Torticollis in newborns

Any pathology at an early age needs close attention from parents and medical professionals. This is especially true of a problem such as torticollis. If you do not notice it in time and do not correct it, the consequences can be very sad.

What it is?

Torticollis in newborns and infants is a forced improper position of the head, in which it is constantly tilted to one or another opposite side.

This is due to pathological changes or anomalies in the development of soft tissues, skeleton, nerves. Most often, the head is turned in the opposite direction due to pathologies of the sternocleidomastoid muscle, cervical vertebrae. Often torticollis is the result of birth trauma.

The head is tilted to the shoulder and the face turns out to be turned in the other direction, the face itself can be asymmetrical. The movements of the baby's head are very limited. In fact, the head is fixed in the wrong position.

Muscle torticollis is very common. Among all lesions of the musculoskeletal system in newborns, it takes the deserved third place in prevalence. In front of her is only a congenital dislocation of the hip and clubfoot. According to Russian medical statistics, up to 2% of newborns suffer from torticollis. The World Health Organization cites other figures - up to 16%.

Also, statistics say that little girls are more susceptible to pathology, their disease is more common. And in 85% of cases, right-sided torticollis is recorded.

The danger of this condition lies not only in the fact that the child is motor limited in development, but also in the fact that often torticollis is accompanied by disorders of the organs of vision, hearing, mental retardation... In the absence of adequate treatment and care, torticollis does not go away on its own and in the future can cause irreversible deformation changes in the vertebrae, skeleton, and cause disability.

Types and reasons

Sometimes torticollis becomes obvious immediately after the birth of a child, and then they talk about a congenital form of pathology.

If the baby was born completely healthy, and the prerequisites for a curvature of the neck appeared later, then torticollis is called acquired. Accordingly, different species have different causes.

Congenital

Such torticollis is visible almost immediately after the baby is born. It is believed that the cause of the curvature of the neck is intrauterine trouble or pathological childbirth.

It is not always possible to establish the reason, because the list of possible prerequisites is quite large:

severe late maternal toxicosis (The relationship has not been proven, but very often in women with severe gestosis, newborns suffer from torticollis, which is currently the subject of medical study);
small amount of amniotic fluid (with low water, the risk of developing torticollis while still in the womb is assessed as high);
multiple pregnancy (usually torticollis is found in one of the twins, the one who was not in the most comfortable position in the uterus for a long time);
long entanglement of the baby in the womb umbilical cord;
breech or transverse presentation of the fetus during pregnancy;
pathological birth process (rapid or protracted labor, the use of obstetric forceps or a vacuum aspirator, the need to use drugs to stimulate labor);
caesarean section by itself and in connection with the hasty removal of the fetus through an incision in the uterus;
violation of the biomechanism of labor, in which the baby did not turn the head in the way provided by nature, in connection with which there was a birth injury to the neck.

Congenital torticollis is right-sided, left-sided, and even mutual.

Acquired

Such a curvature of the neck in a child can happen at any age. It occurs when the mechanisms for keeping the neck in the correct position are disturbed.

If this is due to weakening or excessive tension of muscle tissue, torticollis is called muscle or myogenic.
Pathological processes in the vertebrae of the cervical spine are not excluded, and then torticollis is called bone or osteogenic.
If the joints are affected, limiting the movement of the neck, torticollis is called arthrogenic.
When nerves are damaged, neurogenic torticollis is detected.
When the neck is forced to be in the wrong position for a long time, a compensatory curvature develops.

Myogenic (spastic)

This form is the most common. By itself, muscle pathology can be congenital or later. If a baby is born with such torticollis, then the development of the sternocleidomastoid or trapezius muscle is usually impaired. An anomaly of its development can occur in the first or second trimester of pregnancy under the influence of a variety of adverse factors. It is during this period that the muscle tissue of the fetus is formed. By the nature of the lesion, the muscle may be underdeveloped if the vascular network is disturbed, and therefore it is poorly supplied with blood.

In the acquired form, muscle pathology is usually associated with the fact that one of the two indicated muscles could be injured, for example, torn, and over time its gross scarring occurred.

Often in newborns there is a combination of congenital and traumatic factors. After birth, this form of torticollis develops most often against the background of acute myositis (muscle inflammation), with Grisel's disease.

Bone and articular

These forms can also have intrauterine roots. During the formation of bones and their mineralization (the middle of the first - the beginning of the second trimester), certain factors can lead to the fact that the cervical vertebrae are not developed correctly - underdeveloped, spliced together, they can have an irregular shape, for example, wedge-shaped, there may be less of them, than necessary, or, conversely, additional extra vertebrae are found. In any of these cases, the functioning of the cervical spine is impaired.

In the case when such torticollis is acquired, it usually means subluxation or dislocation of the joint, fracture of the vertebrae, as well as their destruction and destruction due to tuberculosis, osteomyelitis, a present tumor, etc.

