|Torticollis (wry neck) is a symptom that causes a child's chin to be rotated to one side and his head to the other side. Disorders that can cause torticollis include congenital muscular torticollis, acquired torticollis, atlanto-axial rotary subluxation, and spasmus nutans (head tilt, nystagmus and head nodding).
Children with acquired torticollis will usually hold their neck to one side and are unwilling to move it because of pain. The cause is usually unknown, but it can be secondary to trauma or inflammation after an upper respiratory tract infection, and generally improves in two to three days without treatment. Things that may make your child more comfortable include using pain relievers and a heating pad (but do not leave your younger child unsupervised with a heating pad) and more rarely a neck brace or muscle relaxers. Acquired torticollis can also be from more serious brain and spinal cord abnormalities, so a careful evaluation by your Pediatrician is usually required and may include cervical spine x-rays and/or a CT scan.
Congenital muscular torticollis occurs when the sternocleidomastoid muscle on one side of your infant's neck becomes tighter than the other, pulling the head and neck to that side. This can occur when scar tissue forms in this muscle so that it can't grow properly. Congenital torticollis is sometimes the consequence of injury to the muscle during delivery, although it is also thought that it may occur prior to delivery and be a contributing cause to a difficult birth and not its consequence. It can also be caused by congenital abnormalities of the cervical spine, so sometimes xrays are required in evaluating newborns with torticollis.
If the right sternocleiomastoid muscle is affected, the infant will hold his head with his chin rotated to the left and his head rotated to the right. In addition to the head posture, you may be able to feel a lump in the affected muscle, which is usually most noticable between 2 and 8 weeks of age. Unlike acquired toticollis, congenital muscular torticollis is usually painless.
Congenital muscular torticollis usually improves with range of motion and stretching exercises and massage, but it can lead to positional plagiocephaly and facial asymmetry if your child's head lies in the same position all of the time. If it isn't quickly improving, then your child may need to be evaluated by a physical therapist. In cases that aren't improving by 12-18 months, a surgical release/lengthening of the sternoidcleidomastoid muscle may be required.
Torticollis Internet Resources:
- Congenital Muscular Torticollis: learn about causes, symptoms and what your doctor can do about your child with congenital torticollis.
- Instructions for Stretching and Positioning Left Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.
- Instructions for Stretching and Positioning Right Sternomastoid Torticollis: stretching, side bending, rotation, positioning, carrying and other suggestions to treat your child with congenital torticollis.
- Torticollis Kids: support and treatment information for children with torticollis, including symptoms, before and after pictures and helpful hints for parents.
- Stretching Exercises for Torticollis - learn to do gentle stretching exercises to help your child with torticollis.