one side and therefore shortening the neck muscles on one side.
What are the signs of Plagiocephaly or Torticollis?
There are 3 main signs to look out for in your child:
1 - do they have an asymmetrical head shape or a flat head? (After 2 weeks post birth as babies heads can be all sorts of strange shapes immediately after birth!)
2 - do they keep their head to one side or only look one way most of the time ?
3 - do they keep their head tilted to one side most of the time? (Is their ear closer to their shoulder on one side more than the other?)
When should I worry about my babies flat head or looking only one way?
If you are noticing one or more of these three things you should speak to a healthcare professional. It is likely they will refer you to see a paediatric physiotherapist to get personal tailored advice for your baby. Treatment works best when it is started early so it’s best to highlight your concerns straight away rather than ‘wait and see’.
Can baby flat head be corrected?
Can torticollis correct itself?
How can I help my baby look both ways?
So what can you do to help? The main thing to do initially is get the ball rolling to see a healthcare professional. They will be able to assess your baby and work out exactly what tailored advice you will need. However whilst you are waiting for this there are a few things you can start doing.
Disclaimer: The following advice is general advice around how you can help your baby turn their head to both directions and promote symmetry. However this advice is not personal to your baby and you should still seek professional medical advice if you have any concerns.
Alternate positions regularly. Avoid spending too much time in any one position. Little and often is key! Remember even if you have had a busy day moving around, (for example, gone from home, to the car, to the shops, to the car, to a friends house, to the car and home again), If baby has stayed in their car seat travel system throughout, then they have not moved or changed position! Read our article on safe use of travel systems here
Lots of little and often awake tummy time. Even just a few seconds at a time can be enough as long as long it is repeated regularly throughout the day. Tummy time can be done in a variety of ways. It doesn't have to be on the floor. Lying on your chest if you are reclined back counts to!
Side lying play. An alternative awake lying position is on their side. This is a lovely position to lay down next to them and have a chat or sing. Their hands will naturally be more together making it easier for them to play with their hands.
Minimise awake time spent in containers or lying on their back. Babies still need to follow the back to sleep advice but when they are awake and supervised by an adult try to minimise the amount of time spent in containers. Things like baby bouncers, car seats etc… lying on their back to play is an important position but like all positions should be alternated regularly. When lying on their back awake try to encourage head turning away from their preferred side to minimise pressure going through the flattened area and put more pressure through the other side of their head.
Present toys and people from their least preferred side.
Switch sides for feeding even if bottle feeding.
Adapt the environment or babies position within the environment, to encourage looking to the non preferred side. Always ask yourself; ‘which way is there head turned to or which way are they looking and what can I do or adapt to change it?’
Hang toys on non preferred side on play mat
Encourage baby to reach for toys in midline (in the centre or imaginary middle line of their body) and either side with both hands.
Show visually stimulating slow moving toys or vision flash cards in a rainbow arc shape, approximately 30cm away. Start on the preferred side and move slowly to the non preferred side encouraging baby to turn their head and track the toy or card with their eyes. Watch to see if they can turn their head to both sides without lifting their shoulders and body off the floor. (check out our vision flashcards on our Bloss products page for this activity)
Alternate which side you hang toys on the pram/car seat
Your physiotherapist may also recommend some gentle stretches to help lengthen their neck muscles to help them to turn their head both ways.
You may have seen babies wearing helmets, this can be a method used to help regain a symmetrical head shape. This is usually paid for privately rather than available on the NHS.
In most cases if the head asymmetry is detected early and the treatment/advice is followed well, most babies' head shapes will improve significantly without the need for a helmet. However this is an option if needed.
Remember don’t be afraid to ask for help. Your local Physiotherapist would rather see you early and prevent a problem.