Neurogenic (neurological)

This form, if it is congenital, usually indicates that the baby in the womb experienced a state of oxygen deficiency or there was an intrauterine infection. Often accompanied by muscular dystonia.

If the cervical nerves are affected after birth, the cause usually lies in serious concomitant diagnoses. This form of torticollis is often found in children with cerebral palsy, in babies after poliomyelitis, encephalitis, and various neoplasms in the spinal cord or brain.

There is an additional subspecies of neurogenic torticollis - reflex. It is accompanied by severe pain and most often starts if the child's parotid glands become inflamed, there are pathologies of the mastoid process, a broken collarbone, etc.

Compensatory

The compensatory form is never congenital, only cases of the acquired form of torticollis are recorded. Most often, it develops against the background of vision problems: children with strabismus, astigmatism strain their neck in order to see better.

Installation

Sometimes the neck is bent with pathologies of the inner ear (with hearing loss, for example).

Such a diagnosis can also be given to a child who both hears and sees quite normally if he was not properly looked after: he was constantly put in the crib only on one side, worn on a regular basis with the head turned only to one side, bright and attention-grabbing rattles were hung and toys exclusively on the right or only on the left side.

This form is called positional or positional.

Symptoms - how to recognize pathology?

It is not difficult to determine congenital torticollis: with the naked eye you can see the incorrect position of the baby's head, and the exact type of lesion is determined already in the first hours or within 1-2 days after the baby is born... Therefore, the newly-made mother learns about the diagnosis in the maternity hospital. In rare cases, minor torticollis remains unsolved, but already in the first weeks of a baby's life, the pediatrician manages to understand and discern the anomaly.

If the neck bent during a difficult birth, as a result of a birth trauma, then it is not always possible to see such torticollis at once, but the symptoms increase gradually, and by 2-3 weeks of the baby's life they can be determined during examination. Usually, such forms are detected at the first examination at the age of 1 month.

If the degree of curvature is mild, then it can remain unsolved not only by parents, but also by a pediatrician for several months.

To understand if a child has torticollis, you need to observe him: babies with such an anomaly have a fixed head tilt towards the shoulder. The chin is turned to the side opposite from the damaged side.

If, for example, the right cervical muscle is injured, then the tilt of the head will be towards the left shoulder.

The muscle itself, regardless of whether it is bony, articular, or another form of torticollis, will be tense. It looks a bit enlarged. Attempts by mom or dad to gently turn the head to the correct central position or in the other direction will meet fierce resistance from the baby: he will cry, scream, protest in all ways and means available to him by age.

If you look closely at the baby's face, you can notice some asymmetry: one eye, one eyebrow and one ear (from the side of the slope) are located lower than similar parts of the body from the healthy side. The eye looks narrower from the side of the slope, and the shoulder itself is slightly raised on this side. Respectively, it should be understood that if such signs are found on the right side, damage or anomalous development of bones, muscles or nerves will be located on the left side.

If torticollis is bilateral, then in such children the head is usually thrown back or pressed with the chin to the sternum. The child practically cannot turn his head to the right or to the left.

If the pathology is of a bone nature, you can, by looking closely, see a violation of the bend of the cervical spine, the head is set lower.

With a neurological disorder, the muscles of the neck are in hypertonicity on one side and in hypotonia on the other. Problems with cervical nerves are also indicated by the clamping of the cam in the newborn on only one side - from the side of the lesion... One leg on the same side is usually bent, but the child can move the head in both directions.

If torticollis is not noticed in the first month of life, then further it can be recognized by impaired motor functions: a baby with such an anomaly does not hold his head well at both 3 and 4 months, and this fact should alert attentive parents. If it turned out that up to 5 years of age the pathology was not detected, then by this age changes occur that leave no doubt about the diagnosis: the child's cheek on one side becomes flatter than on the other, the jaws are improperly developed, one eye is located lower the other, sometimes noticeable underdevelopment of the auricle from the side of the slope.

Children with undiagnosed torticollis suffer from slow, gradual deformation processes of the skeleton, skull, face... They have their baby teeth erupting late, they learn to walk, sit, crawl much later, while the crawling itself looks quite asymmetrical, they do not keep their balance in an upright position. Hearing and vision may gradually decrease on one side, and squint may develop. These children are more likely to suffer from headaches..

Surveys

External signs alone are not enough to establish an appropriate diagnosis. If the parents have suspicions that the newborn may have torticollis, be sure to contact the pediatrician... The children's doctor will give referrals for consultations to a traumatologist-orthopedist, to a neurologist, as well as to an ophthalmologist and an ENT specialist to assess the baby's vision and hearing.

Mom will be asked about how the pregnancy proceeded, what the birth was like, whether the baby was sick with myositis, whether he suffered severe viral infections after birth. After collecting the anamnesis, the baby will be sent for examination.

Usually, an ultrasound of the neck, or rather the cervical spine, is quite informative., but sometimes other methods are recommended, for example, X-ray of the cervical vertebrae, computed tomography or MRI.

