Abnormal Head Posture (AHP)

What is an abnormal head posture?

An abnormal head posture is present when the head is not held straight while focusing. The head may be tilted up or down, tilted or turned to the right or left, or show a combination of these positions. The cause can be an eye problem, but it can also be completely unrelated to the eyes.

Which eye problems can cause an abnormal head posture?

Strabismus (Squint / Crossed Eyes):
When a child has strabismus, the degree of misalignment changes depending on the direction of gaze. The child positions their head so that the eyes are least misaligned, which helps reduce double vision and eye discomfort.
Nystagmus (Involuntary Eye Movement):
Sometimes a child’s eyes may shake or move involuntarily. In this case, the child might turn or tilt their head because it slows or stops the nystagmus, allowing them to see better.
Anisometropia (Unequal Refractive Power):
If a child sees better with one eye than the other, they might turn their head to bring the viewed object closer to the better-seeing eye, improving vision.
Ptosis (Drooping Eyelid):
A child with a drooping eyelid may lift or tilt their chin. This allows them to “look under” the drooping lid, improving their field of vision.
Refractive Errors (Need for Glasses):
If a child needs glasses to see better, they may turn their head in a way that allows them to see more clearly without glasses.

Can my child see if they hold their head abnormally?

Yes. If the abnormal posture is due to an eye problem, most children adopt it to see better. It is important not to correct the posture before treating the underlying cause, so that the child can continue to see well in the meantime.

Can a long-standing abnormal head posture cause permanent problems?

Yes. An abnormal head posture can lead to neck pain and headaches. It can also cause the facial bones to grow unevenly.

What causes abnormal head posture that are unrelated to the eyes?

f a child is born with shortened neck muscles, this can lead to head tilt. Other causes include reduced mobility of the neck muscles, atypically fused cervical vertebrae, or hearing loss in one ear.

How can it be determined whether an eye problem is causing the abnormal head posture?

An ophthalmologist (eye doctor or eye surgeon) will perform a full eye examination to look for eye problems that could cause the head posture. Sometimes one eye is covered with a patch to see whether the abnormal posture improves — this can help determine if the cause is eye-related.

Are there treatment options for abnormal head posture?

Yes. Treatment depends on the underlying cause. For eye problems, surgery, glasses, or patching one eye (occlusion therapy) can help. Surgery may be beneficial for strabismus, nystagmus, or ptosis. Glasses or patching can help if amblyopia (lazy eye) is present.

Physiotherapy can be useful if shortened or tense neck muscles are responsible for the abnormal posture.