In our lives, we often see many children with a tilted head, which becomes more pronounced the more carefully they try to look at things. Most parents think that this is caused by a disease in the neck, but in fact, about more than half of the children’s tilted head may be caused by eye strabismus, which we call oculocutaneous squint. Clinically, ophthalmic squint should be considered in children who have no obvious abnormalities in the neck muscles and have a tilted head. Ophthalmic strabismus is mostly due to congenital paralysis of the eye muscles, which makes the eye muscles impaired in certain directions of movement, causing diplopia (seeing things with 2 non-overlapping shadows), and a compensatory response to avoid diplopia. When the child’s head is in a particular position (many times it can show a tilted neck), diplopia disappears, thus reducing the discomfort caused by strabismus, maintaining binocular vision, and protecting visual function. If parents find that their child is looking askew, it is best to visit an ophthalmologist first, so that the diagnosis can be clarified and treated early. This is because long-term head tilting can have many negative consequences for the child. First, it is the facial asymmetry brought about by the crooked head (lopsided neck), which makes one side of the face plump and the other side thin due to the effect of gravity. Secondly, it is the effect on the bones of the neck, causing scoliosis of the cervical spine. Thirdly, it may also cause developmental deformities of the jaws. So how to distinguish oculocerebral from myocerebral? In addition to taking the baby to the hospital for surgical and ophthalmologic examination at an early stage, parents can also do the examination at home by themselves first. The easiest way is to cover one of the baby’s eyes with something for at least 20 minutes. If the tilted head disappears or gets better, it means that the tilted head may be related to the eyes and the baby should be taken to an ophthalmology examination for a clear diagnosis.