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- Types Of Torticollis
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- Diagnosis Of Acute Torticollis
- Torticollis Medical Treatment
- Home Remedies For Torticollis
- Long-Term Care For Torticollis
Little Sammy fell asleep on the couch, rather uncomfortably, while watching The Wizard of Oz. Next morning, he woke up complaining about a pain in his neck. On closer examination, his mom realized that he was unable to move his neck much. Worse, his head was tilted to a side, and his chin was almost pointing to the side.
What Sammy had was a classic case of torticollis. Also known as wry neck, it is literally a “pain in the neck”! MomJunction explains about pediatric torticollis, its symptoms, why it is caused, and how it can be treated.
What is Pediatric Torticollis?
Pediatric torticollis is a painful condition where the neck is bent or slightly twisted. In most cases, the top of the head is tilted towards the sore or painful side of the neck and the chin is lifted up. Children with torticollis usually have a stiff neck and are unable to move it freely.
The word torticollis is derived from the Latin terms “tortus” which means twisted and “collum” which means neck. While torticollis is common in babies, children, and adults, here we talk about pediatric torticollis.
[ Read: Scoliosis In Children ]
Types Of Torticollis In Children
Several factors can cause neck pain in a kid. But torticollis is a condition that occurs when the trauma or strain on the neck is severe. It can also occur due to other factors, based on which the condition is divided into the following types.
1. Temporary torticollis:
Improper sleeping patterns and positions that strain the neck can result in pain in the neck. If the strain is too much, it can lead to stiffness of the neck and temporary torticollis. Sometimes, your child can develop torticollis due to an infection in the ear, throat or a cold, which causes swelling of the lymph nodes.
The condition usually lasts for a couple of days or more and can be treated with home remedies and ample rest. You can help your child keep the neck still by wrapping it with a towel or a neck brace. Temporary torticollis can become worse if you do not take proper care.
2. Fixed torticollis:
Sometimes, torticollis in kids can be a permanent condition, because it is either congenital (baby is born with it) or the neck is irreversibly damage due to trauma. Fixed torticollis, also known as acute torticollis, is usually caused due to a flaw in the bone structure or the muscles. It can also be a result of a tumor in the brain or the spinal cord. Babies with fixed torticollis may have a flattened or slightly tilted head.
3. Muscular torticollis:
Sometimes, tight muscles on one side of your child’s neck can cause a type of fixed torticollis called muscular torticollis. The tightness of muscles prevents easy movement of the neck and even tilts the head to a side.
4. Cervical dystonia:
Also known as spasmodic torticollis, cervical dystonia is a rare condition that is recurrent. Children with cervical dystonia have difficulty moving their head to the sides, and sometimes even forward or backward due to pain.
The severity of the condition, the treatment, and the symptoms may depend on the type of torticollis in the child. But how do you know what kind of torticolis your child has? Well, watch out for the symptoms.
[ Read: Nursemaid’s Elbow In Children ]
Torticollis Symptoms In Children
Unlike other diseases or medical conditions that aren’t very obvious, torticollis has outward symptoms that are hard to miss. Here are the symptoms you should look out for, to diagnose in a torticollis child.
- The child’s head is visibly tilted to one side.
- There is stiffness in the neck, accompanied by pain when your child tries to move his neck.
- A headache is also a symptom, although not all children complain of it.
- Swelling in the neck muscles.
- Your kid cannot move his neck beyond a certain range and in all directions.
- In babies, the head may seem flattened and unbalanced.
- In some types of acquired torticollis that are recurrent, the episodes may be accompanied by dizziness, nausea or vomiting and irritability.
- In the case of congenital torticollis, you may notice a pea-sized tumor-like lump on the sternocleidomastoid (SCM) muscle in the neck. The lump usually goes away as the baby grows.
- In some cases of early or infantile torticollis, there may be a slight delay in motor (muscular) development.
