Causes of torticollis in children. Treatment of congenital torticollis in children: the earlier, the more effective. How to use a circle for bathing newborns
Torticollis in newborns is a fairly common orthopedic pathology and ranks third in frequency of occurrence after congenital dislocation of the hip and clubfoot.
Torticollis Is a disease characterized by limited movement in the cervical spine. This condition of the baby is expressed by the fact that the head is tilted to one side or the other, depending on which side the muscle is shortened from. Very rarely - in extremely severe cases, face asymmetry is observed. False torticollis is associated primarily with muscle hypertonicity, which is treated much faster.
1. The most common cause of muscle torticollis is shortening or underdevelopment of the sternocleidomastoid muscle.
2. Birth trauma, misalignment of the fetus before childbirth or intrauterine entanglement with the umbilical cord, which causes a spasm of the posterior muscles of the neck (oblique muscle of the neck, the upper portion of the trapezius), in addition to torticollis, there is a violation of cerebral circulation, and this entails consequences.
Torticollis is a rather complex disease that simultaneously belongs to several medical fields - neurology and traumatology. This is a disease that simultaneously affects soft tissues, the skeleton, and nerves.
Torticollis is manifested in the turn of the head with its simultaneous tilt to the other side.
- 1. C-shaped posture of the spine, lying on the stomach;
- 2. Compressed cam on one side;
- 3. Deformation of the skull;
- 4. The child falls asleep badly lying on his tummy, keeps his head to one side;
- 5. Not a complete turn of the head;
- 6. Tension of the neck muscles.
Torticollis in newborns Komarovsky. Signs, massage, treatment
The main thing, when diagnosing torticollis in infants, is timely treatment, which leads to a complete correction of the head tilt and leaves absolutely no consequences. Treatment is carried out depending on the cause of torticollis. There are several forms of torticollis: bone, neurogenic and muscular.
Bone - congenital anomaly of the cervical spine: wedge-shaped vertebrae, accessory hemivertebrae, unilateral fusion of the atlas with the occipital bone.
Neurogenic - with damage to the central nervous system and peripheral nervous system by any pathological process or during difficult childbirth.
Muscular - occurs more often than others, due to the underdevelopment of the sternocleidomastoid muscle, or the incorrect position of the 1st cervical vertebra, which turned around due to the pressure of the spasmodic uterus during childbirth on the head and tightens the muscles on one side (by the way, this reason is found in 40% of babies). Bilateral torticollis may occur - shortening of two sternocleidomastoid muscles and curvature in the anteroposterior direction - pronounced cervical lordosis. It can be congenital or acquired. Torticollis can be spastic in nature, it can be a reflex manifestation, arthrogenic torticollis, dermatogenic, hypoplastic. Also torticollis can be compensatory, bone and neurogenic.
Either an orthopedist or a neurologist can treat.
If the reason is the shortening of the muscles, then it is necessary to carry out their plastic surgery. Then massage, therapeutic gymnastics is prescribed. If it is compensatory torticollis, then hearing or vision must be treated. and then torticollis will go away on its own, if the process has not gone too far, in which case the operation is again shown.
With neurological torticollis, certain medications are prescribed, here it is also very important to consult a psychologist, because very often the cause of torticollis is very strong nervous stress, without which treatment this problem cannot be dealt with.
With dermatogenic torticollis, it is sometimes necessary to carry out a cosmetic operation, remove scars, which lead to the development of this disease. Therefore, as varied are the causes, so are the methods of treatment. But it is impossible to start torticollis, since the process goes to the spine, which not only affects the child's appearance, but also leads to disruption of the internal organs.
The best results can be achieved by complex treatment, including: positional treatment; massage; medical gymnastics.
Also, the doctor may prescribe physiotherapy procedures.
Massotherapy must be entrusted to a specialist. However, parents can also do a lot for their baby. The final result depends on how actively mom and dad are involved in the treatment.
What massage is needed for torticollis? - Doctor Komarovsky
Position treatment
Posture therapy is intended to passively stretch the affected muscle, as well as to form the correct body pattern so that the incorrect head position does not become habitual and natural for the child. Such treatment should be ongoing. The main role here is assigned to the parents of the baby.
To begin with, parents must choose a hard mattress for their baby. The child does not need to put a pillow. The task of the parents is to initiate the turn of the baby's head towards the affected muscle. Therefore, a baby should be placed in a crib in such a way that when he wants to look at his mother, he has to turn his head to the “unloved” side. Light should also fall from the side of the affected muscle. You can also stimulate the turn of the baby's head to the "unloved" side by hanging bright toys from the corresponding side of the crib. Thus, watching what is happening in the room or being carried away by a new toy, the child will involuntarily stretch the affected muscle.
When the baby is in the crib, parents should make sure that the baby's head is in the correct position. To do this, a bag of sand is placed under the head (it must be rinsed and calcined in the oven), salt or millet, a roller tightly twisted from a towel or several diapers is also suitable. The pouch or roller is placed in such a way that it rests against the shoulder, then it will fix the child's head in the desired position. In addition, it is necessary to check that the baby's body lies correctly and symmetrically.
