The Reflux-Torticollis Connection Nobody Warns You About

One thing I have seen consistently in my practice that surprises parents: torticollis and GI upset (especially reflux) show up together far more often than you'd expect, and it's not a coincidence. When a baby has reflux, that burning, uncomfortable sensation in the esophagus makes them want to arch, extend, and twist their body to try to relieve the discomfort, often pulling the head and neck to one side in the process. This can eventually cause the tightness seen by parents. On top of that, babies who are uncomfortable from reflux/gas or constipation often get ‘stuck' in whatever position soothes them most, whether that's tilted to one side during feeds, held a certain way to ease digestion, or avoiding the flat, symmetrical positions (like tummy time) that would normally help stretch and strengthen the neck evenly. They often prefer to be stiff and extended or arching to ease the pain. Over weeks, that asymmetric positioning can create genuine muscle tightness on top of the digestive issue.

This is exactly why infant physical therapy is often part of the care plan even when the root issue looks like just a GI problem. As a Physical Therapist who works with newborns, I’m not only stretching a tight neck muscle. I’m looking at the whole picture: how your baby's discomfort is shaping the positions they default to, overall body tension and tightness, how feeding posture might be reinforcing a lean to one side, and how to build in movement and tummy time in ways that don't fight against your baby's comfort level. Craniosacral Fascial Therapy can help decrease this tension and help with GI upset as well.

What every new mom should know about Torticollis

As a pediatric physical therapist who spends my days working with babies in their first year of life, torticollis is one of the most common reasons families get referrals for PT. It is very treatable, especially when caught early. Torticollis (Tightness due to the head being tilted to one side and/or a preference to turn one way) can occur for many reasons. Most cases are called ‘positional' or ‘congenital muscular torticollis,’ and they develop from a baby's position in the womb, a difficult birth, or simply favoring one side after birth. As a mom, the easiest way to spot it is to watch how your baby naturally rests: does their head consistently tilt to the same side when lying down, feeding, or sitting in the car seat? You can look through pictures of your little one and see if this has been ongoing. Do they seem to prefer turning their head only one direction, or struggle to turn fully to the other side? You might also notice a flat spot developing on one side of the head (this is called plagiocephaly and often presents alongside torticollis).

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So when should you actually worry, and when should you pick up the phone? 

A little bit of head preference in the first few weeks is common and not automatically alarming. Newborns are still finding their strength. But I'd encourage an evaluation if you notice:

• a consistent head tilt or turning preference that lasts beyond 2-3 weeks

• if your baby resists or seems uncomfortable turning their head one direction

• if you feel a lump in the neck muscle, or

• if you're noticing head flattening on one side. 

The general rule I give parents is: earlier is always better. Babies evaluated and treated for torticollis before 3-4 months of age typically respond beautifully to physical therapy. Often just a few months of positioning strategies, stretches, bodywork to decrease overall tension and tummy time coaching resolves it completely. Waiting doesn't make it go away on its own, and the longer the muscle stays tight, the more it can affect motor development, feeding, and even facial symmetry. 

If anything about your gut says something's a little off with how your baby holds or moves their head, trust that instinct and reach out. I'd genuinely rather see a baby who turns out fine than miss the window when treatment is easiest.