When Feeding Only Works on One Side
Your baby latches easily on the left. On the right, it falls apart: they arch, turn away, pop off, and your nipple comes out creased. Then one provider mentions torticollis, another mentions a tongue-tie, and you're left wondering which one is behind the struggle.
Here's the short answer on torticollis and tongue-tie. They often show up in the same baby and both can make feeding harder, but they're separate issues. Neither is known to cause the other, and a tongue-tie release doesn't treat torticollis. Tight neck muscles are usually treated with pediatric physical therapy, while a tongue-tie is judged by how the tongue works during feeds.
At Latched Beginnings in Austin, we often see babies with neck tightness and a possible tongue restriction at once, and knowing which one drives the trouble changes the plan. Here's how each affects the latch and what you can try today.
What Is Torticollis in Babies?
Congenital muscular torticollis means the sternocleidomastoid, the rope-like muscle running from behind each ear to the collarbone, is shorter and tighter on one side. The head tilts toward the tight side while the chin turns toward the opposite shoulder. It's often linked to positioning in the womb and is more common after breech positioning or a difficult delivery.
Most cases are noticed in the first 6 to 8 weeks, and with early stretching and positioning guidance, the vast majority of babies do very well. Mention any head tilt to your pediatrician early.
Signs Neck Tightness Is Showing Up in Feeds
A Head Tilt, Turning Preference, or Flat Spot
Your baby's head rests toward one shoulder, or they look the same way almost every time you lay them down. A flat spot on the back or side of the head often travels with it.
Easier Feeds and Less Pain on One Side
One breast is easy and the other is a battle, often with a creased or sore nipple only on that side. A tongue restriction tends to affect both sides, so one-sided trouble points toward head and jaw alignment. The American Physical Therapy Association's 2024 torticollis guideline notes that as many as 44 percent of babies with torticollis may prefer feeding on one side.
An Uneven Jaw or Chin
A lower jaw that sits slightly off-center can be an early sign of torticollis, and a case series in the Journal of Human Lactation described it as a possible contributor to latch difficulty, nipple pain, and poor milk transfer.
Why a Tight Neck Changes the Latch
A deep latch depends on alignment: ear, shoulder, and hip in a line, and a jaw that opens wide and evenly so the tongue can extend under the breast. When one neck muscle is short, one breast asks your baby to turn or tilt the hard way. The jaw opens unevenly, one corner of the mouth takes in less breast, and the tongue works harder to hold on. Babies slide toward the nipple tip, click, tire out, or pull off, while the easy side lines up fine.
Supply can follow, since an avoided breast is emptied less often and may make less milk. If that's already a worry, our guide to low milk supply and tongue-tie covers what to watch.
Can Tongue-Tie Cause Torticollis?
Not as far as current evidence shows, and torticollis doesn't cause a tongue-tie either. Both are common in newborns, so they often overlap. The tongue, jaw, and neck are linked through muscles and the hyoid bone, so tension in one area can change how another moves during a feed. That's a reason to look at both, not proof that one creates the other.
A shallow latch, clicking, long feeds, and nipple pain can come from a tight neck, a restricted tongue, or both. A baby with torticollis can look tongue-tied, and a true restriction can be missed if everything gets blamed on the neck.
So does a tongue-tie release help torticollis? A release changes how the tongue moves. It doesn't lengthen a tight neck muscle, so the neck still needs its own care.
Feeding Positions That Work With a Tight Neck
The goal is to stop asking the neck to do the hardest thing at every feed. If you're in physical therapy, ask which direction you're working on; many therapists show parents how to fold gentle turning into feeds. Good places to start:
- Slide, don't flip. If cradle hold works on one breast, slide your baby across to the other breast in a football (clutch) hold so their head stays turned the comfortable way.
- Lean back. Laid-back nursing lets your baby lie tummy-down on you and choose their own head angle.
- Try upright. A koala hold, with your baby straddling your thigh, asks for less neck rotation. Support the shoulders, not the back of the head.
- Offer the harder side when your baby is drowsy and calm.
- Protect supply. Hand express or pump the avoided breast so it keeps producing.
- Switch bottle arms. Alternate the arm you hold bottles in so your baby practices turning both ways.
