Infant Torticollis: Treatment Options and Solutions

Infant torticollis

My friend has a child who is almost eight months old.
A little over a month ago, the doctor diagnosed him with torticollis at the 12 o'clock position, and it has now changed to the 2 o'clock position.
An ultrasound was performed, confirming that there is more pronounced fibrosis in his neck muscles.
The doctor stated that a neck brace is necessary and mentioned that if the condition improves, it could take about six months to resolve.
Is it really necessary to wear a neck brace for correction? Are there any other treatment options available?

Shi, 30~39 year old female. Ask Date: 2002/06/11

Dr. Luo Zhongwei reply Orthopedics

Hello Ms.
Shih! Your child has a torticollis issue (if the diagnosis is correct, as a differential diagnosis must be performed!).
Since your child is under one year old, the manipulation method can be used, which involves the adult repeatedly performing corrective positions without the need for a neck brace.
A neck brace is used for older children who already exhibit facial asymmetry and have undergone surgery.
I hope you can bring your baby in for a complete examination.
The most important principle is that the earlier the treatment, the better the outcome.
After one year of age, surgical intervention must be considered.
Thank you for your inquiry!

Reply Date: 2002/06/11

More Info

Infant torticollis, commonly referred to as "wry neck," is a condition characterized by an abnormal, asymmetrical head or neck position. In infants, this condition can arise due to various factors, including muscle tightness, birth trauma, or even positioning in the womb. The scenario you described, where your friend's child has been diagnosed with torticollis and is experiencing muscle fibrosis, is not uncommon.

Treatment Options for Infant Torticollis
1. Physical Therapy: The first line of treatment for torticollis is often physical therapy. A pediatric physical therapist can provide exercises to stretch the tight muscles and strengthen the weaker ones. This approach is non-invasive and can be very effective, especially if started early. Parents can also be taught how to perform these exercises at home.

2. Positioning Techniques: Parents can help by encouraging the child to turn their head in the opposite direction during playtime. This can be done by placing toys or engaging the child in activities that require them to look away from the affected side.

3. Neck Brace or Collar: In some cases, as mentioned by the physician, a neck brace or collar may be recommended. This is typically considered when there is significant muscle fibrosis or when conservative measures have not yielded satisfactory results. The collar can help maintain proper alignment and prevent further tightening of the muscles. However, it is essential to monitor the child closely while using a collar to ensure it does not cause discomfort or impede development.

4. Surgery: In rare cases where conservative treatments fail and the condition is severe, surgical intervention may be considered. This typically involves releasing the tight muscles to allow for more normal head positioning. Surgery is usually a last resort and is only considered after all other options have been exhausted.

Additional Considerations
- Monitoring Progress: Regular follow-ups with a pediatrician or specialist are crucial to monitor the child's progress. If the condition is improving with physical therapy and positioning, the need for a neck brace may be re-evaluated.

- Parental Involvement: Parents play a vital role in the treatment process. Consistent engagement in prescribed exercises and positioning techniques can significantly impact the child's recovery.

- Consulting Specialists: If there are concerns about the effectiveness of the current treatment plan or if the child is not responding as expected, seeking a second opinion from a pediatric orthopedic specialist or a pediatric neurologist may provide additional insights or alternative treatment options.

- Long-term Outlook: Most infants with torticollis respond well to treatment, especially when initiated early. With appropriate intervention, many children can achieve normal head and neck positioning without long-term complications.

In conclusion, while the use of a neck brace may be necessary in some cases, it is essential to explore all available options, including physical therapy and positioning strategies. Continuous communication with healthcare providers will ensure that the child receives the most effective and appropriate care for their condition.

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