Helping Your Child with Torticollis: What Parents Need to Know

Torticollis is a condition where a child's head is tilted to one side. This can also include a head turn due to the peculiar contraction of the sternocleidomastoid muscle, which usually tilts the head to one side and turns it to the opposite. If the head is tilted to the left, this indicates left-sided torticollis, although the tilt may be imperceptible and only manifest in the head turning to the right. Despite this, the torticollis remains left-sided.

Types of Torticollis

Types of torticollis can be classified as follows:

• Congenital: from birth
• Acquired: appeared later
• Acute: suddenly occurring
• Paroxysmal: periodically appearing and disappearing

Congenital forms are characterized by

• Limited head movements – the child cannot turn the head independently or with the help of hands
• Discomfort when attempting to turn the head (pain, resistance, crying)
• Thickening of the sternocleidomastoid muscle
• Abnormally short neck
• Clavicle fracture
• Paresis of the upper limb muscles

Transient Torticollis (Positional)

• Movements in the neck are completely free
• Appears in the first months of life
• Disappears as the child masters voluntary movements (approximately 2.5 – 4 months)
• Thickening of the sternocleidomastoid muscle may be visible on ultrasound, but this examination is not diagnostically valuable if movements are not restricted

Myositis

• Neck movements are restricted due to pain
• Appears during or after a viral infection or injury
• Quickly resolves
• May affect not only the sternocleidomastoid but also the upper parts of the trapezius muscle

Benign Paroxysmal Torticollis of Infants

• Neck movements are free
• Parents often have migraines
• Starts quickly and lasts from several hours to weeks
• The child is often uncomfortable: nausea/vomiting, paleness/flushing, possible dizziness and coordination issues

Other Causes of Torticollis

• Torticollis caused by the shortening of specific muscles
• Fracture of the shoulder girdle bones or neck
• Skeletal abnormalities in the cervical spine
• Central nervous system developmental anomalies
• Excessive volumes (hemorrhages, tumors, cysts with a large amount of fluid in the neck)

Such children begin to be treated from the first days of life. Now about the acquired forms:

• Probably, gradually developing torticollis in the first months of life is positional transient torticollis, not requiring aggressive treatment.

Recommendations

Recommendation No. 1, and the most important: at any signs of torticollis, it is necessary to show the child to a doctor and get clear recommendations. Answers to possible questions:

• For positional torticollis, collars and orthopedic pillows are not needed. Definitely not.
• The most competent opinion on torticollis can be obtained from an orthopedist. Neurologists often exceed their authority in this matter.
• Remember that this topic is complex and has many nuances, so a doctor's examination is mandatory.

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