Infant Torticollis

Infant torticollis, also known as “wry neck” or “loxia,” occurs when a baby’s neck is twisted, resulting in the head tipping to one side while the chin points upwards. Torticollis can be caused due to birth trauma, although in some instances, it happens later on in infancy or childhood through accidents and illnesses. It’s important to learn the symptoms early on so that treatment can start as soon as possible.

About Infant Torticollis

Experts suggest that infant torticollis is a relatively common disorder which occurs in both infant boys and girls. Babies who develop torticollis usually act the same way as other infants, aside from their neck restraints.

Infant Torticollis Causes

Infant torticollis can happen for many reasons. In some cases, there doesn’t appear to be any apparent reason at all, but the most common causes include:

  • Vacuum extraction injury
  • Forceps injuries
  • Improper, forceful pulling by the physician during delivery
  • Spine misalignment while in utero
  • Abnormal birth presentation, such as the breech position

When torticollis is acquired, it can happen due to:

  • Tonsilitis
  • Tumors
  • Accidents, such as falling from high places
  • Grisel’s Syndrome
  • Too much time spent lying down or in car seats, strollers, bouncers, etc.

In other instance, torticollis can be inherited, passed down via genes. According to the North Shore Orthopaedic Institute, infants can inherit genes with certain characteristics that may result in torticollis.

Infant Torticollis Symptoms

Most signs and symptoms of infant torticollis are generally the same, but will vary in severity. In addition, not all infants will have all of the following symptoms. The most common signs and symptoms include:

  • Constantly leaning the head in only one direction
  • Headaches (which is difficult to determine in infants)
  • Head tremors
  • Neck pain
  • One shoulder may be higher on the body than the other shoulder
  • Neck muscle stiffness
  • Neck muscle swelling (may be present right after birth)
  • Awkward chin position (pointing up)

Tests and Exams for Infant Torticollis

A series of tests and exams may be administered by your baby’s pediatrician to diagnose infant torticollis, including:

  • A CT scan of the infant’s neck
  • An MRI of the infant’s brain
  • An EMG to determine if and which muscles in the neck are affected

A physical exam may be administered as well, in which the physician will:

  • Look for signs of shortened neck muscles
  • Examine if the head tilts toward the affected side while the chin points to the opposite side

Infant Torticollis Treatment

When torticollis is present at birth, babies may need to undergo stretching the shortened neck muscle on the affected side. Known as passive stretching, this technique is a form of static stretching used to re-position the affected neck muscle. Stretching is often the only kind of treatment for infants under three months of age.

If stretching treatment fails, surgery may be the next option, but typically cannot be performed until the baby reaches pre-school age (around 4 years of age). However, if torticollis was caused by spine, muscle, or nervous system damage, the following treatment options may be available:

  • Heat, traction, and massage therapy to the spine
  • Neck braces
  • Medication
  • Routine injections (usually every three months) of botulinum

Infant Torticollis Long-Term Outlook

The sooner torticollis is treated, the better. In fact, experts state that infant and children are much easier to treat when compared to adults. However, the aforementioned treatment methods are not guaranteed, and the infant may develop long-term tingling and numbness in the affected area if treatment options fail to work. Furthermore, there may be chronic muscle swelling in the affected area due to constant pressure. In severe cases, the infant may develop scoliosis or  plagiocephaly. 

The good news, however, is that most cases of infant torticollis are treated successfully. According to the Journal of Manual Medicine, passive stretching and applied pressure on the affected area helps 97% of all infants with torticollis, as long as the condition is diagnosed in a timely manner and treatment starts as soon as possible.

Is There a Way to Prevent Infant Torticollis?

Unfortunately, there isn’t yet a way to help prevent torticollis, aside from physicians taking the utmost caution and care when delivering infants. However, if treatment is started early enough, it may prevent the condition from exacerbating.

Sources:

  1. Patel M, Shah K. Orthopedics. In: Rakel RE, ed. Textbook of Family Medicine . 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 42.
  2. http://ortho.northshorelij.com/conditions-treatments/torticollis-wryneck