Wry neck, medically known as torticollis, is a condition where a baby's neck muscles cause their head to turn and rotate to one side. It can be present at birth (congenital) or develop later (acquired), limiting the baby's ability to move their head freely.
Understanding Wry Neck (Torticollis) in Infants
Torticollis in babies occurs when one of the neck muscles, most commonly the sternocleidomastoid muscle (SCM), becomes tight or shortened. This causes the head to tilt to one side while the chin points to the opposite shoulder.
Congenital Muscular Torticollis (CMT)
This is the most common form of wry neck in babies and is usually noticed within the first few weeks or months after birth.
- Causes: Often linked to the baby's position in the womb (e.g., breech position, limited space), which can put pressure on the neck muscles. It can also be associated with birth trauma, such as a difficult delivery that might stretch or injure the SCM muscle.
- Characteristics: Babies with CMT often develop a small, non-tender lump or "mass" in the affected neck muscle, which usually disappears by 4-6 months of age.
Acquired Torticollis
This type develops after the baby is born, sometimes suddenly.
- Causes: Acquired torticollis can stem from various factors, including minor neck injuries, viral infections that cause lymph node swelling in the neck, or even vision problems where a baby consistently tilts their head to see better. Less commonly, it can be a symptom of more serious underlying conditions, such as tumors or neurological issues, though these are rare.
Common Signs and Symptoms
Recognizing the signs of wry neck early can lead to more effective treatment. Look for the following:
- Head Tilt: The most obvious sign is the baby's head consistently tilting to one side, with their chin pointing to the opposite shoulder.
- Limited Head Movement: Difficulty turning their head in both directions, especially towards the affected side.
- Neck Lump: A small, soft lump in the neck muscle (more common in CMT).
- Feeding Preference: Favoring feeding on one breast or bottle side due to difficulty turning their head.
- Flattened Head (Plagiocephaly): Due to constant pressure on one side of the head from always lying in the same position.
- Facial Asymmetry: Over time, if untreated, the baby's face may appear slightly uneven.
Causes of Wry Neck in Babies
The specific causes vary depending on whether the condition is congenital or acquired:
- Muscle Shortening/Tightness: The primary cause of CMT is a tight or shortened sternocleidomastoid muscle.
- Intrauterine Positioning: Being cramped in the womb can restrict fetal movement, leading to muscle shortening.
- Birth Trauma: Difficult or assisted deliveries can sometimes cause injury to the neck muscles.
- Inflammation or Infection: Swollen lymph nodes or infections in the neck can cause acquired torticollis.
- Vision Problems: Babies might tilt their head to compensate for poor vision in one eye.
- Reflux: Severe gastroesophageal reflux can sometimes cause babies to arch their back and turn their head in an unusual position (Sandifer syndrome).
- Rare Conditions: In some cases, neurological issues, bone abnormalities in the neck, or tumors can cause torticollis.
Diagnosis and Treatment
Early diagnosis and intervention are key to successfully treating wry neck and preventing long-term complications.
Diagnosis
A pediatrician typically diagnoses wry neck through a physical examination, observing the baby's head posture and range of motion. They might feel for any lumps in the neck muscle. In some cases, imaging tests like ultrasound may be used to confirm the diagnosis or rule out other causes.
Treatment Approaches
Treatment for wry neck usually involves simple, non-invasive methods, often starting with home exercises and physical therapy.
Home Exercises and Stretches
Parents play a crucial role in treatment through gentle exercises:
- Neck Stretches: Carefully turning the baby's head to encourage movement towards the restricted side. For example, if the head tilts right, gently encourage turning the head to the left and tilting the left ear towards the left shoulder.
- Tummy Time: Regularly placing the baby on their tummy encourages neck muscle strengthening and helps prevent flat spots on the head.
- Positioning: Place toys or objects of interest on the side the baby avoids turning towards to encourage them to rotate their head.
- Feeding Positioning: Offer the breast or bottle in a way that encourages the baby to turn their head towards the affected side.
Physical Therapy
A physical therapist specializing in pediatric care can provide specific stretches and strengthening exercises tailored to the baby's needs. They can also guide parents on proper handling and positioning techniques.
When to See a Doctor
Consult your pediatrician if you notice any signs of wry neck, especially if:
- Your baby consistently tilts their head.
- They have difficulty turning their head in one direction.
- You notice a lump in their neck.
- The head tilt worsens or doesn't improve with home exercises.
| Feature | Congenital Torticollis | Acquired Torticollis |
|---|---|---|
| Onset | Present at birth or first few weeks | Develops after birth, can be sudden |
| Primary Cause | Tight neck muscle (SCM), intrauterine positioning, birth trauma | Infections, injury, vision issues, other conditions |
| Typical Age | Infants | Any age, including older babies and children |
| Prognosis | Generally excellent with early intervention | Varies depending on underlying cause |
Most cases of wry neck resolve with conservative treatment within the first year of life, particularly when diagnosed and addressed early.
Further Resources
- American Academy of Orthopaedic Surgeons (AAOS) - Torticollis (Example link)
- Mayo Clinic - Torticollis (Example link)
