Acute Torticollis, Pediatric

Torticollis is a condition in which the muscles of the neck tighten (contract) abnormally, causing the neck to twist and the head to move into an unnatural position. Torticollis that develops suddenly is called acute torticollis. Children with acute torticollis may have trouble turning their head. The condition can be painful and may range from mild to severe.

What are the causes?

This condition may be caused by:

  • Sleeping in an awkward position.

  • Extending or twisting the neck muscles beyond their normal position.

  • An injury to the neck muscles.

  • A neck condition that prevents the neck from rotating properly (atlantoaxial rotatory fixation, or AARF).

  • An infection.

  • A tumour.

  • Long-lasting spasms of the neck muscles.

  • Certain medicines.

  • A condition called Sandifer syndrome.

In some cases, the cause may not be known.

What increases the risk?

This condition is more likely to develop in children who:

  • Have an inflammatory condition, such as juvenile idiopathic or rheumatoid arthritis.

  • Have a condition associated with loose ligaments, such as Down syndrome.

  • Have a brain condition that affects their vision, such as strabismus.

  • Had a difficult or prolonged delivery.

What are the signs or symptoms?

The main symptom of this condition is tilting of the head to one side. Other symptoms include:

  • Pain in the neck.

  • Trouble turning the head from side to side or up and down.

How is this diagnosed?

This condition may be diagnosed based on:

  • A physical examination.

  • Your child’s medical history.

  • Imaging tests, such as:

    • An X-ray.

    • An ultrasound.

    • A CT scan.

    • An MRI.

How is this treated?

Treatment for this condition depends on what is causing the condition. Mild cases may go away without treatment. Treatment for more serious cases may include:

  • Medicines or shots to relax the muscles.

  • Other medicines, such as antibiotics, to treat the underlying cause.

  • Having your child wear a soft neck collar.

  • Physiotherapy and stretching exercises to improve movement and strength in the neck.

  • Neck massage.

In severe cases, surgery may be needed to repair dislocated or broken bones or treat nerves in the neck.

Follow these instructions at home:

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  • Give over-the-counter and prescription medicines only as instructed by your child’s healthcare provider. Do not give your child aspirin because of the association with Reye’s syndrome.

  • Have your child do stretching exercises as instructed by your child’s healthcare provider.

  • Massage your child’s neck as instructed by your child’s healthcare provider.

  • If directed, apply heat to the affected area as often as instructed by your child’s healthcare provider. Use the heat source that your child’s healthcare provider recommends, such as a moist heat pack or a heat pad.

    • Place a towel between your child’s skin and the heat source.

    • Leave the heat on for 20–30 minutes. Do not leave a young child alone with a heat pack.

    • Remove the heat if your child’s skin turns bright red. This is especially important if your child is unable to feel pain, heat, or cold. Your child has a greater risk of getting burned.

  • If your child wakes up with torticollis after sleeping, look at his or her bed or sleeping area. Check for lumpy pillows or toys in the bed. Make sure the sleeping area is comfortable for your child.

  • Keep all follow-up appointments. This is important.

Contact a healthcare provider if:

  • Your child has a fever.

  • Your child’s symptoms do not improve or they get worse.

Get help right away if your child:

  • Has trouble breathing.

  • Makes loud, high-pitched sounds when he or she breathes, most often when breathing in (stridor).

  • Starts to drool.

  • Has trouble swallowing or pain when swallowing.

  • Develops numbness or weakness in his or her hands or feet.

  • Has changes in speech, understanding, or vision.

  • Is in severe pain.

  • Cannot move his or her head or neck.

  • Is younger than 3 months and has a temperature of 38°C (100.4°F) or higher.

  • Is 3 months to 3 years old and has a temperature of 39°C (102.2°F) or higher.

These symptoms may represent a serious problem which is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services.

Summary

  • Torticollis is a condition in which the muscles of the neck tighten (contract) abnormally, causing the neck to twist and the head to move into an unnatural position. Torticollis that develops suddenly is called acute torticollis.

  • Treatment for this condition depends on what is causing the condition. Mild cases may go away without treatment.

  • Have your child do stretching exercises as instructed by your child’s healthcare provider. You may also be instructed to massage your child’s neck or apply heat to the area.

  • Contact the healthcare provider if your child’s symptoms do not improve or they get worse.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.