Childhood Disabilities & Disorders
- When to Seek Therapy
- Disabilities & Disorders
- ADHD/ADD
- Anxiety Disorders
- Apraxia of Speech, Childhood
- Articulation Disorders
- Asperger's Syndrome
- Autism Spectrum Disorder
- Birth Injuries
- Central Auditory Processing Disorder
- Cerebral Palsy
- Clubfoot
- Conduct Disorder
- Down Syndrome
- Elimination disorders (enuresis and encopresis)
- Failure to thrive/feeding disorder
- Fine and Gross Motor Delays
- Fluency/Stuttering
- Fracture
- Fragile X Syndrome
- Gait abnormalities
- Global Developmental Delay
- Hip dysplasia
- Language Delays
- Learning Disabilities
- Legg-Calve-Perthes Disease
- Mental Retardation
- Mood Disorders
- Oppositional Defiant Disorder (ODD)
- Oral Motor Disorders
- Orthopedic conditions
- Osgood-Schlatter Disease
- Pervasive Developmental Disorder
- Pica
- Reactive attachment disorder of infancy or early childhood
- Reading Disorders
- Scoliosis
- Selective Mutism
- Sensory Processing Disorder
- Separation anxiety disorder
- Tic disorders
- Torticollis (Wry Neck)
- Additional Resources
Torticollis (Wry Neck)
Torticollis (also referred to as Wry Neck) is the clinical term for a twisted or rotated neck. It is a condition in which the head is tilted toward one side and the chin is elevated and turned toward the opposite side due to unilateral shortening of the sternocleidomastoid muscle. A child with a right torticollis would present with his head tilted to the right and his chin rotated upward to the left.
Torticollis can be either congenital or acquired. Facial asymmetry is typically present in children with congenital torticollis, but rarely in those with acquired torticollis. This differentiation is sometimes used to distinguish each type. Up to 90% of cases will present with plagiocephaly (flattening of the skull). Some children find a head preference for sleep and the result is shortened musculature on one side.
Congenital torticollis
The reported incidence of congenital torticollis is 0.3% to 2.0%. Its cause is unclear, though both birth trauma and intrauterine malposition are two likely causes. Other less common causes include infections, tumors and ophthalmologic problems. Even more rare are congenital abnormalities of the cervical spine, such as Klippel-Feil Syndrome, therefore an x-ray or an MRI is sometimes needed to evaluate infants with torticollis.
In general, if torticollis is not corrected, facial asymmetry can develop. If left untreated, it is believed that the soft tissues may not grow relative to the child’s skeletal growth. A cervical scoliosis may result as well as ocular and vestibular impairments.
Early intervention shows the best results. However, head position typically can, and should, be improved up until the age of 18. Physiotherapy is introduced as early as the initial diagnosis is posed. The role of the physiotherapist is also to assure proper acquisition of gross motor milestones in the child with a torticollis. The therapist will coach parents through the various stages of development and prevent delays as much as possible. Most pediatric specialists believe that excellent results are possible when therapy is provided before one year of age. Exercises, stretches and specific positioning and handling techniques are shown to the parents in an effort to improve the condition.
A TOT collar is sometimes used. Approximately 5% to 10% of individuals with congenital torticollis require "surgical release" of the muscle.
Acquired torticollis
Acquired torticollis presents itself at all ages – typically in normal children and adults – and is caused by another underlying problem, such as:
- Trauma to the neck
- Ear infections and surgical removal of the adenoids, which can cause Grisel’s syndrome
- Infections in the posterior pharynx
- Tumors of the skull base
- The use of certain drugs, such as antipsychotics
- Unilateral shortening of the sternocleidomastoid muscle due to static positions or heavy lifting