It is useful for such a diagnosis to put a special therapeutic ring made of fabric with a filler under the baby's head and neck, which can be purchased at the pharmacy. Although you can easily make such a device yourself, twisting a "donut" from a bandage, cotton wool or diaper. Moreover, if the child is lying on a healthy side, a pillow is not needed, if on a sick person, a pillow is required.
If you decide to take your baby in your arms, also do not forget about posture treatment. Limit your baby's cheek to turn the head towards the healthy muscle.
We do gymnastics
Before starting gymnastics, you need to consult with a specialist. He will tell you how to properly carry out this or that exercise. Parents need to understand that some exercise can be unpleasant and painful for the baby. Therefore, you need to be patient: you need to do it persistently, but carefully, without violence.
Place the baby on his back, then clasp the baby's face with your palms and gently tilt it towards the healthy muscle, while turning your face towards the affected muscle.
Place the baby on the side with the injured muscle and hold the baby's head with your hands. Then, gently remove the hand that is holding the baby's head from below. The damaged muscle will stretch under its own weight. Do the same strengthening exercise for a healthy muscle.
Gently tilt the baby's head towards the shoulder joint and return it to its place. This will stretch the damaged muscle.
It is recommended to carry out such gymnastics 3-4 times a day for five minutes. The duration of the course is determined by the doctor. It can be 4-5 months. It must be remembered that the load on healthy and damaged muscles is different: the ratio of exercises is 3: 1, respectively.
To prevent the appearance of facial asymmetry, massage your cheeks: stroke, pinch, rub.
If a child has a "false" torticollis, that is, muscle hypertonicity, then in this case the main emphasis is on physical education and massage, which very quickly lead to the correct position of the baby's head.
They also add exercise therapy, electrophoresis, gymnastics in water and exercises on the ball to the therapeutic massage for torticollis. With the help of massage, it is possible to improve the trophism (nutrition) of the affected muscles, because of this, the resorption of the hematoma is accelerated and scarring is prevented.
Patience, dear parents! Love your little ones!
Torticollis is a congenital or acquired disease of early childhood, in which there is a curvature of the neck in the form of an incorrect position of the head to the side and to the side.
Congenital torticollis is more common than acquired. The frequency of occurrence of this anomaly occupies one of the leading places among all malformations of the musculoskeletal system. Statistical data indicate that torticollis occurs several times more often in boys, and the turn of the neck to the right side prevails.
What are the causes of torticollis?
According to modern data, the occurrence of this developmental anomaly has not yet been fully clarified. There are two main reasons for the development of torticollis.- Structural disorder or deformation of one or more cervical vertebrae... The deformed vertebra can be wedge-shaped, that is, it narrows to one side. This creates conditions under which the general location of the remaining cervical vertebrae. The neck, in this case, takes the wrong position.
- Violation of the development of the sternocleidomastoid muscle on one side of the neck. Normally, these muscles should be developed evenly, which determines the straight position of the head. With torticollis, one of these muscles is shorter than the other.
Signs of torticollis in newborns
At birth, the baby looks completely normal, the head freely turns to both sides of the body. But already at 2-3 weeks, upon close examination, you can notice that the child's head is turned to the right or left side. During this period, changes begin to appear on the part of one of the sternocleidomastoid muscles, that is, it begins to gradually shorten and if it is probed, then a clear thickening is determined. 
The sternocleidomastoid muscle, as the name implies, is attached to the bones of the same name of the head, chest and clavicle. Its main function is to bend the head in its direction, and simultaneously turn it in the opposite direction. When the head is straight, both muscles are relaxed.
The more time passes without taking any medical procedures, the more clearly and distinctly the symptoms of congenital muscle torticollis begin to appear. Approximately in the third month of life, the pathologically altered muscle undergoes significant changes, greatly lags behind in growth and is shortened. This is immediately reflected not only in bending the head towards the affected muscle and turning the face in the opposite direction, but other characteristic symptoms also begin to appear.
- Asymmetry of the neck and face appears.
- The shoulder girdle on the affected side is higher compared to the opposite side.
- Curvature of the spinal column may develop in the form of cervicothoracic scoliosis.
Diagnosis of torticollis
Diagnosis of congenital muscle torticollis is inherently associated with the clinical symptoms of the disease and the conduct of an objective medical examination of the patient. Early, at 2-3 weeks, the appearance of the first symptoms of the disease will clearly indicate a congenital pathology.
During a physical examination, the pediatrician feels the neck area for a seal in the area of \u200b\u200bthe sternocleidomastoid muscle. At a later visit to the doctor for help, when trying to turn his head to a straight position, the child begins to cry and scream. It is not possible to fully straighten the position of the head due to a significant shortening of the sternocleidomastoid muscle.
X-ray examination
To clarify the diagnosis, as well as to clarify possible bone pathologies that caused torticollis, several X-rays are taken.
On radiographs, you can see the abnormal structure of the cervical vertebrae (the presence of an additional wedge-shaped vertebra, or deformation of other cervical vertebrae). Also in the pictures you can see a partial fusion of the cervical vertebrae, which accordingly leads to the appearance of torticollis.
Acquired neck abnormalities occur in the following cases:
- With a spasm of the cervical muscles, limiting the rotation of the head. The movements of such patients do not obey their will.
