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Neck Pain

  • Neck pain is relatively common among children and teenagers and has an adverse / negative impact on their physical and psychological health. 
  • Neck pain has a broad differential diagnosis, ranging from benign to imminently life threatening causes. Neck pain can be non-specific, but when associated with restricted movement, then inflammatory joint disease must be suspected although isolated neck involvement in inflammatory joint disease is unusual. Cervical spine arthritis which is a well-recognised complication of juvenile idiopathic arthritis (JIA) especially with late presentation or lack of access to appropriate treatment. Chronic neck arthritis in JIA often associates with a small jaw (micrognathia).
  • Trauma and infection (including meningitis) represent the most common causes  of  neck pain in the paediatric emergency department. In the majority of cases, the underlying diagnosis can be made based on history and physical examination alone. 
  • Torticollis is an abnormal twisting of the neck that causes the head to be held in a rotated or tilted position and often presents with concomitant neck pain.
  • Torticollis in children can be congenital or acquired.
    • The most common causes of acquired torticollis in children are trauma and acute infection.
    • Serious central nervous system pathologies are important causes of acquired torticollis such as posterior fossa or cervical spinal tumours.
  • Red flag features of neck pain are:
    • Symptoms of high intracranial pressure (headaches and vomiting)
    • Focal /abnormal neurologic examination 

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