This was a retrospective review of children < 18 years who presented to the pediatric emergency department with torticollis in a single center over a 6 year period.
Clinically significant underlying etiologies included infection, tumor, or atlantoaxial rotary fixation requiring surgery (AARF).
352 children with a median age of 4.8 years presented with torticollis and 59 were found to have a significant underlying etiology.
Children with infectious causes were younger and more likely to be febrile and have an elevated CRP. Infections included retropharyngeal abscess, lymphadenitis and cervical spine osteomyelitis. AARF was associated with prolonged symptoms, older age, midline tenderness and restricted motion. Tumor related cases often featured additional red flag symptoms such as headache and vomiting and symptom duration ranging from 5 days to 3 months.
References
Shemer M, Noyman S, Rimon A, Cohen N. Predictors of clinically significant underlying etiologies in children presenting with torticollis. Paediatr Child Health. 2026 Jan 12;31(2):111-119. doi: 10.1093/pch/pxaf113. PMID: 41821840; PMCID: PMC12976673.