Torticollis sleeping positions: which way should my baby face?

It's an easy thing to miss. Most parents notice the flat spot before they notice the neck, because the flat spot is what shows up in photos and at the four month checkup. But the two are connected. A baby who always looks left is spending most of their day and night with pressure landing on the same part of the skull, and the reason they always look left is usually that turning right is harder or less comfortable for them.

Congenital muscular torticollis, the medical term for this neck tightness, is present in up to 70 to 95 per cent of babies who go on to develop a flat spot, according to research published in Contemporary Pediatrics.² That's a much higher number than most parents expect. It usually develops from position in the womb rather than anything that happens during birth or afterwards, so there's nothing you did or didn't do that caused it.

The pattern is straightforward once you know what to look for. A baby with a tight muscle on, say, the right side of their neck will tend to tilt their head toward that side and turn their face toward the left, the side they'll come to favour without meaning to. Left alone, they'll spend most of their time in that position, which is exactly the position that lets a flat spot develop on the back left of the skull.

Your baby always goes on their back to sleep. That's the safe sleep position and nothing in this article changes it. What you can influence is which way their head naturally falls once they're down.

The Royal Children's Hospital Melbourne's guidance on this is specific and practical: change the position of the cot so your baby has to look toward the door or the main light source, since babies naturally turn toward light and activity. If they've been facing left because that's where the window is, moving the cot, or turning it around, so the window is now on their other side gives them a reason to turn the other way without any force involved.

Red Nose Australia gives similar advice: alternate which end of the cot your baby's head is at from night to night, and alternate which side you settle them looking towards.⁵ Some babies fix on a particular spot in the room as they fall asleep, so changing what's on each side changes what draws their attention.

No, and this is worth being direct about. Positioning wedges, rolled towels, and specialty pillows placed in the cot to hold a baby's head in one direction are not safe. The Royal Children's Hospital's guidance is blunt on this point: nothing goes in the cot to manage head shape, because of the increased risk of sudden infant death syndrome. That rule doesn't bend for a good reason.

This is different from a firm, contoured head shaping surface like the Perfect Noggin, which a baby lies on rather than something wedged around them. It doesn't hold the head in position or restrict movement, and it isn't placed in the cot the way a wedge or pillow would be. It's designed to redistribute pressure away from an existing flat spot while your baby sleeps in the normal back position, not to force a turn. It's suited to babies who aren't yet rolling from back to belly, used alongside the positioning strategies here rather than instead of them, and it's still not a substitute for addressing the neck tightness itself.

Most of the useful work happens while your baby is awake, not asleep. A few things make a real difference:

• Place toys, mobiles, and your own face on the side you want your baby to turn towards, so there's a reason to look that way.
• Feed from both sides where you can. If you usually feed on the left, try starting the next feed on the right.
• Carry your baby so their head is encouraged toward their non-preferred side, resting against your chest or shoulder on that side.
• Build up supervised tummy time gradually through the day. It strengthens the neck muscles that repositioning alone can't reach.

None of this replaces physiotherapy if the tightness is genuinely there. Think of it as supporting the muscle work a physio will show you, not doing the job in its place.

Sooner rather than later, and it's rarely too late to be worth starting. Outcomes for congenital muscular torticollis are good: 90 to 95 per cent of babies improve within their first year, and that climbs to 97 per cent when physiotherapy starts before six months, according to a 2023 clinical review published on the NCBI Bookshelf.¹ Timing still matters, though. Studies consistently show earlier intervention leads to faster progress and a shorter course of treatment than starting later, simply because there's less growth left to work with the longer you wait.

If you've noticed a turning preference at any age, that's reason enough to ask your GP, child health nurse, or paediatric physiotherapist for an assessment rather than waiting to see if it resolves by itself. It's a straightforward, hands-on check, and a physiotherapist can also rule out anything else that might be going on.

It's common, which isn't quite the same as something to leave alone. Plenty of newborns settle into looking one way, and for some it really is just a habit that changes as they get stronger and more mobile. For a meaningful number of others, it's the neck. The only way to know which one you're dealing with is to get it looked at, which costs you a short appointment and gives you a clear answer either way.

In the meantime, positioning your baby's cot, toys, and feeds to encourage the other side is safe, simple, and worth doing regardless of the cause. It won't undo a genuine muscle tightness on its own, but it takes pressure off the part of the head that's been doing all the work, and it's one less thing to wonder about at your next check up.