Congenital strabismus mainly includes congenital external strabismus, internal strabismus, paralytic strabismus and some special types of strabismus. The most common one is congenital internal strabismus, which usually develops within six months after birth; congenital external strabismus usually develops within one year after birth; paralytic strabismus in children is most commonly known as superior oblique muscle paralysis, which occurs after birth and usually shows a tilted head at three months of age. A child with strabismus develops a crooked head because he uses compensatory methods such as crooked head and face turning to promote fusion and overcome the discomfort caused by diplopia in order to avoid possible diplopia due to non-parallel eye axes. Prolonged head tilting can be secondary to cheek asymmetry and scoliosis. It is worth noting that most parents believe that their child’s crooked head is a neck disorder and take their child to surgery without finding any problems, and eventually find out that the crooked head is caused by strabismus. If a child with a crooked head is not found to have a cause in both ophthalmic and surgical examinations, it is also possible that the crooked head is not the result of a disease. Generally in this case, the child’s crooked head is not obvious and will tend to improve with age; however, most children with a crooked head will have one or both of strabismus and a surgical disease (such as squint). In addition, examination for strabismus often requires a high level of cooperation from the child and is repeated several times. If the child is too young to cooperate well, or if a single examination does not reveal a problem, it does not mean that the child does not necessarily have strabismus. Therefore, for children who have not found the cause of the strabismus, it is crucial that they have regular follow-up examinations at the ophthalmology department. Remember not to think that the strabismus is all about neck diseases and blind surgery, which suffers from pain while not solving the underlying problem.