Torticollis in Children: Causes and Treatments

• Torticollis is a condition where one side of the neck muscle is abnormally tight or shortened, causing the head to tilt to one side and the chin to turn toward the opposite shoulder. This can usually be noticed from around 2-4 weeks of age. Children often turn their face in only one direction, and in some cases, there may be slight facial asymmetry. When feeling the side neck muscle, a lump-like mass may be detected, which results from fibrosis or muscle contraction, leading to limited movement of the head and neck.

• The head tilts to one side and the chin turns toward the opposite shoulder.
• The child appears uncomfortable or upset when trying to turn their head to the opposite side.
• The child prefers to face in only one direction all the time.
• In cases of congenital torticollis, a small lump like fibrosis may be felt in the side neck muscle.
• In some cases, facial asymmetry or flattening of one side of the head may become noticeable if left untreated for a long time.

If these signs of torticollis are present, parents should promptly take their child to a pediatrician or a specialist in pediatric orthopedics for diagnosis and early treatment, to reduce the risk of complications such as permanent facial or head deformity.

- Plagiocephaly and facial asymmetry: If a child lies with the head turned to one side for a long time, the pressed side of the head may become flat and the face may become asymmetrical. Changing positions and encouraging the child to turn the head regularly can help reduce this problem.

- Delayed development: Tilting of the neck or limited movement may affect visual development, crawling, or balance.

- Vision problems: If torticollis is caused by vision problems, or if it leads to incomplete vision, additional eye examinations and correction may be required.

Parents should take proper care and strictly follow the doctor’s advice to prevent long-term complications.

Pediatric torticollis is a common condition and is mostly caused by tight neck muscles, which can often be corrected with physical therapy and proper early care. If parents are concerned or notice the symptoms mentioned above, they should promptly take the child to a specialist for accurate diagnosis and appropriate treatment, so that the child can develop well and grow up healthy.

Pediatric torticollis can result from several causes.

• Congenital muscular torticollis (CMT) is the most common condition. It is believed to be caused by shortening or fibrosis of the large muscle on the side of the neck (sternocleidomastoid muscle). Contributing factors may include:

    - Genetics

    - The baby’s position in the womb, with the head being pressed in one position for a long time

    - Difficulties during labor or the use of assisted delivery tools, which may cause minor injury to the neck muscle

• Torticollis resulting from abnormalities of the cervical spine, such as congenital malformation of the cervical vertebrae or fusion of the cervical bones.

- Torticollis resulting from vision problems. The child may have abnormal vision, such as strabismus or severe astigmatism, causing them to tilt their head to see more clearly.

- Torticollis resulting from neurological problems, such as a brain tumor or other neurological disorders (very rare).

- Torticollis resulting from infection/inflammation, such as throat infection, enlarged lymph nodes, or inflammation of the cervical joints (such as Grisel’s syndrome).

- Torticollis resulting from other causes, such as postural torticollis, which occurs when the infant regularly lies with the head turned to one side, leading to tightness of the neck muscle on that side and possibly associated with flat head deformity.

Most cases of torticollis, especially congenital torticollis, are highly treatable and usually do not require surgery if treatment begins early. For less severe torticollis or postural torticollis, the doctor may recommend observation and regular exercises at home. The main treatments include:

- Physical therapy is the primary and most important treatment for congenital torticollis. A physical therapist will teach parents stretching exercises for the tight neck muscles and strengthening exercises for the weaker muscles, to balance both sides of the neck.

- Encouraging the child to turn the head and neck to the less-preferred side, such as by placing toys on that side, feeding from that side, positioning the head to turn that way when lying on the back, or using a specially designed pillow to prevent flat head.

- Promoting tummy time to strengthen the neck and body muscles, which are essential for age-appropriate development.

- Medication. In some cases where torticollis is caused by inflammation or infection, the doctor may prescribe antibiotics or anti-inflammatory medicine.

- Surgery. If the child is older than one year and has not fully responded to physical therapy, or if the muscle shortening is very severe, the last resort is surgery. A pediatric orthopedic surgeon will lengthen the shortened muscle. However, physical therapy must still continue after surgery to achieve the best treatment outcome.