Causes Of Torticollis In Children
A simple pain in the neck is nothing to worry about. But if that pain is causing abnormal rotation of the head or restricted movement of the neck muscles, you should explore the reasons further. Torticollis in kids can be acquired, meaning it develops at a certain point due to external factors or illnesses. Sometimes, it can be genetic and may need more than just simple medication and exercises to go away.
1. Congenital torticollis:
In congenital torticollis, the SCM muscle is shorter and tighter and is a common condition in babies. This may make the baby’s head to stay tilted to a side at all times. Here are some of the reasons why that happens:
- The condition can develop in the womb when the baby’s neck is in the wrong or an uncomfortable position.
- Abnormal development of the SCM muscle or trauma caused to it.
- There is no substantial proof that the condition is hereditary, but some in the medical fraternity consider that as a possibility.
- In rare cases, congenital torticollis is a result of the Klippel-Feil Syndrome, a congenital disability that results in fusion of neck vertebrae.
- Bone growth disorders like achondroplasia or congenital bone abnormalities.
- Shortened neck, short limbs or dwarfism.
- Multiple epiphyseal dysplasia, a disease that can hamper bone and muscle growth in the child, can also result in torticollis.
- A genetic metabolic disorder called Morquio’s syndrome, which prevents breakdown of sugar molecules in the body, can also cause torticollis.
- Congenital webbed skin on one side of the neck can also cause congenital torticollis.
Congenital torticollis can also be a result of certain anomalies involving the eyes, bone, skin and the central nervous system (CNS).
2. Acquired torticollis:
Torticollis caused due to an external factor or illness after birth is called acquired torticollis. Given that the condition can be ‘acquired,’ several factors can result in a wry neck in kids:
- Trauma to the head or neck or both. This could also include fracture and dislocation, muscle spasms or damage to the neck muscles, especially the SCM muscle or the trapezius muscle.
- Infections in the neck, head, spine or the CNS can cause torticollis. The condition could also develop due to infections in the ear or posterior pharynx.
- Surgical removal of adenoids, respiratory infections or infections in the neck’s soft tissues.
- In certain cases, vision problems (ocular dysfunctions).
- Gastroesophageal reflux (GERD), inflammation in the neck region, spasmus nutans, and sandifier syndrome.
- A tumor in the brain, especially in the skull or spinal cord. Sometimes, tumors in the posterior fossa can result in torticollis accompanied by nausea, headaches, vomiting and other neurological symptoms. (1)
While you can detect the presence of torticollis or wry neck by looking at the child, you will not be able to identify the exact cause of the condition. That is where diagnosis plays an important role.
[ Read: Fractures in Children ]
Diagnosis Of Acute Torticollis
When we talk about diagnosing torticollis, we are talking about the underlying illness or cause that has resulted in the condition. To pinpoint the reason and to treat it, your child has to undergo certain tests and procedures.
- A physical examination of the neck is done to check for tenderness or swelling. If there are no external signs, an investigation through diagnostic procedures is recommended.
- Doctor will also check for congenital muscular anomalies by examining the shape of the head and the hip.
- Neurological, visual, and ENT examinations are recommended to check for infections.
- The physician will suggest cervical spine X-ray in case there is tenderness or pain in the region.
- If he suspects an anomaly in the CNS or brain, he would recommend a CT scan.
- An EMG is done to detect the damaged muscles in the neck.
Torticollis Treatment In Children
Torticollis can be treated by medication, physical therapy or surgery, depending on the severity of the condition and the underlying cause. An early detection of torticollis in children can prevent the related symptoms and problems.
If the wry neck is congenital in nature, it can be treated by stretching of the neck muscle. This must be started soon after the birth. If this treatment is started within months of birth, it can be successful.
2. Acquired torticollis:
If the problem is not congenital but acquired, there are various ways to treat it, depending on the cause:
- Stretching exercises
- Heat application
- Neck braces
A good and planned course of medications also help treat torticollis in children. These medicines might include a combination of:
- Muscle relaxants
- Injections that need to be given every few months
- Other special medicines to manage and control the tremors that are experienced in Parkinson’s disease.
