Question: We had a baby recently. He is doing well, but his head is twisted to one side. The pediatrician says he has torticollis. Is this the same condition that grown-ups get and should he get botulinum toxin treatments?

Answer: The onset of cervical dystonia in early childhood is generally a different condition than in adults. Babies can be born with twisting of their necks. This is called congenital torticollis. It is not the same disease as idiopathic torticollis in adults. Congenital torticollis is usually due to shortening of the sternocleidomastoid muscle, which rotates the neck. The treatment is with physical therapy at first. This is often curative. If not, surgery may be needed in a few cases to lengthen the muscle. There are other causes of torticollis in infants. These may include a hiatal hernia (Sandifer’s syndrome – causing vomiting, feeding problems, and posturing of the neck during feeding, improving with fasting), eye muscle abnormalities (producing head tilt), lack of oxygen or high bilirubin levels during the perinatal period (producing cerebral palsy), infections of the brain (encephalitis), head or neck trauma, tumors and metabolic diseases. The infant should be assessed by a child neurologist. Most children outgrow torticollis without surgery and without permanent impairment. Few, if any, of these children will benefit from treatment with botulinum toxin.

Paul A. Cullis

Medical Advisor’s Column