Congenital torticollis

Congenital torticollis will mostly present in the first moths of life. You or your child’s nurse may have noticed that your child’s head tilts to one side more than the other, and you may have even heard the word “torticollis”. But what is torticollis?

Torticollis is the medical term used to describe a twisting of the neck which usually appears around 2-4 weeks in which the head tilts to one side and the chin points in the opposite direction. Torticollis is common in children and newborn babies.

There are 3 types of congenital torticollis:

Stability - In which the baby has a preference to one side, but there is no involvement of the muscles or neck immobility.

Muscular - in this type there is involvement of the neck muscles which are under tension and there is a restriction in the range of motion

Mass of the neck muscles - in this type there is a thickening of the neck tissue and restriction of the range of motion

What does it look like?

Head tilted to one side - the chin points to the opposite side of the forehead. For example, if the child’s forehead points to the right, the chin will point left.

Sometimes, there can be other signs, such as:

Lump in the neck on the same side the forehead is pointing.

Facial asymmetry : Face seems abnormal, or one side is different than the other

Painful movement of the neck

Difficulty moving the head and/or neck

Children may experience bouts of vomiting, pallor, irritability, drowsiness, restlessness for hours/days, but most often these symptoms disappear on their own

Tight jaw muscles, muscle spasms, speech difficulty

Treatment

In general, congenital torticollis can be cured spontaneously , but untreated congenital torticollis could lead to asymmetry of the face, and the earlier the treatment is started the more efficient the treatment and the less time it will take.

Why treat?

To achieve a symmetrical position

To achieve motor skills

To prevent / improve conditions associated with asymmetry

To improve the range of motion in the neck

So how do we start?

The initial recommended treatment includes a combination of posture changes and grips, environmental adjustments, and physiotherapy interventions to facilitate passive and active range of motion of the neck and torso and to development symmetrical posture, function and movement.

Physiotherapy treatment:

  1. Postion arrangement:

Rotate the baby’s chin towards the injured side’s shoulder during breastfeeding. A child who’s head is tilted to the right , and neck to the left should be held with the parents left arm so the head rotates to the left and the chin to the right during breastfeeding. In addition, it is very important to place the baby in their stomach while they are awake and under supervision of an adult which strengthen the muscles of the neck and torso.

2. Passive stretching. It should be noted that children who have a cervical spine problem must consult a doctor before performing neck stretches.

3. Assistance in active movement of the neck and torso

Interventions that help with the initial treatment such as neck massage, neck movements, medical ultra-sound and other treatments that Physiotherapy can provide.

6 months since you’ve begun treatment and still no improvement? The problem might be from a source outside of the neck , such as eyes. Children who suffer from movement problems or eye stability ( i.e. strabismus - cross eyes) might tilt their head to prevent double sight.

Problems with the skull structure

Distortion of the cervical spine

If a child with congenital torticollis is 6-12 months old and is still has trouble with the range of motion of the neck/ asymmetry in the face you should speak to your Pediatrician or Pediatric Orthopedist.

What will the future look like?

Most cases of congenital torticollis are cured with the basic treatment described above.

Last update: 08.02.2020


Sources:


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