An X-ray image of the first and second cervical vertebrae is considered very informative: their position usually makes it possible to easily find out whether the pathology is bone or articular, whether there were dislocations, subluxations, whether there is a fusion, whether the vertebrae are deformed.

More difficult to diagnose neurological torticollis... To understand if the nerves in this part of the child's body are working normally, the child is prescribed electroneurography. To assess the condition of muscle tissue - electromyography. Only after receiving the survey data can the type, type and degree of torticollis be established. After this, therapy is prescribed.

Treatment

The sooner torticollis is detected, the earlier treatment can be started. The younger the child, the more effective it will be, provided that the parents comply with all medical prescriptions: curing torticollis in a child under one year old is always easier than in children at an older age.

Maintaining the correct position of the baby's neck is the mainstay of treatment. This can be achieved with the help of orthopedic collars (Shants collar, for example), as well as with the help of such methods as taping, when the muscles are fixed in anatomically correct position with adhesive tapes.

You need to understand that it will take a long time to heal, it takes time to correct the pathology, it takes patience and a lot of effort on the part of the parents.

They are encouraged to stimulate the child's desire to turn the head to the correct position. This is helped by bright toys, hung from the "problem" side, carrying the child in his arms with the head turned to the side of the lesion.

Correction of muscle torticollis is a special therapeutic massage, physiotherapy exercises, physiotherapy, electrophoresis. Mom can gradually learn how to do massage at home, and this will help to save nerves and family budget.

Swimming is useful for babies with myogenic torticollis. If the degree is higher than mild, then the orthopedist recommends the child to wear a cervical brace... Treatment can last up to one and a half to two years. If after this time the result cannot be achieved and torticollis persists, doctors recommend an operation - a myotomy is performed (dissection of the cervical muscle, its removal), or plastic changes in the state of the muscle by surgery.

Bone and articular forms of torticollis require no less long-term correction with the help of a Shants collar, special holders for the head... If the dislocation or subluxation cannot be corrected, as well as in the absence of a result from orthopedic correction, a surgical operation (fusion) is performed, in which the adjacent cervical vertebrae are immobilized relative to each other.

With the neurological form of the disease, medications are used, the purpose of which is to relax the muscles (muscle relaxants), as well as drugs to reduce the increased excitability of the nervous system of the toddler. Massage and remedial gymnastics are of great importance.

Forecasts and prevention

No matter how terrifying the possible consequences and complications of children's torticollis may seem, the prognosis for it is quite favorable, and this should reassure the parents and make them tune in to a creative mood - up to 90% of babies whose treatment for torticollis began in the first 6 months fully recover, deformities are a thing of the past.

If treatment is started later than a year, then it will be difficult to completely eliminate the deformation, but the child's condition will be noticeably easier. In any case, a baby who has been diagnosed with such a diagnosis, even if he is cured, will be registered with an orthopedist until he reaches the age of majority. This is the law.

To avoid an unpleasant diagnosis, you need to take care of prevention even during pregnancy. After the birth of the child, he must be properly laid in the crib, each time changing the side on which the baby will rest, you need to hang toys in the center, as well as on the right and left sides at the same time.

It is important to remember that the neck of infants is very easily injured, you need to be very careful with it.

The opinion of Dr. Komarovsky

The famous pediatrician and TV presenter Yevgeny Komarovsky urges parents to show maximum responsibility when it comes to a diagnosed torticollis - this is a serious disease that, without correction, can lead to sad consequences. Komarovsky considers therapeutic massage and orthopedic devices very useful. But he urges parents not to go to extremes. In particular, he warns them to go to an osteopath.

Despite the fact that osteopathy is recognized by the Ministry of Health, unlike homeopathy, it has not become more scientific, says Komarovsky. That is why there is not a single intelligible evidence that an osteopath can cure a child with torticollis. But you can harm him with such treatment: an inept osteopath or an under-trained manual therapist can lead to additional injury to the neck, which then may require surgical correction.

There are several known cases of the death of infants in the hands of osteopaths and chiropractors with dubious diplomas and reputation, but high prices for their sessions.

It is much more useful, says Komarovsky, to visit a qualified medical masseur and ask him to show the technique of therapeutic massage so that later, in a calm home environment, the mother herself can do it to the child.

You need to visit exercise therapy specialists and learn exercises for daily gymnastics, on fitball and without it, which should be aimed at the correct development of the cervical muscles. All this will be beneficial to complement the treatment program.

Reviews

According to the parents, the treatment of torticollis in newborns and infants is very long and costly. But it gives results if everything is done in strict accordance with the doctor's prescriptions. There are a lot of thematic forums on the Internet, where mothers of children with torticollis support each other, share their experience, advice, information about good masseurs, neurologists, orthopedists.

The main thing, say experienced mothers, is not to panic. The disease is unpleasant, but not fatal and fixable.