- For burns and other skin injuries in the neck area.
- As a result of inflammatory processes in the cervical lymph nodes.
- With Grisel's disease. Change in the normal position of the first cervical vertebra (atlanta) in inflammatory diseases of the pharynx and nasopharynx. The displacement of the Atlanta entails a tilted position of the head.
- Less commonly, torticollis occurs in inflammatory painful conditions of the cervical muscles (myalgias).
Treatment of torticollis
The choice of treatment method depends on the degree of shortening of the sternocleidomastoid muscle, as well as on the timing of the beginning of the treatment. Treatment should begin immediately after an accurate diagnosis has been established. If the pathology is not associated with deformation of the cervical vertebrae, then they start with simple methods of conservative therapy.
Conservative treatment is carried out in stages, depending on the timing of the beginning of the treatment.
- Conduct special gymnastic exercises aimed at strengthening and stretching the pathologically altered sternocleidomastoid muscle. Gymnastics is carried out 3-4 times a day for about 5-10 minutes, and consists in turning the head to the right and left sides.
- Periodic light massage of the cervicothoracic region in combination with warming procedures will slow down the development of pathological shortening of the affected muscle.
- The baby must be properly placed in the crib. For this, the child is laid to the edge of the bed in the direction with which he turns his head, that is, in the direction of the healthy muscle. With sound stimuli, the child will try to turn his head towards the shortened muscle, while the head is given the correct position. A long stay in this position will allow the sternoclavicular muscles to develop correctly on both sides.
- Using a cotton-gauze-lined cardboard collar will keep your head straight.
If up to two years of age the conservative treatment carried out did not give tangible results or the child's parents did not seek help from the pediatrician, then they resort to using plaster neck collars. Plaster neck collars fix the head, neck and torso, and change at regular intervals for new ones, depending on the success of the head position correction.
Surgery for crankshaft
If the conservative treatment is unsuccessful, the question of the need for surgical intervention is raised. The operation is carried out under general anesthesia, and does not present any difficulties.The essence of the operation is to cut off the legs of the sternocleidomastoid muscle, which creates conditions for its lengthening. If necessary, plastic surgery is performed on the pathologically altered muscle.
After the operation, a cardboard cotton-gauze collar is put on for several days. Then the appropriate plaster cast is selected.
Postoperative management of the patient consists in periodic head turns (every 7-10 days), tilting in the direction opposite to the deformation. These measures are carried out until complete healing of the surgical wound occurs and the head is permanently fixed in a normal position. After that, the plaster cast is removed and massage courses and physiotherapy exercises are conducted.
The recovery period reaches several months, until new motor skills are developed for the child and the coordination of head and body movements is restored.
Prevention of torticollis
Why does torticollis occur in a newborn?
The main causes of muscle torticollis:- congenital underdevelopment of the sternocleidomastoid muscle;
- rupture of the fibers of the sternocleidomastoid muscle during birth - birth injury;
- inflammation of the sternocleidomastoid muscle;
- violation of the blood supply to the sternocleidomastoid muscle on one side.
- Anomalies of the cervical vertebrae... They may have the wrong ( wedge-shaped) shape, sometimes adjacent vertebrae grow together.
- Klippel-Feil syndrome - hereditary disease in which the cervical vertebrae grow together or their total number decreases. The child's short and sedentary neck is noteworthy. It is important to diagnose Klippel-Feil syndrome on time, as it may be accompanied by other developmental defects.
- Severe diseases of the nervous system... For example, tumors of the brain or spinal cord.
What is acquired torticollis? What are the reasons?
Acquired torticollis is the result of illness and injury acquired over a lifetime. The main types of acquired torticollis:- Underdevelopment of the neck muscles - trapezoidal and sternocleidomastoid, - on one side.
- Subluxation of the cervical vertebrae– arthrogenic (associated with joint pathology) torticollis.
- Decreased vision or hearing... At the same time, a person is constantly forced to turn and tilt his head in the same direction in order to better see and hear. In this case, torticollis is a compensatory response.
- Scar on the skin... For example, after burns. It restricts the movements of the neck and head, forces them to constantly keep them bent to one side.
- Neurological diseases... With damage to the brain or spinal cord, nerves on one side, on the affected side, muscle tone decreases and mobility is limited.
- Spastic torticollis.
- Prolonged forced position of the head,when you have to constantly keep it tilted and turned to one side. This happens in people of some professions.
What is spastic torticollis?
Spastic torticollis, or cervical dystonia, - a disease resulting from tension in the muscles of the neck. Its causes are not well understood. It is believed that spastic torticollis results from damage to certain structures of the brain.
Spastic torticollis in numbers and facts:
- The disease occurs in 1 in 10,000 people.
- Women get sick about 1.5 times more often than men.
- Cervical dystonia can occur at any age. Most often people are 30-60 years old.