Keep a simple log for a few days: which side and position worked, feed length, and diapers. Call your pediatrician promptly if your baby has fewer than about 6 wet diapers a day after day 5, isn't gaining well, seems unusually sleepy, or struggles to breathe during feeds, or if a head tilt appears suddenly or comes with fever.
Which Comes First: Physical Therapy or a Tongue-Tie Evaluation?
For torticollis, pediatric physical therapy is the first-line treatment, usually through a referral from your pediatrician. Earlier tends to work better. Many families also add bodywork, and our post on bodywork before and after a tongue-tie release explains how it fits.
For the tongue, the question is always function. When a baby has both, we often suggest starting physical therapy and positioning first, then reassessing, since the latch frequently improves as the neck loosens. If feeding stays painful or inefficient and tongue movement is clearly limited, a release may be one part of the plan.
During a 1-on-1 feeding and oral tie consultation, Dr. Kacie watches a full feed on both sides, checks tongue movement with your baby's head supported in a neutral position (a tilted head can make the tongue look more limited than it is), and notes jaw symmetry and how far your baby turns each way. Bring your feeding log, any therapy notes, and a short video of a feed on the harder side.
How Latched Beginnings Helps With Torticollis and Tongue-Tie in Austin
Hearing two explanations for one-sided feeding can leave you feeling pulled in every direction. You need someone to watch the whole feed and help you decide what matters first.
Dr. Kacie Culotta, DMD, is the only dentist in Austin who holds both a laser certification for tongue-tie releases and a lactation counselor certification. Our all-mom team works alongside IBCLCs, pediatricians, and pediatric chiropractors and bodyworkers, and when physical therapy or bodywork should come first, we guide you to appropriate providers. If a release is the right call, we offer a LightScalpel CO2 laser tongue-tie release with a customized aftercare plan. When your baby thrives, you do too.
Frequently Asked Questions
Is it common for a baby to have torticollis and tongue tie at the same time?
It isn't unusual, since both are common in newborns on their own, but having one doesn't mean your baby has the other. Torticollis is usually spotted in the first 6 to 8 weeks, while tongue function is best judged by watching real feeds.
How long does torticollis take to improve with physical therapy?
It depends on how early therapy starts and how tight the muscle is, and babies who begin in the first month tend to finish fastest. In a study cited in the American Physical Therapy Association's 2024 guideline, those starting before 1 month averaged about 1.5 months of therapy, versus closer to 6 months when starting at 1 to 3 months.
Should I just stop nursing on the side my baby refuses?
Not necessarily, because many babies come back to the harder side as their neck loosens, often over several weeks of therapy. Keep that breast comfortable by expressing it, and talk with an IBCLC if you're considering nursing on one side long term.
Why does my baby's head tilt look worse after a tongue-tie release?
Often it's neck tightness that was already there becoming easier to see, since babies may hold their head differently while the mouth is tender for the first several days. Tell your releasing provider and pediatrician, and call right away if the tilt comes with fever, swelling, or unusual sleepiness.
Does my baby still need a tongue-tie release if physical therapy fixes the latch?
Often not: if feeds are comfortable and your baby gains well, the AAP's 2024 clinical report says a tight frenulum with normal feeding needs no intervention. Reassessing after a few weeks of therapy is a reasonable, conservative step.
Where can I get my baby evaluated for torticollis and tongue tie in Austin?
Latched Beginnings, at 1701 Simond Ave, Suite 107A in the Mueller area, evaluates tongue function and feeding and guides you to physical therapy or bodywork when the neck comes first. For the torticollis diagnosis itself, start with your pediatrician. We serve Austin, Mueller, East Austin, North Austin, Round Rock, Cedar Park, Pflugerville, Leander, and Georgetown. Call (512) 814-7480.
Call to Action
If feeding works on one side and falls apart on the other, you don't have to untangle torticollis and tongue tie on your own. Schedule a 1-on-1 consultation with Dr. Kacie Culotta and our all-mom team, and we'll look at the neck, jaw, tongue, and a full feed together to decide what your baby needs first. Trust your instincts. We're here to guide you every step of the way.
