Torticollis, also known as "wry neck," is a well-known and common condition in children characterized by pain and limited movement of the neck. Two distinct forms of this condition are fundamentally different from each other.
Infantile Torticollis (Congenital Torticollis):
This form appears during the first year of a baby's life, usually shortly after birth. The baby experiences a physical limitation in the rotation of the neck, and at times, there may be a small lump in the muscles on one side of the neck. The reason for the limited movement is an issue with these muscles. The exact cause of the lump is not always clear, but it is believed to result from an in-utero injury to the muscle, possibly during birth, causing the muscle to stretch and the lump is a sign of healing. The condition is generally treated with neck exercises. Parents learn to move the baby's neck by gently rolling the baby's head while lying on their back and stomach (while the baby is awake).
Sleeping on the back with the head consistently turned to one side can lead to the soft skull of the infant being pressed. Therefore, it is essential to encourage placing the baby's head on a different side each time.
This condition usually resolves within several months and requires follow-up with a pediatrician or pediatric orthopedic specialist. In some cases, a more in-depth evaluation may be necessary to rule out more complex reasons for the baby's difficulty in turning the neck symmetrically in both directions. For example, in infants approaching one year of age who tilt their heads unusually in response to visual or auditory stimuli, there may be an issue with these senses.
Acute (New-Onset) Torticollis in an Otherwise Healthy Child:
This form of torticollis is entirely different from the condition described above. Here, the event is sudden and occurs in a child who had previously had no problems with the neck. Several factors can lead to the development of this condition suddenly.
The most common and primary factor is trauma - such as a blow, fall, sudden movement, etc. These can lead to muscle strain in the neck, resulting in spasms and pain.
Another factor is an infection in the respiratory passages, throat, ears, or other neck tissues. Such an infection can irritate the neck muscles and cause contractions. As a result of this contraction, the child adopts a unique posture of the neck (usually head tilt to one side and rotation to the opposite side).
In some cases, there may even be an abnormal movement of the upper neck joints, even up to subluxation in the upper spinal joints.
Therapeutic Goals:
In infants, the goal of treatment is to acquire proper movement of the head, allowing the baby to follow with their eyes and ears as the head turns. Treatment helps the baby develop the eyes, skull, and face symmetrically on both sides without long-term damage. In children developing sudden torticollis, the goal is to reduce pain, restore movement in the neck, and, most importantly, prevent subluxation in the neck joints.
Treatment:
At any age, the pain should be alleviated using suitable medication of the appropriate type and dosage (it is advisable to consult with the treating physician). After relieving the pain, lay the child on their back and gently roll the neck to the right and left slowly and gently, avoiding any pain. Alternatively, perform gentle neck bends (ear toward the shoulder). All movements should be done slowly and gently without causing pain. Local heating of the area with a heating pad, massage cream, or any other method can be used to reduce the strain on the painful neck during the day. If the condition does not improve within 2-3 days, consult a physician.
When Is Hospitalization Required?
In some cases, we may need to hospitalize the child for more intensive treatment, including physical therapy and even a "cervical traction" device. The traction device leads to rapid pain relief, and usually, the child recovers quickly. During hospitalization in the pediatric department, we perform tests to identify additional reasons that may cause torticollis that does not improve with regular treatment. We perform imaging of the neck and involve other specialists in the evaluation process. There is significant importance in improving the neck's condition promptly, as without treatment, the child may develop a permanent deviation of the neck.
This explanation is general and is not a substitute for individual explanations provided by the treating physician.
For any questions, you can contact Dr. Ehud Lebel via email at lebel@szmc.org.il.
The explanations provided here are written in masculine language for convenience purposes only and are correct for both genders.