When none of the treatments mentioned above works, your doctor might suggest an appropriate torticollis surgery for your child. There are various types of surgeries:
- Surgery to cut muscles or nerves.
- Surgery to lengthen neck muscles.
- Surgery to help fuse abnormal vertebrae.
- In case of severe dystonia, surgery for deep brain stimulation might also be done to interrupt the nerve signals.
[ Read: Jumper’s Knee In Children ]
Home Care And Remedies For Torticollis
Torticollis cannot be treated at home, but you can certainly make the condition bearable for your child. Here are a few things you can do at home to ease the pain and discomfort that torticollis causes to your child.
- Temporary torticollis goes away after a day or two of rest. So let your child rest as much as possible.
- If your child complains of neck pain in the morning, check the place where he has slept. A lumpy, uneven pillow can often result in wry neck.
- Give your child pain medicines like ibuprofen, which can heal any muscular discomfort. Consult a doctor before you do, though.
- Warm compresses can alleviate the pain caused by still neck. They loosen the neck muscles and make it easier to move the head.
- A muscle relaxant can help, if the pain killer does not work.
- Help your kid use a neck collar to keep the head still to prevent further strain.
Long-Term Care For Torticollis In Children
Treating acquired torticollis can be easier if the condition is detected in time. However, congenital torticollis and permanent torticollis do not go away with medications. They need to be corrected only through surgery and can affect the child’s overall health. Fixed torticollis can lead to:
- Difficulty in driving
- Swelling of neck muscles
- Trouble performing day-to-day tasks
- Chronic pain
Such health problems can make life difficult for a child. As a parent, you can help your kid manage the condition better until it is corrected through treatment. Here is how.
- The time duration needed to cure the problem is primarily based on the cause of torticollis. So try to ease the pain and discomfort with the help of exercises and massages.
- Physiotherapy may be recommended for a year or more.
- Take your child on regular visits to the doctor to ensure his progress.
- Try and help your child build a positive attitude towards the problem and help him cope actively.
Questions To Ask Your Doctor
Torticollis treatment for kids can be effective when you take proper care of the child at home. And to do that, you need to be aware of the condition, its severity and what you can do to make it better for your kid. Remember to ask your doctor about:
- The type of torticollis that your child has.
- Home remedies to help your child move his or her neck easily, without aggravating the pain.
- Any changes that need to be made to the child’s bed to prevent further strain to the neck.
- Any side effects of the medication prescribed.
- Physiotherapy exercises that you can do at home to relieve pain.
- The frequency of doctor visits and term of medication or treatments.
1. Is congenital torticollis common in children?
Congenital torticollis is common and affects one in 300 newborns.
2. Which doctor should I consult if my child has torticollis?
Ask your child’s pediatrician first. She may recommend a surgeon or physiotherapist depending on the severity of the condition.
3. Can torticollis be prevented?
No. It is not possible to prevent torticollis. You can, however, try and avoid getting a stiff neck.
4. How long does the treatment last?
The duration of the treatment depends on the severity of the condition.
5. I noticed that my daughter tilts her head only to the left side. Should I be worried?
If your daughter’s head is constantly tilted to one side, you should take her to a doctor immediately.
6. Who is at a higher risk of getting congenital torticollis?
Congenital torticollis may affect any child. However, studies point out that firstborn children and twins are the most affected. In case of twins, one of the babies could end up with a damaged SCM muscle due to “cramped space” inside the womb.
7. What exercises should I make my son do to fix torticollis?
Please consult a physiotherapist who can recommend the right kind of neck exercises for treating torticollis in your child.
While most forms of torticollis cannot be prevented, there are a few which you can proactively avoid. Take precautions to prevent acquired torticollis. Also, congenital torticollis can be corrected early on in babies. So watch out for any symptoms and signs that indicate a wry neck in the child and resort to physical therapy first. If that doesn’t work, surgery can always help.
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