Symptoms of spastic torticollis
With spastic torticollis, the head takes a forced position as a result of muscle tension. There may be a headache, neck pain that radiates to the shoulder. Some patients subsequently develop spasms of other muscles, usually the face and shoulder. The pains can be so excruciating that the patient's ability to work decreases, he falls into depression.Treatment of spastic torticollis
Cervical dystonia is difficult to treat. Many drugs that are used for this disease have severe side effects. Surgical treatment does not always bring results.| Treatment method | Description |
Botulinum therapy:
 | The botulinum toxin in these medications relaxes the muscles and brings relief. Botulinum therapy provides a good, but short-lived effect for spastic torticollis. Usually, injections have to be done every 3-4 months. |
| Parkinson's disease drugs | Often used in combination with botulinum therapy. Improves the effect, but often have side effects:
|
Muscle relaxants (drugs that reduce skeletal muscle tone):
 | They are used infrequently, as they are not very effective and give side effects, the most common of which are:
|
Pain relievers (analgesics) | They are used when spastic torticollis is accompanied by pain. Usually, your doctor prescribes over-the-counter drugs, and for severe pain, more powerful prescription drugs. |
Physiotherapy (exercise therapy) | A well-chosen exercise program can help reduce muscle tension and make your neck more flexible. |
Surgery | If medication doesn't work, your doctor may order surgery to cut through the muscles and nerves. It helps, but not everyone. |
Deep brain stimulation | It is used in severe cases when other methods of treatment do not help. The surgeon inserts a thin electrode into the area of \u200b\u200bthe brain responsible for the movement of the spasmodic muscle and tries to interrupt the pathological impulses. |
How to choose a pillow for crankshaft?
Currently, there are special orthopedic pillows for children under one year old, designed for the prevention and treatment of torticollis, rickets and other pathologies. In combination with physical therapy and massage, such a pillow can be beneficial, but in this regard, the opinion of doctors is ambiguous. Despite the benefits of orthopedic pillows for young children, they also have some disadvantages. For example, some of them are shaped as if the child already has a cervical curvature of the spine, although in fact, normally, its formation begins when the child holds the head. At a younger age, such a pillow will strain the neck muscles and do more harm than good.
An orthopedic pillow fixes the child in a supine position - this is not very good if the child often regurgitates.
Considering all the above, it is worth using an orthopedic pillow only as directed by a doctor. The doctor should also suggest a suitable model.
- The filler should easily allow air to pass through - in a dream, the child can turn over face down.
- If the child often spits up, be sure to tell the doctor about it. The doctor will either advise you not to use the pillow at all, or recommend a suitable model.
- The seams of the pillow should be fairly tight and tucked in. Make sure the filler is not sticking out anywhere.
- The filling of the pillow must be hypoallergenic. Materials such as polyurethane foam, holofiber, comfortel, sintepon, latex.
- The pillow cover should be made of natural material that can be easily washed: chintz, linen, cotton.
What exercises do they perform with torticollis?
The most important rule of gymnastics for torticollis in a child is that it should be performed only as directed by a doctor. Exercises that help stretch the sternocleidomastoid muscle during muscle torticollis can, on the contrary, worsen the condition with bone pathology. Gymnastics tasks for torticollis in children:
- muscle lengthening;
- elimination of spasms;
- improvement of blood circulation and metabolic processes in the muscle;
- alignment of the tone of the sternocleidomastoid muscles on the right and left, elimination of asymmetry.
Do I need to wear a collar when crooked? How to choose it correctly?
If a newborn is sick, the doctor may recommend wearing a special orthopedic collar - shants collar... It helps to fix the head in the correct position and, in combination with other treatments, helps to correct the incorrect head position. Rules for choosing and wearing a Shants collar:
- It should be used only as directed by a doctor.... Wearing a Shants collar for too long when not needed for a child can weaken the neck muscles. The kid will start holding his head later.
- Follow your doctor's recommendations for when to wear the collar and for how long. Usually the doctor recommends using it after physiotherapy, massage, exercise therapy.
- The Shants collar must be matched strictly... If it is too small or too large, it will not be able to provide sufficient head support. Usually in orthopedic salons models for newborns are presented with a width of 3 to 5 cm.
- See what materials the collar is made of... It should be good enough, but not too hard, with a cover that is easy to wash and does not irritate the skin.
- Practice good hygiene... The collar of Shants should always be clean, there should be no pellets and dirt between it and the skin. Keep your baby's skin free of irritation.
Is electrophoresis done for torticollis?
Electrophoresis - a procedure during which two electrodes soaked in a solution of a medicinal substance are applied to the skin. Electrical impulses are applied to the electrodes, with the help of which the drug penetrates the skin. When bony torticollis electrophoresis is useless. When muscular and neurogenic can be effective when combined with other treatments. Usually drugs are used: papaverine, euphylline, lidazu, iodine... The first two drugs help to relax the sternocleidomastoid muscle, the second two - promote the resorption of scar tissue.
Other physical therapy methods used for torticollis:
- Infrared irradiation special lamps.
- Heat therapy: paraffin treatment.
What can be the consequences of torticollis?
In most cases, with the timely start of treatment, torticollis can be dealt with. An exception is Klippel-Feil syndrome. With this disease, it is not possible to restore the mobility of the neck. Untreated torticollis in children threatens with various consequences:
- With age, it becomes more difficult to treat it, since cicatricial changes in the sternocleidomastoid muscle are growing.
- The growth and development of the skull on the affected side is impaired. Over time, the child's face becomes more and more asymmetrical.
