Beware of your baby's "cute" head tilt! If you have these 4 symptoms, be careful of "torticollis" in children

"Doctor, why does my baby always like to tilt his head to one side? He always sleeps on one side. After I help him straighten it, it returns to the original position. Is it a habitual posture?"

Experts from Hanshou County People's Hospital said that it is cute for a baby to tilt his head occasionally, but if the baby frequently and cannot control the head posture independently and always tilts to one side, parents should pay attention, because your baby is likely to have congenital torticollis.

1. What is congenital torticollis?

Congenital torticollis in children, commonly known as "twisted neck in children", is caused by tight muscles on one side of the neck, which causes the baby to extend the head to the side of the damaged muscle, while the chin points in the opposite direction. Typical manifestations include abnormal tilt and rotation, including tilting to the right or left, extending backward, flexing forward, and twisting.

If torticollis of various causes is not cured for a long time, it may cause facial deformities (different-sized face, different-sized eyes), strabismus, scoliosis, etc.

2. Classification of torticollis

Clinically, there are several common types of torticollis in children:

1. Congenital muscular torticollis

It is a torticollis in children caused by contracture of the sternocleidomastoid muscle on one side. It is the most common type of torticollis in children.

2. Bony torticollis

It is due to abnormal development of the child's cervical vertebrae, such as cervical fusion, cervical hemivertebra deformity, abnormal connection between the cervical vertebrae and the skull base, etc. This type of torticollis will cause the child's neck to have limited movement and inflexible neck rotation.

3. Ocular torticollis

The crooked neck is caused by eye diseases such as eye muscle paralysis, strabismus, esotropia (commonly known as "cross-eyes") and other eye diseases in children.

4. Acute torticollis

Also known as "inflammatory torticollis", it is caused by inflammation of the neck. This type of torticollis is caused by the child's head and neck being normal before the onset of the disease, and the onset of torticollis is sudden.

5. Neurogenic torticollis

Torticollis caused by intracranial tumors, syringomyelia, etc. is relatively rare.

6. Spasmodic torticollis

Torticollis caused by neck muscle spasm has unknown causes and is relatively rare. It is not easy to examine and diagnose, and there is no good treatment method.

7. Habitual torticollis

After excluding torticollis caused by the above-mentioned organic lesions, the existing torticollis is called habitual torticollis. That is to say, the child has undergone many examinations, but the cause of torticollis has not been found. It may be habitual torticollis, but do not make a diagnosis of habitual torticollis lightly because the underlying cause may not have been discovered yet.

3. Clinical manifestations of congenital muscular torticollis

1. Torticollis

After the baby is born, parents may find that the baby's head is tilted to the affected side, the face is turned to the healthy side, and the lower jaw is facing the healthy shoulder.

2. Neck lumps

Generally, a neck mass can be felt within 2 weeks after birth. At the same time, the sternocleidomastoid muscle on the affected side is obviously tense, and some parts can be felt as cords. The mass is mostly fusiform and painless.

3. Craniofacial deformities

The main manifestations are asymmetry of the head and face, different sizes of eyes, both eyes are not on the same horizontal line, the healthy side of the face is round and full, and the affected side is narrow and flat.

4. Limited neck movement

When the baby is 2 to 3 weeks old, parents will find that the baby's head always likes to turn to one side, and the range of turning to the other side is limited. For example, the baby always likes to drink milk on one side and is not willing to turn to the other side, and only likes to suck on the hand on one side.

4. Treatment of muscular torticollis

The best age for treatment is within 6 months, and the earlier the treatment, the better the effect.

1. Rehabilitation

For babies under one year old, most of them can get satisfactory results through regular rehabilitation treatment, which is related to the nature of the tumor, the start time of treatment, the frequency of treatment, posture management, etc. Conventional rehabilitation treatment methods include local warm compress, massage, stretching, exercise therapy, posture management, family guidance, etc.

2. Surgical treatment

Babies over 1 year old with torticollis or those who have not achieved satisfactory results after rehabilitation treatment can choose surgical treatment to avoid complications of serious facial deformity, postural strabismus and abnormal cervical spine posture. Neck brace is generally required for postoperative fixation. After the fixation is released, rehabilitation training of neck posture and function can be carried out as needed.

5. Recommendations for preventing torticollis

1. Strengthen head and neck activities

Appropriate head and neck activity training is encouraged, especially when the baby is awake. Through play and interaction, the baby can be stimulated to move the head in different directions to help strengthen the symmetrical development of the neck muscles.

2. Correct holding posture for infants and young children

Improve the child's holding and feeding posture in daily life, avoid using the same arm to hold the baby for a long time, and change the arm holding the baby regularly to reduce the pressure of the head and neck being continuously tilted in one direction.

3. Infant and young child sleeping position guidance

A fixed sleeping position for a long time can increase the incidence of acquired torticollis. It is recommended to change the baby's sleeping position regularly, such as adjusting the direction of the baby's head to avoid sleeping in one direction for a long time.

4. Early monitoring and screening

Parents should regularly observe their baby's head and neck movements and postures. If they find that their baby's head and neck are persistently tilted or fixed to one side, they should seek professional medical advice promptly.

5. Active physical therapy

For torticollis detected at an early stage, studies have found that early and long-term manual traction can achieve good results for most children. Physical therapy for children, such as manual traction and massage, can promote normal muscle stretching and increase muscle strength, and promote the symmetrical development of the craniofacial region.

6. How do parents determine whether their baby has torticollis?

● Gently touch the baby's neck from behind the ears to the collarbone. Do the neck muscles on both sides feel consistent? Are there any round or fusiform lumps?

●Observe whether the baby’s head shape and face are asymmetrical, and whether the eyes and ears are on the same level?

●Parents can simply observe at home whether the baby can maintain a symmetrical posture when lying on his back, prone, or upright?

●Observe whether the range of the baby’s head and neck active rotation to both sides is consistent when sleeping, playing and drinking milk?

When the baby has any of the above symptoms, parents need to pay attention and take the baby to the pediatric rehabilitation medicine department or pediatric orthopedics department for examination as soon as possible to avoid complications such as craniofacial deformities, strabismus, hip dysplasia, brachial plexus injury, distal deformity, early developmental delay, continued developmental delay, submandibular joint dysfunction and other serious conditions.

Source: Publicity Department of Hanshou County People's Hospital

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(Edited by YT)