The skewed neck in children is a condition where the head and neck are not in a straight line on the torso. Usually, the head leans towards one shoulder, while the chin turns towards the other shoulder. Other postures can also occur. The crooked neck is called torticollis in Latin: torti means twisted and collis means neck.
In a child with a crooked neck, it is not possible to turn the head so that it is straight on the trunk again. If this is possible, it is not a skewed neckline, but a preferred posture. You can read more about this on the page ‘ Preferred posture ‘.
The most common form of the crooked neck in children is congenital and is caused by an abnormality in one of the neck muscles. The congenital crooked neck occurs in one in 100 children. The condition manifests itself in the first two months of life. Three out of four children with a crooked neck have their head tilted to the right. Let’s see Symptoms of Skewed neck in children.
Symptoms of Skewed neck in children
With a crooked neck, your child’s head and neck are bent sideways towards one shoulder. At the same time, your child’s head is also turned, with the chin pointing towards the other shoulder. If you try to turn your child’s head straight, this will be partially, but not entirely possible.
If you feel in your child’s neck for the muscles that run there, you may feel that one of the muscles has hardened and feels tight. In the first weeks after birth, it is often possible to feel a thickening in this muscle. This form of crooked neck is not painful. If the crooked neck has been around for some time, a flattening of one side of the head can often be observed.
How does crooked neck develop?
Skewed neck is caused by one of the neck muscles, the sternocleidomastoid, being shorter than the others. This too short muscle prevents the head from being turned and tilted properly to one side. For a long time, it has been thought that bleeding into this muscle as a result of damage during laborious labor would be the cause of the muscle shortening.
However, crooked neck also occurs in children born after the cesarean section. It is now believed that the condition develops in the womb before birth. Possibly due to swelling in the muscle or problems in the blood supply to the muscle. Another cause could be an abnormal posture of the child in the womb, but that may be a result of the crooked neck. For example, a difficult delivery can be the result of the abnormal position of the head, instead of the reverse, as is often thought.
See also, First pregnancy check
Other causes for a crooked neck are abnormalities in the vertebrae of the neck, causing a crooked position of the neck. These may be vertebrae that are only half-developed (hemivertebrae) or a shift of the first in relation to the second cervical vertebrae (atlantoaxial subluxation). A harmless cause that occurs especially in older children is a stiffening of the muscles in the neck as a result of catching a cold or incorrect movement. The misalignment of the neck that this causes will disappear automatically within two to three days.
Ideopathic spasmodic torticollis may also have the condition in teens and adults. In this condition, there is a problem in the regulation of muscle tone, which occasionally causes a crooked neck. This condition may disappear temporarily and then come back. This mainly occurs in people between the ages of 30 and 60.
Rarer causes for a crooked neck are inflammation of the lymph nodes or other areas of the neck, an eye movement disorder, or rare neurological conditions.
What can you expect?
When the general practitioner or the clinic doctor has found symptoms of a crooked neck in your newborn child, he will refer your child to the pediatrician in the hospital. The pediatrician will examine your child and feel for the muscles in the neck. Often an X-ray or scan of the neck is made to rule out any abnormalities of the vertebrae as the cause of the crooked neck. If it turns out to be the congenital form of crooked neck, the doctor will institute treatment to prevent subsequent consequences of this condition.
Consequences of torticollis
If congenital torticollis is not going to be corrected, your child will lie on one side of his head a lot and may get a flattened head. Symmetrical development of both the left and the right half of the body will also be less easy. Often your child will develop a preference for one side and pay less attention to the side that he or she cannot see well. Despite a flattened head, the brain develops and grows normally.
One in ten to twelve children with a crooked neck also appears to have abnormal development of the hips. This concerns the condition of hip dysplasia. You can read more about this on the page ‘ Hip abnormalities in children ‘.
To prevent crooked neck problems, it is important to detect this condition early and treat it promptly. Treatment is with physiotherapy. With exercises and gentle movement, the shortened muscle is slowly stretched until both muscles are the same length and the crooked neck has disappeared. Four out of five children manage to make the crooked neck disappear completely in this way within two to three months.
