Red flags & when to go in person for Torticollis (Acute Wry Neck) - Triage

Audience: pediatric

Torticollis, also known as acute wry neck, is a condition where a child's neck muscles cause the head to tilt or turn to one side. It often develops suddenly and may cause discomfort or limited neck movement. Many cases improve with gentle care and time. However, some signs mean your child should see a healthcare provider in person promptly. These include severe pain, fever, difficulty moving, or signs of infection or injury. Telemedicine can help assess mild cases, provide advice, and guide care at home. But it cannot replace physical exams or emergency care when serious symptoms occur. Knowing when to seek in-person evaluation helps keep your child safe and ensures proper treatment.

Red flags — go in person / ER

• Child has a fever above 38°C (100.4°F) with neck stiffness or severe pain — seek emergency care immediately.
• Child shows difficulty breathing, swallowing, or drooling — seek urgent medical attention.
• Child has weakness, numbness, or loss of coordination in arms or legs — go to emergency services promptly.

What telemedicine can do

• Initial symptom assessment via video or phone.
• Providing guidance on gentle neck care and home management.
• Advising when in-person evaluation is necessary.
• Answering questions and offering reassurance.

What telemedicine cannot do

• Performing a physical neck examination.
• Diagnosing serious underlying causes requiring imaging or tests.
• Managing emergencies such as breathing difficulty or severe neurological symptoms.
• Prescribing certain medications that require in-person evaluation.

What is Torticollis (Acute Wry Neck)?

Torticollis is when a child's neck muscles tighten or spasm, causing the head to tilt or twist to one side. It may happen suddenly or develop over time. It can cause discomfort and limit neck movement. Causes include muscle strain, minor injuries, or sometimes infections.

Common Symptoms

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Most children with torticollis feel better with rest and gentle care.

When to Seek In-Person Care

Certain signs mean your child needs to see a healthcare provider in person right away:

These could indicate serious conditions requiring urgent care.

How Telemedicine Can Help

Telemedicine providers can:

However, they cannot perform physical exams or emergency treatments.

Tips for Home Care

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How to prepare for your tele-visit

• Have your child’s recent symptoms and their onset time ready to describe.
• Prepare to show your child's neck movement on video if possible.
• Note any recent injuries, illnesses, or fever.
• List any medications your child is taking.
• Ensure a quiet, well-lit space for the tele-visit.
• Have a thermometer available to check temperature if needed.

After your tele-visit

• Follow the care advice given during the tele-visit carefully.
• Monitor your child’s symptoms for any changes or worsening.
• Use recommended pain relief or comfort measures as advised.
• Schedule an in-person visit if symptoms do not improve or red flags appear.
• Keep a record of symptom changes to share with healthcare providers.

FAQs

What causes torticollis in children?

Torticollis in children often results from muscle strain, minor injuries, or sometimes infections affecting the neck muscles. It can also be due to muscle tightness present at birth (congenital torticollis). Most cases improve with simple care.

Can torticollis go away on its own?

Yes, many cases of acute torticollis improve on their own or with gentle home care like rest and warm compresses. However, if symptoms persist or worsen, medical evaluation is important.

When should I take my child to the emergency room?

Seek emergency care if your child has a high fever with neck stiffness, difficulty breathing or swallowing, severe neck pain, or neurological symptoms like weakness or numbness. These signs may indicate a serious condition.

Is telemedicine safe for evaluating my child's torticollis?

Telemedicine can be helpful for initial assessment and advice for mild symptoms. It allows healthcare providers to guide care and decide if an in-person visit is needed. However, it cannot replace physical exams or emergency care when serious symptoms are present.

What treatments are usually recommended for torticollis?

Treatment often includes gentle neck stretching exercises, pain relief with safe medications, warm compresses, and avoiding sudden neck movements. A healthcare provider can offer specific advice based on your child’s condition.

Sources

1. Torticollis — MedlinePlus, U.S. National Library of Medicine.
2. Torticollis in Children — American Academy of Pediatrics.
3. Acute Neck Pain in Children — Mayo Clinic.
4. Torticollis — Merck Manuals Consumer Version.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your child shows any red flag symptoms or if you are concerned, seek prompt evaluation by a healthcare professional.