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This case report describes a method of differential diagnosis for torticollis in a 4-month-old male infant who also had hydrocephalus.The infant presented to physical therapy (PT) with a “classic torticollis posture.” Differential diagnosis was completed to determine the cause of the signs and the appropriate intervention. PT consisted of positioning, strengthening, stretching, and neuromuscular facilitation techniques to assist the infant to develop gross motor skills and a midline head position. A home exercise program was incorporated into the family’s routines.After 6 months of PT, the infant demonstrated considerable gains in cervical range of motion but continued to exhibit gross motor delay and difficulty in maintaining the head in midline. Intervention for infants with torticollis should address corrective positioning to facilitate symmetry during positioning and handling. Differential diagnosis is critical in establishing the appropriate plan of care.