- With torticollis, blood flow through the cervical vessels to the brain is disrupted. This manifests itself in the form of headaches, impaired memory, attention, thinking. The child lags behind in intellectual development from peers.
- Due to the constant tilt of the head, deformation of the trachea occurs. The functions of the respiratory system are impaired, the child becomes more prone to respiratory diseases.
- If torticollis occurs at an early age, the symmetry of the chest is disrupted.
- Deformation of the skull leads to frequent inflammation of the paranasal sinuses (sinusitis), hearing impairment, strabismus.
What is false torticollis?
There are such types of torticollis as true muscular and false... When true, there are pathological changes in the sternocleidomastoid muscle, it is shortened and due to this it tilts its head to one side. With false torticollis, the muscle is tense, but there are no pathological changes in it, the root cause of the problem lies in the dysfunction of the nervous system.During the examination, it is important for the doctor to understand whether torticollis is true or false. Treatment will depend on this.
Torticollis is a common and rather serious pathology associated with deformation of the baby's neck. The disease is determined by an incorrect position of the head and a violation of the musculoskeletal system. In mild forms of torticollis, it is difficult for a child to turn the head and look normally, and in severe forms it can provoke facial paralysis and lead to disability. Therefore, it is advisable to notice the disease in time and start treatment. If you do not start timely treatment, then this disease in a baby can begin to progress. And as a result of growth, disorders of the bones of the skull, spine and posture can form.
Signs of torticollis in infants are not immediately noticeable, they can be seen 2-3 weeks after birth. The first symptom is usually a slight lump in the area of \u200b\u200bthe sternocleidomastoid muscle (may form during childbirth). If the baby's head is constantly tilted to one side, and the face seems to be turned to the healthy side.
By the age of 2 months, the activity of the muscles of the back and neck increases in the baby. And by 5 months, the growth of teeth, teething slows down, the baby does not react well to sounds. By the age of 7 months, squint may appear, the tone on the upper and lower parts of the body increases, the baby becomes irritable. By 1 year, vision and hearing deterioration is possible, facial features change, curvature of the spine, developmental delay, etc. may occur. In rare cases, torticollis is not visible until 3 years, then the treatment is performed surgically.
So at the first suspicion of torticollis, you should immediately contact a specialist. It happens that this is muscle tone, but in any case, you need to play it safe.
Types and causes of torticollis
Torticollis in infants can occur for various reasons, but in most cases it appears even inside the womb or during childbirth. In congenital pathology, a bilateral nature is possible.
Causes of torticollis
- deviation of the formation of the mastoid muscles
- consequences of violation of the vertebral discs during childbirth
- difficult labor in which a muscle can rupture
if the fetus has neck inflammation in the womb, then it becomes chronic (after birth, the muscle becomes almost non-elastic and short) - improper placement of the fetus in the mother's abdomen
- prolonged hypoxia
- lack of water during pregnancy
- umbilical cord entwinement
Currently, there are 2 types of this pathology: congenital and acquired.
The congenital species is subdivided into 3 types:
- Bone. Pathology is caused by some abnormalities in the formation of cervical vertebrae (there may be cervical ribs, wedge-shaped, accrete vertebrae)
- Muscular. It is difficult for the baby to move the head due to an abnormal development of the neck muscles (if the uterus squeezes one half of the fetal head)
- Dermal. It is characterized by the appearance of cicatricial elements that prevent the proper development of the neck muscles, poor skin elasticity
The most common congenital torticollis is the muscle type. It is mainly due to a malformation of the sternocleidomastoid muscle. At the same time, the muscle becomes more shortened and its function is impaired.
Most often, the congenital form of the disease affects the right side of the muscle. For different types of torticollis, different treatments are suggested. Certain forms of congenital pathology are not always amenable to conservative treatment, so sometimes you have to resort to surgical intervention.
The acquired view is subdivided into 5 types:
- Bone (osteogenic). The bone composition of the vertebrae is affected in osteomyelitis or tuberculous lesions, as well as in neoplastic neoplasms of the neck tissues
- Muscular (myogenic). This type is due to inflammatory processes (chronic and acute) in the muscle. And dystrophic actions that, instead of muscle, form connective tissue
- Cutaneous (desmogenic). It may appear due to trauma, hypothermia or burns, accompanied by inflammation of the lymph nodes. The child's skin is changed to scar structures
- Secondary (compensatory). Appears with a complication of a long-term disease of the ear, eyes and salivary glands
- Neurogenic. Is caused by certain infections that damage the nervous system (paralysis)
As you can see, torticollis is not only congenital, but can also arise in the process of life. Usually acquired torticollis is unilateral (for example, only on the right side).
Diagnosis of torticollis
Usually, there are no problems with the diagnosis. An orthopedic surgeon or surgeon will examine the child, visually assess the position of the head, direct the head to the correct position, feel the muscles with his fingers and compare it with the healthy side.