When it is not possible to remove the symptoms of the crooked neck with the help of the above exercises, an operation is often required. In this operation, the shortened muscle is worked in such a way that it becomes the same length as the muscle on the other side of the neck. The operation is performed by a pediatric surgeon.
When to go to the doctor?
If you discover that your child’s head is not straight on the trunk or that your child is constantly looking to one side, it is wise to discuss this with your general practitioner or the consultation office doctor. This person can assess whether it concerns a preferred posture or crooked neck. In the latter case, he will refer you to the pediatrician in the hospital. With both conditions, it is important to detect them in time, in order to prevent later problems. That is why the health clinic doctor will always be alert when examining your child for signs that may indicate a crooked neck or a preferred posture.
Toddler and older child
When you discover that your slightly older child has a crooked head position, this is usually a harmless spasm of the neck muscles as a result of irritation from cold or overstretching. These symptoms will be greatly reduced within two to three days. If this is not the case, it is wise to contact the general practice.
What can you do about it yourself?
It is very important that the shortened muscle in the neck is gently stretched several times a day, usually four to six times. Older children themselves have an important task in this regard. The physiotherapist will explain and demonstrate the exercises to your child, after which your child can perform them himself. It is very important that your child does this practice consistently. In this way, surgery can often be prevented. Below are a few exercises that you can do with a baby. Only do these exercises in consultation with the pediatrician or physiotherapist.
Exercises to gradually lengthen the oblique neck muscle
- Sit with your back against a firm background and pull your knees up slightly. Now put your child on your thighs, so that his or her bottom is against your stomach and the legs are up along your stomach and chest. Your child’s head is at the level of your knees. The exercises listed below are for stretching the right oblique neck muscle. If your child has a shortened oblique neck muscle on the left side, you should read left wherever you say right and you should read right wherever you say left.
- Place your left hand on your child’s right shoulder and press the shoulder down a little. Then put your right hand on your child’s forehead. Now gently bend the head towards the left shoulder until you cannot go any further due to resistance. Hold this position for ten seconds and then gently release the head. Then repeat these exercises fourteen more times. Do such a series of exercises four to six times a day.
- Place your left hand on the left side of your child’s face. Make sure that your arm is in front of the left shoulder so that you can make sure that this shoulder does not move. Now grasp your child’s chin with your right hand and try to gently turn the chin to the right side until you feel a lot of resistance. Also, hold this position for ten seconds. Then release your child gently. Then repeat this exercise fourteen times and do this four to six times a day.
In addition, it is important that you encourage your child to discover the world, on the side where he is not looking. You can do this by paying attention to the points below.
Things to consider when sleeping
For the first two weeks after birth, put your child to sleep in the side position, alternately on the right and left side. If your child always sleeps with the head on the same side, turn the head over as soon as he sleeps well. If your child turns their head back right away, try again after five minutes. Turn your child’s bed over regularly so that the light also comes from the other side. If you cannot turn the bed over, you can also make the bed the other way around. Place your child’s favorite toy or stuffed animal on the non-preferred side.
Points to consider when grooming
Try to place the changing mat right in front of you, so that your child can look straight at you. Your child will then lie with his head against the back of the changing table and with his feet near your stomach. If this does not work, put your child alternately with his head to the right and left side of the changing table. Place your child on the right and left arm alternately when feeding. This already happens automatically during breastfeeding. When you are there, place your child on its tummy: this way it can turn its head in all directions.
Points for attention in the position
If you hold your child against you, make sure that the head is turned to the non-preferred side. If you carry your baby in a sling, turn the head alternately to the left and to the right. Play with your child while it is on your legs, this also stimulates looking straight ahead. Have your child sit on your lap so that your voice comes from the non-preferred side. Hang the toys on the non-preferred side in the box.
General advice and precautions
You cannot prevent your child from developing skew. You can, however, be alert for signs of it. Skewed neck is not hereditary. You therefore do not have an increased risk of a second child with this condition during a subsequent pregnancy.
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