Pediatrics Week 4-Torticollis

What is torticollis?

Tightness of the SCM muscle

T/F babies who have torticollis can have bone structure changes as a result of severe torticollis

True

What are some factor categories that result in torticollis?

Prenatal, perinatal, postnatal

How early can you palpate a nodule on the SCM?

As early as 2-3 weeks

Nodules in the ____ 1/3 of the SCM are most likely to resolve with conservative stretching

lower

What has contributed to an increased torticollis population recently?

increased baby container usage

What are some histologic changes of the SCM?

excessive fibrosis, hyperplasia, atrophy.

___% of the asymmetries for posturing is due to non-muscular causes

18

What is the time frame for best early resolution?

By 1 month

What are the 6 history items that are recommended in the torticollis CPG?

-Chronological age/corrected age at initial visit

-Age of symptom onset

-pregnancy and birth hx

-Head posture/preference and facial/head asymmetries

-Other medical conditions

-Developmental milestones

When to refer a baby back to PCP?

-Non-muscular causes of asymmetry

• associated conditions

• History of acute/late-onset torticollis at 6 months or later

• Change in infant color during neck PROM

• SCM mass that changes shape or location

• Infants over 12 months with facial asymmetry

What organ systems should you screen?

-MSK, Neuro, Integumentary, movement, GI

Red flags for torticollis babies

• Suspected hip dysplasia

• skull/facial asymmetry

• atypical presentation

• Abnormal muscle tone

• late-onset torticollis

• Visual abnormalities

• Hx of acute onset

What conditions can mimic Torticollis?

• Absence of SCM

• Benign paroxysmal torticollis

• congential malformations

• bony anomalies

• brachial plexus injury

• ocular disorders

• neurological impairments

What are red flags in the musculoskeletal system?

Fusion of cervical vertabrae, clavicle fx, congential scoliosis, c1-c2 rotary subluxation

What should you include in a MSK screening?

• atypical positions

• asymmetrical cervical vertabrae on palpitation

• acute pain response with cervical motion

• tissue masses outside SCM

• Down syndrome

• C1-C2 instability

• late onset of head tilt

What are red flag visual conditions?

Asymmetrical posturing observed, ocular apraxia, stabismus, ocular muscle imbalances, nystagmus

What are red flag GI conditions

• Sandifer syndrome

• hiatal hernia and reflux

What to screen for when it comes to GI?

• infant behavior during before and after feeds

• Arching trunk and head turning to extend away from esophagus

What are red flags for integumentary conditions?

Redness or irritation in neck folds, asymmetry, color of skin

What are neurological conditions consdiered red flag?

Brachial plexus injury, CNS lesions, astrocytomas, brain stem or cerebellar gliomas, agenesis of CNS structure, hearing deficits

What should you screen for when it comes to cardiopulmonary system?

Stridor, wheezing, SOB, cyanotic lips

At what time do you need to refer back to the physician if there is no progress being made?

4-6 weeks

What does FLACC stand for when it comes to the pain scale?

Face, legs, activity, cry, consolability

For babies with mild torticollis, how long is their care typically?

2-3 months

For babies with severe torticollis, how long is their care?

5-6 months

What are the 5 first choice interventions for CMT?

• neck PROM

• Neck and trunk AROM

• Development of symmetrical movement

• Environmental adaptations

• Parent/caregiver education

What are some supplemental interventions for CMT?

• microcurrent

• soft tissue mobs

• traditional chinese medicine massage

• KT tape

T/F cervical manipulations are recommended

False

What interventions have little evidence?

TOT collar, cervical collar

What are the 5 criteria for discontinuation of direct services?

• Cervical PROM within 5d of nonaffected side

• Symmetrical active movement patterns

• Age appropriate motor development

• No visible head tilt

• Parents/caregivers understand what to monitor as the child grows