Additional examination will be needed in order to establish the cause of the appearance and development of torticollis. The doctor decides to establish the cause and prescribe the correct treatment. Most often prescribed:
- x-ray of the spine (to detect abnormalities in the formation of the vertebrae)
- electromyography
- biochemical blood tests
- appointment with a neurologist (to exclude neurological diseases)
Treatment of torticollis in infants
Treatment of torticollis is mainly carried out by conservative methods, starting from two weeks of age. The methods are selected individually for each child, they depend on the type and specific form of the disease. If the disease is severe and defects are clearly expressed, then surgical intervention is also possible. Only the operation can be performed when the baby is 2-3 years old. This is due to the fact that a child's body up to 1 year old is able to change in some amazing way and adapt to the environment.
It is good to start treating torticollis in newborns as soon as they are born. Because fabrics are more elastic and can be fixed quickly.
There are several methods of conservative therapy:
- special massage for torticollis, based on light strokes, which helps to increase muscle tone, relieve inflammation and normalize blood circulation
- use of orthopedic collars and bandages (for example, Shants collar)
- the use of gymnastics (combined with massage, will give an excellent result). Exercise improves blood circulation and has a positive effect on muscle fibers
- physical procedures - the use of heating pads, electrophoresis, sollux lamps
- carry out a special laying of the child on its side in order to stretch the muscle through the position
- put a roller or rolled up towel under the back, and put the baby to sleep in a special position
Usually torticollis is corrected about 5-6 months after treatment, the diseased muscle begins to stretch and becomes equal to the healthy muscle.
Treatment of torticollis position
This method helps passively stretch the sore muscle. Parents must position the baby correctly in the crib or in the arms. The baby should sleep on a firm mattress; you can put a rolled up diaper under the head. It is desirable for the child to turn the head to the sick side, for this you can direct the light in this direction, put toys and approach the baby from this side too. For the sake of curiosity, he will try to turn his head, and thereby begin to stretch the deformed muscle.
It is very important to return the baby's head and body to the correct position all the time. You can also use an orthopedic pillow or Shants collar.
Gymnastics with crotch in babies
Parents can perform therapeutic exercises on their own, the doctor can show how to do it once. Basically, torticollis gymnastics consists of head turns and bends. Elements must be performed without sudden movements. It is necessary to do exercises with the child confidently and accurately, because some movements can cause pain.
Consider several exercises for treating torticollis:
This exercise is essential for all babies. We put the baby on the tummy. He will try to raise his head on his own and look to the side, for example, in the direction where his mother is standing. This position increases the elasticity of the muscles in the back and neck, and also strengthens the skeleton.
We put the baby on the table, then take him by the handles and gently lift (pull) him towards us so that he can sit down.
It is necessary to perform circular movements of the head, during which mom or dad fix the forearms.
We sit down on a chair and lay the baby on his lap with his tummy. The head and arms will hang slightly. And so we hold for 10 seconds.
We put the baby on the table, take a loud colorful rattle and knock it on the table. Out of curiosity, the baby will begin to try to turn the head in the affected direction.
We put the baby on the barrel and carefully raise the head to the top.
Also, classes in the pool would be an excellent option, the water temperature should be no more than 35 degrees.
It is advisable to perform these exercises for torticollis 2 times a day, in the morning and in the evening. The main condition for gymnastics is regularity.
Massage for torticollis in a child
Massage is considered a very effective method of treatment for torticollis in crumbs. The basis of the massage is to relax the neck muscles, which must find their correct position. Also, massage improves blood circulation, promotes muscle elasticity and even restores elasticity.
Treatment with torticollis massage should be carried out by an experienced specialist. Movements should be stroking and light. In no case should you make beating and rubbing movements. The massage is done for a general strengthening, during which the whole body is involved (back, arms, legs, tummy, face).
Consider the massage technique:
We put the child back on the table. We begin the procedure by lightly stroking the neck, chest and extremities. Stroke the muscle on the painful side very gently.
Then we begin to stretch the neck muscle, take the baby's head in the palm of our hand and pull it slightly towards us, smoothly turn the head to the healthy side, raise the chin a little to the top.
We massage the face, cheeks. We stroke the cheeks along spiral paths, knead the chin. Stroke the tummy clockwise. You can finish the procedure with a foot massage.
We turn the baby on the tummy, stroke the back with stroking movements, go to the neck. We stroke the affected muscle without much effort. Then we turn the crumb one, then the second barrel, this will strengthen the muscles.
If parents do not have the opportunity to find an experienced massage therapist, then you can massage yourself. The main thing is to study the execution technique correctly, because incorrect movements can make the situation worse.
When using conservative treatment, torticollis usually disappears by the age of 1 year. Of course, in rare cases, the treatment does not have the desired effect, then the doctor recommends the parents to carry out the operation by 2-3 years.
Do not self-medicate and treat with folk methods - this can harm the child.
Torticollis in a child can be observed from the first month of life. In this case, the disease is congenital and is caused by intrauterine disorders. The acquired form of pathology is less common. Its appearance is typical for schoolchildren and older children with pathology of the cervical spine.
At what age a child can be diagnosed with torticollis
Congenital forms should be diagnosed in 1-2 months. The sooner pathology is detected, the more effective the treatment. True, pathological spasm of the sternocleidomastoid muscle is not always treated with conservative methods.
According to statistics, most often the disease is found in boys 2-3 months of age. This is due to the more rapid development of the musculoskeletal system in representatives of the strong half of humanity.
