What is wry neck or torticollis in babies and children?
Wry neck, or torticollis, is present when the neck is tilted to one side and the head rotates to the opposite side. This condition can be congenital, i.e. present at birth, or may be acquired.
What causes wry neck?
- Wry neck can be an inherited condition.
- It can be caused by damage to the neck muscles, nerves or blood supply due to trauma.
- May be the result of a difficult birth where one shoulder gets stuck.
- It can also develop in the womb if the baby’s neck is in the wrong position e.g. breech presentation.
- Sometimes the cause is unknown which is referred to as idiopathic torticollis
Types of torticollis
- Temporary torticollis. This type of wry neck usually develops with an ear infection or cold. It is temporary and goes away after a few days when the cause disappears.
- Functional torticollis. This condition is caused by a spasm in the muscle without tears and other pathological changes. In babies, this may be due to the position in the uterus and can be treated by addressing the spine, the thorax, the ribs, the hips, the shoulder blades and other areas of the body that are restricted or display tension.
- Torticollis due to Benign tumour in the muscle. A nodule is present in the sternocleidomastoid muscle and is palpable on one side of the neck. Often it is accompanied by scoliosis and/or plagiocephaly (a condition where the head can become flat on one side from lying in one position for too long). Torticollis should be treated early and consistently otherwise the baby’s head can get stuck in one position. It can take up to several months for the issue to resolve.
- Ocular Causes. When a baby squints because it cannot see properly due to problems with its eyes.
- Klippel-Feil syndrome. This is a rare, congenital form of torticollis. It is a bony malformation in a baby’s neck due to two vertebrae being fused together. Children born with this condition may have difficulty with hearing and vision. Usually, an ultrasound or X-ray is required to diagnose it.
- Infant Cervical Dystonia can happen at any age but when it occurs in infants it is usually the result of birth trauma. It is a neurological disorder that causes involuntary muscle contraction resulting in abnormal movements of the head (dystonia). Most commonly, the head turns to one side or the other. Tilting sideways, or to the back or front may also occur.
- Torticollis due to muscular tears. This is the most common type of fixed torticollis. It results from scarring or tight muscles on one side of the neck.
Symptoms
Symptoms of wry neck can begin slowly. They may also worsen over time. The most common symptoms include:
- an inability to move the head normally.
- a tilting of your baby’s neck to one side.
- neck pain or stiffness.
- a headache.
- having one shoulder higher than the other.
- swollen neck muscles.
Sometimes, the faces of children with congenital wry neck may appear flattened and unbalanced. They may also have motor skill delays or difficulties with hearing and vision.
Treatment
Currently, there’s no way to prevent wry neck. However, getting treatment quickly can keep it from getting it worse. Wry neck caused by a minor injury or illness is likely to be temporary and treatable. You can improve mild forms of wry neck by stretching the neck muscles.
If started within a few months of birth, it can be very successful. When physical therapy doesn’t work botulinum injections or surgery can sometimes correct the problem. Your osteopath can treat wry neck depending on the cause.
Treatments for wry neck may include:
- gentle mobilization of the cervical, thoracic and lumbar spine.
- Release any restrictions that might hinder a good range of motion in the baby’s body.
- Massage.
- Traction of the neck.
- stretching exercises.
Please, consult your physical therapist before attempting any of these exercises.
The following neck exercises are best carried out on the floor.
Right rotation of neck
Lie your baby on their back with the head straight looking up at the ceiling. Put your right hand on your baby’s left shoulder. Put your left hand gently on the side of your baby’s face across their cheek.
Slowly turn your baby’s head to their right, using your left hand to carry out the movement whilst your right stabilizes the left shoulder. Hold this position for a few second and then return the head to the midline.
Left rotation of neck
Lie your baby on their back with the head straight looking up at the ceiling. Put your left hand on your baby’s right shoulder. Put your right hand gently on the side of your baby’s face across their cheek.
Slowly turn your baby’s head to their left, using your right hand to carry out the movement whilst your left hand stabilizes the right shoulder. Hold this position for a few second and then return the head to the midline.
Left side flexion
Lie your baby on their back with the head straight looking up at the ceiling. Put your left hand on your baby’s right shoulder to stabilize it.
Place your right hand on top of their head and slowly sidebend your baby’s head to the left side. Hold this position for a few second and then return the head to the midline.
Right side flexion
Lie your baby on their back with the head straight looking up at the ceiling. Place your right hand on your baby’s left shoulder to stabilize it.
Place your left hand on top of their head and slowly sidebend your baby’s head to the right side. Hold this position for a few second and then return the head to the midline.
Active left rotation
Lie your baby on their back. Gently put your left hand on your baby’s right shoulder. Get a toy that draws your baby’s attention and move it over to the left side to encourage to turn their head.
Active right rotation
Lie your baby on their back. Gently place your right hand on your baby’s left shoulder. Get a toy that draws your baby’s attention and move it over to the right side to encourage to turn their head.
Passive left side flexion
To help decrease tightness on the right side of your baby’s neck you can either sit or stand. Hold your baby facing outwards, against your body. Place the baby’s head in the crook of your right arm.
Put your left arm between their legs and across their body and hold their right shoulder. Slowly lift your right arm up and tilt your baby’ head towards the left side. This movement will stretch the right side of your baby’s neck. Slowly go back to a neutral position.
Passive right side flexion
To help decrease tightness on the left side of your baby’s neck you can either sit or stand. Hold your baby facing outwards, against your body. Place the baby’s head in the crook of your left arm. Put your right arm between their legs and across their body and hold their left shoulder.
Slowly lift your left arm up and tilt your baby’s head towards the right side. This movement will stretch the left side of your baby’s neck. Slowly go back to a neutral position.
Further advice
- Position your child in their cot so you can approach them from the side which is restricted.
- When holding your child across your shoulder, position them to face the side which is restricted.
- When in their car seat, make sure that your baby’s head is in the correct position and not twisted.
- Encourage your child to rotate his/her head on both sides when playing.
- Carry out lots of supervised tummy time when the baby is awake.
REFERENCES
Ellwood, J., Draper-Rodi, J., Carnes, D. (2020). The effectiveness of conservative interventions for positional plagiocephaly and congenital muscular torticollis: a synthesis of systematic reviews and guidance. Chiropractic & Manual Ther., 28 (31). doi: 10.1186/s12998-020-00321-w.
Kaplan SL, Coulter C, Sargent B. (2018). Physical therapy Management of Congenital Muscular Torticollis: a 2018 evidence-based clinical practice guideline from the APTA academy of pediatric physical therapy. Pediatr Phys Ther., 30(4):240–90.
Sargent, B., Kaplan, S.L., Coulter, C., Baker, C. (2019). Congenital muscular torticollis: bridging the gap between research and clinical practice. Pediatrics, 144 (2), e20190582.