Why Is My Baby So Tight?
Understanding fetal constraint, infant tension, and why every baby deserves a closer look.
You're holding your newborn and something feels... off. Maybe their little body feels stiff when you pick them up. Maybe they always turn their head to one side. Maybe breastfeeding is a dream on the left but a wrestling match on the right. Maybe they arch and fuss and you can't figure out why.
You mention it at your pediatrician visit and hear, "That's normal, they'll grow out of it."
And sometimes that's true. But sometimes it's not — and the earlier we take a peek, the easier it is to help.
As a physical therapist and lactation consultant who works with babies every day, I want you to know: what you're noticing matters. Your instincts are good.
And there's almost always something we can do.
What Parents Notice
Infant tension shows up in so many ways, and parents are often the first to sense that something isn't quite right. You might notice:
The "no neck" baby: Their head seems to sit right on their shoulders. They look scrunched, like they're still curled up from the womb.
A head turn preference: They always look to one side — in the crib, during tummy time, while feeding. You try to reposition them and they pop right back.
A tight, stiff feeling body: When you pick them up, they don't melt into you. They feel rigid, like they're bracing.
Arching: They throw their head back, arch away from you during feeding or holding.
Feeding challenges: Difficulty latching, preference for one breast, clicking sounds, popping on and off, painful latch for mom, or reflux symptoms.
A flat spot developing: Because they're always in the same position, you're seeing flattening on one side of their head.
General fussiness: They seem uncomfortable in their body, have trouble settling, or cry during activities that should feel good.
Any of this sound familiar? You're not imagining things.
This Is a Spectrum
Here's something important: infant tension exists on a spectrum.
On one end, you have a baby with a mild positional preference — they tend to look one direction more than the other, but it's subtle and responds quickly to repositioning and a little tummy time.
On the other end, you have a baby with significant congenital muscular torticollis — a tight, fibrotic muscle in the neck that creates a pronounced head tilt, limited range of motion, and often comes with plagiocephaly (flat head), facial asymmetry, and feeding difficulties.
And then there's everything in between.
The 2024 Clinical Practice Guidelines from the American Physical Therapy Association make it clear: early identification and intervention lead to the best outcomes. Babies who are seen before three months of age do better than those who wait. The research is unequivocal on this.
But here's what I want you to hear: even the "mild" cases deserve attention.
A baby with a subtle head preference may not need months of physical therapy. But they might benefit enormously from a single session where I can show you what's happening, teach you some positioning strategies, and give you confidence that you're supporting your baby's development. Sometimes that's all it takes.
So Why Is My Baby Tight? Enter Fetal Constraint
When parents ask me why their baby is tight or has a head preference, I often talk about something called fetal constraint.
This concept has shaped so much of how I understand infant bodies, and I have to give credit where it's due: much of what I know about fetal constraint comes from Carol Gray, a brilliant craniosacral therapist and educator who has written and taught extensively on this topic. Her "Stuck Baby Series" is essential reading for anyone who wants to understand how babies get stuck — and what we can do about it. I'll link to her work at the end of this post.
Here's the basic idea: babies are supposed to move in the womb. That movement is essential for normal development. When something limits that movement — when a baby gets "stuck" in one position for too long — it creates patterns of tension that they carry with them after birth.
What causes fetal constraint? Lots of things:
• First pregnancies (the uterus hasn't stretched before)
• Small maternal stature or a small pelvis
• Low amniotic fluid (oligohydramnios)
• Multiple pregnancies (twins, triplets)
• Breech or other atypical positioning
• Uterine abnormalities (fibroids, bicornuate uterus)
• Early engagement ("dropping") before labor
• Prolonged labor or a long time in one position during labor
Research backs this up. Studies have shown that risk factors for intrauterine constraint — things like breech presentation and first pregnancies — are associated with more severe forms of congenital muscular torticollis. And here's an important finding: many of those babies with severe muscle fibrosis were delivered by cesarean without any labor or birth trauma. The constraint happened before birth.
This isn't about blame. This is about understanding.
You didn't do anything wrong. Your body didn't fail your baby. This is simply what can happen when a growing human is developing in a small space. The good news? We can help.
What Fetal Constraint Can Look Like After Birth
Fetal constraint doesn't just affect the neck. It can show up throughout the entire body:
Torticollis: Tightness in the sternocleidomastoid muscle causes the head to tilt one way and rotate the other. But as Carol Gray teaches — and I've seen clinically — torticollis isn't just a neck thing. The twist often extends through the entire torso.
