Torticollis is sometimes referred to as “wry neck.” The child’s head is tilted to one side with the face turned slightly to the other side. When it occurs during infancy, torticollis is usually not visible at birth but appears a week or so later. The cause is not clear but the problem is usually an excessive tightness in one of the neck muscles. The treatment is usually a careful stretching program. In many cases the deformity will correct with this treatment. If the problem is ignored until the child is older than one year, a stretching program is not likely to be effective, and surgery is usually necessary.
A similar condition may develop acutely in an older child, and it will typically disappear over a few days. Rest, local heat, pain relievers, and possibly physical therapy may be helpful once a physician has confirmed the diagnosis. There are a number of possible causes of this condition, including inflammation or infection in the neck and throat, as well as injury. It is important to have the child checked by a physician to make a diagnosis and initiate appropriate treatment.
Scoliosis is an abnormal curvature (usually sideways) of the spine, most commonly seen in adolescent girls but occasionally found in boys. The cause of this curvature is not known, but it seems to be associated with the growth spurt that takes place around puberty. Often the problem is picked up in school screening programs when the child bends forward at the hips while the examiner looks along the spine. If the ribs on one side appear higher than those on the other, scoliosis may be present. An X-ray is the best way to confirm the presence of a spinal curvature, from which the doctors can measure the degree of curvature.
Usually more than one curve is present. One of the curves is considered the main or primary curve, and the other is called the compensatory or secondary curve. If the primary curve is less than 25 degrees, the child is watched carefully, and an X-ray is usually taken every six months during the growth spurt. Curves greater than 25 degrees may require a brace to prevent the curve from worsening. (It is not intended to reduce the size of the curve.) Bracing is not always effective, however, and sometimes the curve continues to worsen. If the curve exceeds 40 to 50 degrees, surgery is usually recommended. The surgery is designed to decrease the size of the curve and fuse the spine to prevent the curve from increasing again. Steel rods are usually inserted along the spine to hold it straighter while the fusion becomes solid. After the fusion is solid (usually twelve months or more after surgery), the child can return to normal activities.
Kyphosis (or “roundback”) is an accentuation of the normal curvature of pine. Usually this is first noted early during the scene (between ages ten and fifteen) and often simply re-from bad posture. More severe cases are associated with e-shaped vertebrae, a condition known as Scheuermann’s disease. This is treated with an approach similar to that taken with scoliosis. If the deformity is less than 45 degrees the child is taught sitting exercises and watched carefully. If the curve is between 45-70 degrees, bracing is used. Once the curve exceeds 70 degrees, it is usually needed to correct it.
One of the more common causes of back pain in children is spondylolysis defect in a vertebra that may allow it to slide forward onto the one below (condition called spondylolisthesis). Treatment may include rest, and anti-inflammatory medication. If pain persists despite conservative treatment or if the gradual slipping of vertebra onto the other worsens, surgery may be necessary to stabilize that segment of the spine.