In girls, a crooked neck is found most often at 4-6 months, when the parents notice that the baby turns her head to one side. This situation is observed if the doctors did not identify the congenital form of the disease immediately after the birth of the child.
There are 2 types of torticollis, which determine the time of the onset of clinical symptoms of pathology:
- Bony occurs with wedge-shaped deformity of the vertebrae, dorsal juvenile kyphosis in adolescence, osteochondrosis and scoliosis of the spinal column;
- Muscular - in violation of the development of the sternocleidomastoid muscle on one side. If this type has a congenital etiology, it is found in a baby of one month of age or immediately after birth in the maternity ward.
A crooked neck can be detected in a baby of one month old. Already at 2-3 weeks, he has a curvature of the head to the right or to the left, although after birth, no pathology was noted.
If you feel the baby's sternocleidomastoid muscle with your fingers, you can feel its swelling or localized clavate protrusions.
The structure of muscle tissue in pathology depends on the morphological type of the disease. With an infiltrative form, a limited infiltrate accumulates in the thickness of the cervical muscles, which is displaced on palpation.
With fibrotic changes in the sternocleidomastoid muscle, the fluid content is not felt, but the mobility of the neck is sharply limited due to the shortening of the muscle fibers. It takes 2-3 months for fibrosis to form, so torticollis is formed longer than in the infiltrative form.
According to statistics, a "curved" neck in a month-old child is found only in 1% of cases. Signs that allow you to identify pathology in 1 month:
- The baby's head is always turned in one direction;
- Thickening of the sternocleidomastoid muscle, determined by the hands.
Identifying the problem in 2-3 months
It is easier to find torticollis at 2-3 months than in a month-old baby. On close observation, the parents will find the following signs in him;
- The head is slightly thrown back and turned;
- The kid screams when trying to establish the correct position of the upper limbs;
- The shoulder blades are set apart.
The more time passes, the more intense the manifestations of pathology. So, at 4 months with a fibrous form of the disease, the pathological muscle lags far behind in development from the opposite. This leads to a sharp curvature of the neck and a pronounced turn of the head. These symptoms are hard to miss.
"Curved" neck at 5-6 months is characterized by the presence of several additional manifestations:
- High standing shoulder girdle from the side of the lesion;
- Asymmetry of the face and neck;
- Curvature of the cervicothoracic spine.
Symptoms arise against the background of the fact that shortening of the sternocleidomastoid muscle leads to pulling up the clavicle and downward of the mastoid process of the occipital bone.
Severe clinical manifestations of the disease in a 5-6 month old child often require surgical treatment, since conservative therapy does not bring results. The presence of complications in the form of acute pain syndrome requires doctors to make immediate decisions on how to reduce the discomfort for the child.
When a disease is detected after 6 years, it is difficult to count on the effectiveness of even surgical treatment. In such a situation, only resection of the sternocleidomastoid muscle is possible in order to eliminate pathological tissue proliferation and fibrotic changes.
Conservative treatment of the disease involves a combination of the following methods: massage, manual therapy, electrophoresis with iodine, physiotherapy exercises.
In conclusion, we note that the time of detection of the disease in a child determines the tactics of treatment. It is better to detect torticollis at 3 months than at 6 years of age or later.
Symptoms of pathology violate the psyche of children, therefore, they should be eliminated as early as possible. However, due to the complexity of the performance, the operation for a "curved" neck is performed only when the child is over 3 years old.
Torticollis in newborns - a congenital anomaly of soft tissues or bones - is a fairly common pathology. It is believed that the disease affects about 2% of all born children, mostly girls. It is not difficult to identify torticollis: the head of the newborn is tilted to one shoulder and turned in the opposite direction, the sternoclavicular muscle on the affected side is tense and painful on palpation, the scapula is slightly raised, the occiput has an irregular shape.
In a newly born baby, as a rule, no asymmetry is observed. Torticollis in newborns appears at about 2-3 weeks of a baby's life. Do not panic when you find such a defect in a child. If the disease is recognized in time and vigorous treatment is started, the function of the altered muscle is fully restored after a few months. On the contrary, the lack of therapeutic measures leads to the fact that in the future there will be face asymmetry, strabismus, spinal deformity and even a slowdown in the mental development of the baby.
There are several types of the disease, but, as a rule, muscle torticollis is diagnosed in infants.
Types of torticollis
Doctors distinguish three types of torticollis.
- Muscular torticollis - a disease associated with the pathology of the sternocleidomastoid muscle in newborns. Changes can occur in the prenatal period and are associated with congenital underdevelopment of muscle fibers, poor blood supply to tissues or an uncomfortable position of the baby in the womb. However, an injury to the sternocleidomastoid muscle can also occur during childbirth, when muscle fibers are torn, for example, when using obstetric devices or the breech presentation of a baby.
- Bone torticollis... The disease occurs in newborn babies due to existing defects of the cervical vertebrae - their fusion together, changes in their shape, additional vertebrae or cervical ribs. A bone abnormality can be detected with radiography.
- Neurogenic torticollis associated with a violation of the innervation of the sternocleidomastoid muscle, such a pathology is treated by a neuropathologist. Spastic torticollis can be a consequence of the transferred encephalitis.