Plagiocephaly: Flat spots on the head develop because the baby is always in the same position. Up to 90% of babies with torticollis also have some degree of cranial asymmetry.
Hip dysplasia: Up to 20% of babies with torticollis also have developmental dysplasia of the hip. This is why the APTA guidelines recommend hip screening for all babies with CMT.
Jaw asymmetry: The mandible can develop unevenly, which directly affects feeding.
Scoliosis: That twist in the torso? It's there from the beginning. We just don't usually see it until kids are standing and walking in gravity.
The Feeding Connection
This is where my work as both a physical therapist and a lactation consultant comes together — and honestly, it's one of the things I'm most passionate about.
Feeding is a full-body activity. It's not just about the mouth. When a baby has tension patterns from fetal constraint, feeding can be affected in multiple ways:
• Difficulty turning the head to latch on one side
• Strong breast preference
• Shallow or asymmetrical latch
• Clicking, popping on and off, or losing suction
• Painful latch for mom (sometimes only on one side)
• Poor milk transfer despite what looks like a good latch
• Excessive gassiness, reflux, or colic symptoms
• Fussy, unsettled behavior during feeds
The research confirms what I see in practice: infants with torticollis and associated asymmetries may feed poorly because the anatomic and muscular imbalances stress both the mechanics of feeding and the baby's ability to regulate their state. When the body is tense or twisted, it's hard to coordinate the suck-swallow-breathe pattern that feeding requires.
And here's something that often gets missed: jaw asymmetry is an early sign of torticollis, and it can directly cause latch difficulties, nipple pain, and poor milk transfer. If your baby's chin looks a little off-center, or one side of their face looks different from the other, it's worth having someone take a look.
I can't tell you how many times I've seen a mom struggling with painful breastfeeding or a baby who won't transfer milk — and when we address the underlying tension in the baby's body, feeding transforms.
Every Baby Deserves a Screen
If your baby has tension, a head turn preference, feeding difficulties, or just feels "off" to you — get them screened.
You don't need a referral. You don't need to wait and see. You don't need to prove that it's "bad enough."
A screening is just that — a chance to look, assess, and determine what (if anything) needs to be done. Sometimes I see a baby and we spend an hour together, and I send that family home with simple positioning strategies and a plan to check in. Sometimes the baby needs more support. Either way, you leave with information and a path forward.
The APTA guidelines are clear that early intervention matters. Babies who start physical therapy before three months have better outcomes than those who wait. And the guidelines also emphasize parent education — teaching you how to position, handle, and play with your baby in ways that support their development.
That's what I love about this work. Yes, I can provide hands-on treatment. But just as importantly, I can teach you about your baby. I can help you understand what you're seeing and give you tools to support them every single day.
“Babies who start physical therapy before three months, have better outcomes than those who wait”
The Bottom Line
Infant tension is common. It exists on a spectrum. And in almost every case, it started before birth — with the way your baby was positioned in the womb.
That's not a failure. That's just development in a small space.
The beautiful thing is that baby bodies are incredibly responsive. With the right support — whether that's craniosacral therapy, physical therapy, positioning guidance, or feeding support — these patterns can shift. Babies can find more freedom in their bodies. Feeding can get easier. And you can feel confident that you're giving your little one exactly what they need.
Trust what you're noticing. Reach out. There's always something I can teach you about your baby.
Resources & References
Carol Gray's Stuck Baby Series: If you want to dive deeper into fetal constraint, I highly recommend Carol's work. She is my teacher, a mentor, and a dear friend. Her six-part series on stuck babies is foundational reading.
Sargent B, Coulter C, Cannoy J, Kaplan SL. Physical Therapy Management of Congenital Muscular Torticollis: A 2024 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association Academy of Pediatric Physical Therapy. Pediatr Phys Ther. 2024;36(4):370-421.
Wall V, Glass R. Mandibular asymmetry and breastfeeding problems: experience from 11 cases. J Hum Lact. 2006;22(3):328-34. PMID: 16885493
Genna CW. Breastfeeding infants with congenital torticollis. J Hum Lact. 2015;31(2):216-20. PMID: 25616913
Lee YT, et al. Risk factors for intrauterine constraint are associated with ultrasonographically detected severe fibrosis in early congenital muscular torticollis. J Pediatr Surg. 2011;46(3):514-519. PMID: 21376202
APTA Academy of Pediatric Physical Therapy CMT Resources: pediatricapta.org/clinical-practice-guidelines/
