Supporting Infants with Torticollis and Plagiocephaly: Essential Day Care Guidelines for Prevention and Care
Infants spend many waking hours in child care settings, which places day care providers in a unique and powerful position to help prevent and support conditions like torticollis and plagiocephaly.
These conditions are increasingly common and often related to positioning and limited movement during early infancy.
With the right strategies, caregivers can make a meaningful difference in supporting healthy head shape, neck mobility, and overall motor development while working in partnership with families and healthcare providers.
This guide outlines simple, safe, and effective practices that day care staff can use every day.
Understanding Torticollis and Plagiocephaly
What Is Torticollis?
Torticollis is a condition where an infant has tightness or weakness in the neck muscles, causing the head to tilt or rotate more easily to one side. Babies with torticollis may:
Prefer looking in one direction
Have difficulty turning their head evenly
Show head tilt when resting or playing
What Is Plagiocephaly?
Plagiocephaly refers to flattening of one area of an infant’s head, usually caused by repeated pressure on the same spot. It frequently occurs alongside torticollis, as limited neck mobility leads to consistent head positioning.
Early movement and positioning strategies are especially important because skull bones are most malleable in the first months of life.
Daily positioning and movement variety are key prevention tools. For a deeper dive, caregivers and families may also benefit from 10 pediatric OT and PT approved tips to help prevent flat head syndrome in babies.
Understanding why movement is essential for your baby’s brain development also helps explain why early motor experiences influence both head shape and nervous system organization.
Why Prevention and Early Support Matter
Early support for torticollis and plagiocephaly helps:
Promote symmetrical motor development
Reduce the need for helmet therapy or prolonged intervention
Support feeding, visual tracking, and comfort
Encourage balanced strength and coordination
Day care providers support progress through intentional routines, varied positioning, and environmental setup—small changes that add up over time.
Safe Sleep Practices: What to Do (and What Not to Change)
Always Follow Safe Sleep Guidelines
Day care providers must always:
Place infants on their backs for sleep
Use a firm, flat sleep surface
Keep cribs free of pillows, wedges, or positioning devices unless medically prescribed
Important: Sleep positioning should never be altered without written medical instructions.
What Caregivers Can Do Safely
Alternate the direction infants face in the crib (head at different ends)
Arrange lighting and activity to encourage turning to both sides
Gently reposition the head only if the baby naturally allows it
These subtle adjustments support symmetry without compromising safety.
Tummy Time: A Key Tool for Prevention and Progress
Why Tummy Time Matters
Tummy time supports:
Neck, shoulder, and core strength
Pressure relief on the back of the head
Motor milestone development
Sensory and postural organization
Day care staff play an important role in ensuring babies get frequent opportunities for prone play, especially when families are still building routines at home.
Day Care Tummy Time Guidelines
Offer tummy time multiple short sessions daily
Start with 1–2 minutes at a time and gradually increase
Always supervise closely
Incorporating passive prone as a daily exercise for infants can help support tolerance and success, particularly for babies who initially resist tummy time.
Tips for Success
Get down at the baby’s eye level
Use mirrors, toys, or singing to engage
Roll babies gently in and out of tummy time
Consistency matters more than duration.
Positioning Throughout the Day
Alternate Head Positions & Play Setups
Avoid repeated positioning by:
Rotating how infants are placed on play mats
Encouraging looking toward both sides during play
Switching arms during bottle-feeding (with parent permission)
Incorporating exploring the benefits of sidelying and playful positions can reduce head pressure while supporting midline skills and early rolling.
Limit Container Time
Excessive time in:
Bouncers
Swings
Car seats (outside transportation)
…can increase head pressure and reduce movement. When possible:
Prioritize floor play
Hold infants upright
Encourage free movement
Holding, Carrying, and Therapeutic Movement
Daily handling provides powerful opportunities to support symmetry and regulation.
When holding infants:
Encourage head turning toward the non-preferred side
Hold upright against your shoulder
Use gentle, supportive positioning—never force movement
Caregivers may find it helpful to understand bodywork and therapeutic movement as a framework for supporting comfort, alignment, and nervous system regulation through everyday handling.
Feeding Time as an Opportunity for Symmetry
Feeding offers natural opportunities to support balanced neck movement:
Alternate arms during bottle-feeding
Position yourself so the infant turns toward the less-used side
Keep feeding calm and unrushed
Feeding challenges often intersect with motor and postural development. Families may find helpful context in Lactation: The Ultimate Guide to Confident and Healthy Breastfeeding.
Play-Based Strategies That Support Development
Toy Placement
Place toys on the non-preferred side
Move toys slowly to encourage visual tracking
Use high-contrast colors or gentle sound
Floor Time Variety
Supervised side-lying play
Reaching and grasping activities
Gentle rolling games
Play should always feel fun and responsive, not forced or therapeutic.
Recognizing Signs That Need Extra Support
Day care providers should communicate concerns if they observe:
Strong head preference beyond 2–3 months
Limited neck rotation
Uneven facial features or flattening
Delayed motor milestones
Signs of discomfort during movement
Early observation leads to earlier support and better outcomes.
Partnering with Families and Professionals
Communicate—Don’t Diagnose
Share observations factually
Use neutral, supportive language
Encourage families to consult pediatric providers
Follow Individual Care Plans
If an infant receives:
Physical therapy
Occupational therapy
Helmet therapy
Written positioning instructions
Ensure all staff are informed and consistent. Collaboration supports progress.
Families unsure where to begin may benefit from holistic pediatric wellness: a guide to trusted providers.
**If questions arise or families want guidance beyond the day care setting, book a free 15-minute virtual consult with BWell Tots to talk through positioning, movement, or developmental concerns.
**Explore the B.well tots provider pages to learn more about pediatric occupational therapy and physical therapy services available to support infants and families.
Creating a Torticollis-Friendly Day Care Environment
Simple environment changes can help:
Rotate play areas
Use floor mats at varied angles
Increase supervised floor time
Provide staff education and consistency
Consistency across caregivers is one of the most powerful tools for prevention.
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No. Tummy time supports development but does not replace therapy when prescribed.
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Plagiocephaly itself is typically not painful, though associated neck tightness may cause discomfort.
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No. These are unsafe without medical guidance and should not be used in day care settings.
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Short, frequent sessions spread throughout the day are most effective.
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Early movement and positioning may reduce severity, though outcomes vary.
Day care providers are vital partners in early development. Through intentional positioning, varied movement, and thoughtful communication, caregivers can reduce the impact of torticollis and plagiocephaly—and in some cases, help prevent them altogether.
Your daily routines matter more than you may realize.
With awareness and consistency, you help give every baby the strongest possible start.
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