Sadly. sometimes the parents themselves are to blame for the development of torticollis in the baby, as they "force" him to turn his head all the time in one direction - they hang toys and other attention-grabbing things there
The reasons
Most experts agree that the cause of congenital muscle torticollis is intrauterine pathology of the sternocleidomastoid muscle, which loses its elasticity. During childbirth, a tear of already changed fibers easily occurs, subsequently a connective tissue scar is formed in this place.
Torticollis in a child may be the result of infection, the consequence of which is myositis - muscle inflammation.
Another reason is that the child is inconveniently located in the prenatal period, for example, the body of the uterus squeezes his head, there is an umbilical cord entanglement, gluteal position. This leads to close contact of the points of the flexor muscle, hindered oxygen supply to its tissues, impaired blood circulation and subsequent deformation.
The disease can be either congenital or acquired. Congenital torticollis of newborns is determined already at the moment the child is born. Most often, an anomaly develops in the pathological course of pregnancy (threat of interruption, toxicosis, oligohydramnios). Acquired torticollis in a child may be the result of a neck injury and increased tone of the paravertebral muscles. With hearing loss or strabismus, the child is forced to turn his head to one side in order to better hear sounds or examine an object. Inflammatory processes in the cervical region, muscle phlegmon, burns contribute to cicatricial degeneration and the appearance of an acquired form of torticollis.
Sometimes torticollis in infants occurs due to the fault of parents, who put toys and bright objects on one side of the baby. The child is forced to turn his head to one side, and after 2-3 months he has a persistent neck deviation to the left or right.
Spastic torticollis can occur at an older age, then the wedge-shaped deformity of the thoracic vertebrae becomes its cause. A large backward bend of the spine causes difficulty in the innervation of the sternocleidomastoid muscle.
The main symptom of torticollis is improper position of the child's head and neck muscle tension
Symptoms
In infants, the following symptoms of torticollis may be observed:
- fixed position of the child's head;
- the chin is turned in the opposite direction;
- when probing the sternocleidomastoid muscle, its tension and thickening is determined;
- asymmetry of the face, head and neck;
- raised one shoulder;
- xoglasia;
- attempts to turn the head to the side cause soreness in the baby.
In the absence of proper treatment, noticeable skeletal disorders are formed by the age of 5-6 years. Asymmetry of the neck entails unpleasant consequences: deformation of the chest with the subsequent development of scoliosis. The eyes and ears on the sore side are low, over time the mastoid process, to which the sternocleidomastoid muscle is attached, increases in size. Possible consequences such as underdevelopment of the ear canal, incorrect position of the jaws. Such a baby belatedly begins to sit and stand, crawls asymmetrically, keeps balance poorly. Impaired mental development is caused by insufficient blood supply to the brain as a result of compression of the carotid and vertebral arteries.
Treatment of torticollis most often takes place without surgery: with the help of massage, exercise therapy, gymnastics
How is the disease treated?
Early detection of pathology in a newborn and a quick start of treatment of muscle torticollis allows you to fully restore the function of the sternoclavicular muscle. Treatment of the disease begins with conservative measures - massage, exercise therapy. From 2 months of age, they resort to physiotherapeutic procedures (electrophoresis with potassium iodide, paraffin applications).
Spastic torticollis is treated with pharmacological drugs, as well as massage and electrophoresis.
Position treatment
Correct placement of the child helps to correct torticollis - with the healthy side against the wall. The events taking place in the room will surely interest the newborn, and he will tend to turn his head in the opposite direction, while simultaneously stretching the shortened muscle.
If the child is lying on the affected side, a pillow should be placed under the head. A pillow is not required in the healthy side position.
To fix the correct position of the newborn's head will help "donut", which is made from bandages and cotton wool. Some parents put cloth bags filled with cereals on the sore side or on both sides of the neck: this allows you to maintain the correct position. Such styling is kept for 1.5-2 hours a day.
The doctor may prescribe the constant wearing of the Shants collar. This device is a foam band with Velcro attachments and a chin cut. It is important to choose the right collar size so that it is not too tight and does not obstruct blood circulation. On the other hand, a band that is too long will dangle and will not be able to properly fix the newborn's neck. It is optimal when you can stick your index finger between the neck and the collar.
Physiotherapy
The child is laid on his back, his head is clasped by the arms of one of the parents. He makes smooth inclinations of the newborn's head in one direction and the other, the duration of the lesson is 7-10 minutes, physical education should be carried out 3-4 times a day.
After that, they begin therapeutic massage: with three fingers of the hand, gently massage the tense muscle. Stroking and rubbing circular motions are used. It is advisable to invite a qualified specialist for the massage, who can teach the parents the simplest techniques, and in the future they will be able to independently massage the cervical and pectoral muscles. Hand movements should be carried out gently and gently on the affected side and quite vigorously on the healthy side.
Swimming and exercise on fitball are of great help in the treatment of torticollis.
Forecast
With a mild to moderate degree of muscle damage, a complete restoration of its function is possible. In severe cases, surgical correction may be required; during the operation, the shortened part of the muscle is dissected or its plastic is performed. In any case, torticollis in newborns is not a death sentence, and the chances of recovery with proper attention to the child are extremely high.
