An abnormal head position (AHP) refers to a condition where the head is held or turned away from the primary, normal straight-up posture. It's a common disorder in children and may be congenital or acquired. AHP may occur in the form of a right or left head tilt, chin down, chin up, facial turns to the right or left, or a variation of these odd head postures. The form it takes depends on the underlying cause. If the AHP is due to an underlying eye condition, appropriate treatment may restore the normal straight head posture.

Also Known As

  • Torticollis
  • Abnormal head posture
  • Compensatory head posture


Causes & Risk Factors

AHP can arise due to orthopedic, neurologic and eye conditions. 

Some eye disorders can cause children to assume compensatory head postures. 

Adopting the irregular head position gives the child a demonstrable benefit, including:

Improving clarity or clearness of vision
A compensatory head posture may enable a child to enhance binocular vision. It may occur in disorders such as infantile nystagmus (jiggling of the eyes), abnormal eye movements and ptosis (a droopy eyelid). A child may also use AHP to maximize vision in the fixing eye if improving binocular vision isn't possible. It happens in eye disorders like infantile esotropia with cross fixation, astigmatism, severe restrictive strabismus, and manifest latent nystagmus in a monocular patient.

Maintaining binocularity
AHP may help the child to improve their ability to focus with both eyes on an object and produce a single stereoscopic picture. It's especially the case in eye disorders such as eye misalignment, Duane's syndrome, oblique muscle paresis, sixth nerve paresis, strabismus and monocular elevation deficiencies. 

The problems in each level may also be categorized under innervational and mechanical sources. Innervational causes include both muscle underreaction and excessive innervation of muscles. Mechanical issues can involve eye socket structures, bony abnormalities, soft tissue diseases, and muscle disorders. It includes diseases like neoplasms in orbit, congenital cranial dysinnervation conditions, thyroid orbitopathy and Brown's syndrome.

Centering the binocular vision field
Congenital homonymous hemianopia can cause a child to turn his/her face to the hemianopic field when they focus on the entire field of vision with the body. Chin-up or chin-down head postures can occur due to altitudinal field anomalies. Monocular children may turn a little to the blindside to expand their prospective visual field.

Generating miscellaneous advantage
The orthopedic AHP causes include brachial plexus injury, congenital shortening of the neck muscles (usually known as congenital torticollis) and Klippel- Feil anomaly. Neurologic abnormal posture sources are mainly associated with brain tumors, psychomotor delay, post-inflammatory central nervous system disorders and focal dystonia, while Sandifer syndrome, occipitocervical synostosis, cerebral palsy and unilateral hearing loss are other rare origins of AHP.

The acquired causes may be traumatic or non-traumatic. Trauma reasons include muscle/soft tissue, ligaments, or bone damage. Nontraumatic causes include infections, bone erosion, a habit of holding the head in an unusual position, etc.


The eye doctor will seek to establish the ocular cause of AHP. S/he will conduct a complete eye examination, including cover/uncover tests or ocular motility examination.


Treating the underlying eye disorder can rectify AHP. Surgery therapy can treat AHP associated with jiggling of the eyes, strabismus, and a droopy eyelid. 

Glasses or surgery may help to correct eye misalignments and also rectify refractive aberrations. 

Patching therapy helps to treat an eye with weaker vision.

Physical therapy is usually helpful in addressing congenital torticollis.

Prognosis & Long-Term outlook

A significant AHP can lead to a permanent tightening of the neck muscles. It can cause persistent neck ache or headache. AHP may also lead to abnormal growth of the facial bones resulting in facial asymmetry.

Prevention & Follow Up

The doctor may follow up to monitor the outcome.