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We just noticed that my 3 ½ month old son always tilts his head to one side. He holds it straight too, but never seems to flop to the right. Even if you try to move it that way he resists. He doesn’t seem to be in any pain and is developing on time despite being 6 weeks premature. Is this anything to be concerned about? Paul

Dear Paul,

Isn’t 4 months a great age? Due to his prematurity, you can expect him to act like a 2 month old, so you may have some immature muscular development. He may even have been in a head tilt position in the womb! Be sure your pediatrician is aware to just check his neurological development regularly because a lot of his activity is still reflexive and voluntary movement is just stating to emerge in the control of his head, neck, eyes and hands. He loves red, so have him look at a red yarn ball in the center or midline of the body and watch to see if he slowly moves his head a bit right, a bit left, eyes up, eyes down, etc. Babies love faces, so talk to him and look at him from that same midline position. Change his position often and prop him on his side, alternating when he is resting and sleeping. See if his grasp is so strong that you can sit him in your lap and gently draw him up to a sitting position and see if his neck and head come up straight or if he still tilts. Hold his head so he is fully supported when you do this. Be very careful to support him, as a kind of game. There are lots of possibilities, but most likely it is prematurely and may take his getting used to sleeping in one position. Some babies get rather flat skulls for a while if they always sleep to one side. Change his head and body position frequently and check, check, check that your pediatrician knows now that he has this favored position, just to be on the safe side.

Dr. Susan

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