How to Identify and Treat Torticollis in Children: A Comprehensive Q&A for Parents

What is torticollis?

Torticollis is a condition where the neck is twisted or tilted to one side due to a problem in the neck muscles. It can be congenital (present at birth) or acquired (developed later).

What are the causes of congenital torticollis?

Congenital torticollis is caused by the shortening of one of the sternocleidomastoid muscles (SCMs) in the neck. The exact reason for this is unknown, but it may be related to the baby’s position in the womb, trauma during delivery, muscle disease, or abnormal development.

What are the causes of acquired torticollis?

Acquired torticollis can be caused by various factors, such as vision problems, reflux, medication, cervical dystonia, scar tissue, neck arthritis, inflammation, infection, or injury to the neck muscles. Rarely, it can also be caused by a tumor or bleeding in the cervical spine.

What are the symptoms of torticollis?

The main symptom of torticollis is the head being tilted to one side and rotated to the opposite side. Other symptoms may include neck pain, stiffness, swelling, reduced movement, uneven shoulders, lump in the neck muscle, asymmetrical facial features, head tremors, or headaches.

How common is torticollis?

Torticollis is not a very common condition. According to some sources, the prevalence of congenital muscular torticollis, which is present at birth, is less than 1% of all live births. The prevalence of acquired torticollis, which develops later in life, is estimated to be 1 in 10,000–20,000 people. However, these numbers may not reflect the true incidence of torticollis, as some cases may be mild or under-reported.

What is the physiotherapy for torticollis?

Physiotherapy is a type of treatment that can help people with torticollis improve their neck movement, posture, and appearance. Physiotherapy for torticollis includes the following components :

Stretching exercises: These are designed to lengthen the tight muscles on the affected side of the neck and increase the range of motion. Stretching exercises can be done by the therapist or by the patient or caregiver at home. Some examples of stretching exercises are:

-Turning the head to the opposite side of the tilt and holding for 10 to 15 seconds. Repeat several times a day.

-Tilting the head to the opposite side of the tilt and holding for 10 to 15 seconds. Repeat several times a day.

-Placing a hand on the chin and gently pushing it to the opposite side of the tilt. Hold for 10 to 15 seconds. Repeat several times a day.

Strengthening exercises: These are designed to strengthen the weak muscles on the opposite side of the neck and improve the muscle balance. Strengthening exercises can be done by the therapist or by the patient or caregiver at home. Some examples of strengthening exercises are:

-Lying on the back and lifting the head off the pillow. Hold for 5 to 10 seconds. Repeat several times a day.

-Sitting or standing and pushing the head against a resistance, such as a hand, a towel, or a ball. Hold for 5 to 10 seconds. Repeat several times a day.

-Turning the head to the opposite side of the tilt and holding a toy or an object in front of the eyes. Hold for 10 to 15 seconds. Repeat several times a day.

Positioning and handling: This can help to prevent or correct the deformities and asymmetries that may result from torticollis. Positioning and handling can be done by the therapist or by the patient or caregiver at home.

-Placing the baby or the child in different positions throughout the day, such as on the back, on the stomach, on the side, or in a carrier. This can help to stimulate the head and neck movement and prevent the flattening of the skull.

-Encouraging the baby or the child to look at both sides by placing toys, lights, sounds, or faces on the opposite side of the tilt. This can help to promote the visual and auditory development and the social interaction.

-Supporting the head and neck with pillows, cushions, or collars when sleeping or resting. This can help to maintain a neutral position and prevent further tilting.

Botulinum toxin injections: This is a medical treatment that can help to reduce the muscle spasm and pain in some cases of torticollis. Botulinum toxin is a substance that blocks the nerve signals that cause the muscle contraction. It can be injected into the affected neck muscles by a doctor or a specialist.

What are the criteria for using botulinum toxin injections?

Some clinicians have used botulinum toxin injections for patients who have failed to improve after 6 months of aggressive physical therapy, avoiding operation in 74–95% of patients.

What are the criteria for surgery, regardless of age?

Some surgeons have suggested that the criterion for surgery is the development of facial hemihypoplasia, which is a condition where one side of the face is smaller than the other.

What are the steps involved in the surgical procedure?

The steps involved in the surgical procedure are:

-Transection of the muscle in the middle third, through a lateral collar incision.

-Division of the fascia colli of the neck, which is often tight and may need to be divided anteriorly and posteriorly.

-Intensive physiotherapy, including full rotation and extension of the neck, as soon as possible.

-Application of a soft cervical collar for at least 3 months following the release of the fibrous band.

Medical examination and follow-up are very important in cases of torticollis. With proper physical therapy, torticollis heals in many children without the need for surgery.