In some children with vertical strabismus, the appearance of the strabismus is not obvious, but the distinguishing sign is a compensatory head position, a “tilted head”. This is because when the child’s head is in an upright position, the objects he is looking at appear to be “overlapping”. In order to see clearly, the child will tilt his head to see, so that the objects in front of him will gather to a point and the “ghosting” phenomenon will disappear. Long-term head tilting can lead to facial deformities (e.g., large face on one side and small face on the other) and deformation of the spine and bones. This is also known as a squint, which is caused by strabismus, and a myelopia, which is caused by abnormalities in the neck muscles. Ophthalmic squint requires strabismus correction, while myelopia requires neck surgery. Many patients go through a long search for medical attention before they finally learn that the cause of the crooked head is strabismus. Some children are often blindly operated on for strabismus, resulting in unnecessary pain for the child. After strabismus surgery, the child will still have a crooked head. Some parents put the child’s brace on after the strabismus surgery, and the child cannot overcome the “heavy shadow” by tilting the head, so the child will bend the whole body sideways to overcome the “heavy shadow”, resulting in the shoulder being high on one side and low on the other. I have seen many such children in my practice. If a child has a tilted head, it is recommended to go to the ophthalmology examination of a regular hospital in time to rule out ophthalmic squint rather than rushing to perform squint surgery.