Torticollis (Wry Neck)

What is it?

Torticollis (tort-uh-call-us), or "wry neck," is a common condition in children. It has several different causes, most of them not very serious. A child has torticollis if his or her head seems twisted off to one side or seems to be at an unusual angle compared to the neck. Most children with torticollis complain of pain and stiffness in their necks, and they prefer not to move them. Some children appear to have no pain at all, and happily go about their business with their head turned to one side.

The most common cause of torticollis is a spasm of one of the large muscles in the neck. This spasm causes pain and also shortens the muscle, which pulls the back of the child’s head to the same side, and makes the chin point to the other side. Neck muscle spasm can come from mild trauma during play, from sleeping in an awkward position ("slept funny"), or from a sore or inflamed lymph node (blood filter) in the neck. Usually children with torticollis from a muscle spasm are otherwise well, without fever or other complaints.

Some more serious conditions can also cause torticollis. A severe throat infection that produces an abscess (pus collection) in the tissue behind the throat is called a "retropharyngeal (ret-roe-far-in-gee-al) abscess"). This happens most often in younger children, who almost always have a high fever and appear unwell. Another condition is a partial dislocation or "subluxation" of the top two bones in the spinal column. This can happen from even very minor trauma in younger children and early teens, whose ligaments in the neck are fairly loose. Because of the possibility of this kind of injury, it is important never to try to "straighten out" the neck of a child with torticollis. Very rarely, torticollis can be caused by a problem in certain areas of the brain or balance system.

The biggest concern that most parents have right away is their child’s comfort, and to be certain that nothing serious is going on. Doctors can usually make the diagnosis of torticollis caused by a muscle spasm just by examining the child. The same is true when there is a swollen lymph node. X-rays are usually not needed to diagnose torticollis, unless the doctor is worried about a condition such as an abscess or a subluxation. Doctors may use X-rays, CT scans, or MRI scans to rule out those conditions. Doctors will usually keep children in the hospital if they are worried about these conditions.

The treatment for a muscle spasm is rest and heat, often with some muscle relaxant medication. Diazepam (Valium® and others) is very effective and quite safe if given as directed. Your doctor may prescribe diazepam for a few days to help the muscles relax. You can also give your child ibuprofen (Motrin® or Advil® and others) to help relieve both the pain and the inflammation. You can use a warm washcloth or a heating pad on the "low" setting. Please be sure to avoid using water anywhere near an electric heating pad unless it is specifically designed for "moist heat." Some people get relief from a gentle massage of the sore muscle. You can try this with your child; s/he will let you know right away if it helps or hurts.

If your child’s torticollis is the result of an infected lymph node, your doctor will prescribe an antibiotic as well. Please be sure to give the antibiotic on schedule and until it is all gone. Local heat may also help relieve the pain from the lymph node.

Torticollis from muscle spasm or inflamed lymph nodes is not dangerous, though it is very uncomfortable. In some cases, one of the other more serious conditions could be causing the twisted neck. Here are some things to look for that would make it important to call your doctor:

• Fever
• No improvement in pain or ease of movement after 48 hours of treatment
• Pain that is getting worse with time rather than better
• Headache
• Numbness, tingling, or other unusual feelings in the arms, hands, legs, or feet
• Difficulty walking, or a staggering gait
• Difficulty speaking or breathing
• Change in the sound of the child’s voice
• Lethargy (extreme sleepiness)
• Unusual or uncontrollable eye movements
• Seizure

As we mentioned above, please do not ever try to force a child’s head into a normal position. S/he may be holding it that way for a reason, such as a subluxation, that could become worse if you force it.

In very rare cases children with vision problems may develop a habit of holding their head at an angle to compensate for seeing things "out of line." These children can usually straighten up their heads if you ask them to, but then go right back to the angled position. If you have concerns about your child’s vision, please check with your doctor.