Torticollis (Pediatric)

What is torticollis?

Torticollis occurs when a child’s head is twisted and tilts to one side. This tilt arises from a muscle spasm in the neck (sternocleidomastoid) or back muscle (trapezius). Torticollis may also displace the top two vertebrae in the spine.

What causes torticollis?

In congenital torticollis (caused by birth trauma), stiffness occurs within the first six weeks of life and can be associated with dislocation of the hips or club feet.

Certain syndromes are linked to an increased risk of torticollis such as Down syndrome, Morquio syndrome, Larsen syndrome, Marfan syndrome, and cervical spine arthritis,

Eye impairment is another factor. Children unable to move their eyes from side to side may tilt their head for prolonged periods of time and cause muscle spasms.

Torticollis can also be a side effect of certain medications such as carbamazepine or phenytoin. Or it may be a result of acid reflux, in which case neck spasms come and go and both sides of the neck may stiffen.

Who is affected by torticollis?

Torticollis usually affects children between the ages of 6 and 12, though it can also be diagnosed in infants and toddlers.

What are symptoms of torticollis?

The chief symptom is a stiff, painful neck. Torticollis can produce short episodes of vomiting and drowsiness and alter a child’s way of walking. This condition is benign paroxysmal torticollis and often described as a migraine in children.

How is torticollis diagnosed?

Torticollis needs to be treated immediately if accompanied by fevers, drooling, high-pitched breathing, vomiting, unsteady gait, or headaches. Our doctors rule out underlying infections or neurologic conditions. Torticollis can be caused by throat infections and viral upper respiratory tract infections.

To determine the cause of torticollis, our doctors may order upper (cervical) spine X-rays or a CT scan, if there has been an acute fracture. Diagnosis is also based upon the timing of any injuries or contributing events described by parents or caregivers.

What is the treatment for torticollis?

Treatment for torticollis depends on its origin:

• Triggered by medications, diphenhydramine or diazepam may be administered.
• Due to an infection, antibiotics may be required.
• Due to acid reflux, an anti-reflux medication may be necessary.
• Related to spinal abnormality, a surgeon may be consulted.

For congenital torticollis, stretching exercises 4 to 6 times per day can be effective.

Our rehabilitation specialists also encourage parents to speak to children on their “stiff side,” helping them to stretch that muscle more. Increased “tummy time”—children lying face down while awake—may also help. Children should not lie face down while sleeping as this can be dangerous.

In some cases, Botox injections may alleviate muscle spasms.

Our multidisciplinary approach and customized treatment provide optimal care for our young patients.