In wryneck, also called torticollis, the child holds the head to one side because of problems with the sternocleidomastoid muscle, at the front of the neck. This muscle is sometimes injured at birth and becomes shortened as a result of the injury. Children with this problem may develop neck pain as they get older and their muscles try to compensate. Wryneck in older children is usually due to an injury to a neck muscle, such as from carrying a heavy backpack on one side.
Neck muscle injury is the most common cause of neck pain in children. If the pain is severe, there may be muscle spasm, forcing the child to hold the head tilted to one side for comfort. Pain due to irritation of the sternocleidomastoid muscle radiates into the front of the chest. In contrast, pain due to irritation of the trapezius muscle radiates down into the middle of the back and out toward the shoulder on the affected side. The child may go to bed at night without complaint but wake up the next day stiff and sore, unable to straighten the neck.
The muscles of the neck may also become inflamed by severe sore throat, resulting from infections in the tonsils and infections or other causes of irritation elsewhere in the nose and throat. Similar problems may result from irritation of the jaw, producing spasm of the muscles where the neck and jaw meet. Any child in whom this is a persistent problem without explanation should be evaluated by an ear, nose, and throat specialist (otolaryngologist).
There are congenital bone problems that affect the neck, such as Klippel-Feil syndrome. These are easily diagnosed on X-ray. Other bone problems such as osteoid osteoma (see "Knee Pain") may occur in the neck with findings identical to when they occur lower in the back. Herniated discs (see "Back Pain") and infections may also occur in the neck. It is important to recognize that these problems may initially be reported as headaches and not recognized as coming from the neck.
While spondyloarthropathies predominantly affect the low back, in some children they cause neck pain. In most but not all cases, these children will have previously been recognized to have involvement of multiple joints.
Certain forms of juvenile arthritis commonly lead to problems with the bones in the neck. These children have limited neck motion (often they cannot look up or down or turn their heads from side to side without moving their backs). In some cases, this loss of motion is associated with pain, but more often it occurs gradually and the patient is not immediately aware of the problem.
Any child with prolonged, severe, or unexplained neck pain should be thoroughly investigated with a complete physical examination. If the problem is persistent and the answer has not been found, consideration should be given to evaluation by a neurologist, an ear, nose, and throat specialist, a neurosurgeon or orthopedist who deals with neck problems, and a rheumatologist.
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