Torticollis: A Consequence of Neonatal Abstinence Syndrome?

William T. Basco, Jr., MD, MS


July 19, 2018

Torticollis and Neonatal Abstinence Syndrome

McAllister and colleagues[1] observed some interesting characteristics in infants treated for neonatal abstinence syndrome (NAS) after birth. Upon follow-up, many of these infants exhibited torticollis and plagiocephaly, requiring further intervention and therapy. This finding prompted them to examine torticollis diagnoses at a regional level to determine whether a history of NAS was associated with postnatal torticollis.

The data derived from a single referral clinic in the Ohio and northern Kentucky region where follow-up takes place for babies diagnosed with NAS after birth. All infants with torticollis and a history of NAS who were seen in the clinic between 2012 and 2016 were identified, and the final analytic group included 783 infants who met the inclusion criteria.

Overall, 87 (11.1%) of the NAS group were diagnosed with torticollis, and two thirds of those infants also had plagiocephaly. The infants were diagnosed at a mean age of 3 months, and slightly more were boys (56.3%). Two reference groups were used in comparison with study infants. First, nationally representative data (last published in 1994[2]) suggested that the general prevalence of torticollis should be less than 2%. Second, a cohort was assembled from infants seen during the same study years at affiliated ambulatory pediatric clinics in the same referral region. Among this group of infants, 3.6% had torticollis. This demonstrated that the rate of torticollis among babies with NAS seen in the referral clinic was still three times higher than that of the regional infant population. Awareness of the association can help practitioners identify torticollis in infants affected by NAS, and potentially intervene earlier.


Rates of both torticollis and plagiocephaly have increased since the implementation of "back to sleep" (now called the "safe to sleep" campaign in the early 1990s.[3] This could explain the differences in background rates of these conditions between the regional 2012-2016 cohort and data published before 1994. Torticollis developing in > 10% of the NAS group is a remarkable finding, but it's worth noting that this was a referral population, and it's hard to know how much that fact could influence the findings. Babies who had NAS and attended follow-up could differ from the general population of babies with NAS. But even if the increased torticollis risk among infants with a history of NAS is only twice that of the general population, a torticollis rate of 6%-7% range should certainly grab anyone's attention. So, we need to add risk for torticollis to the larger basket of concerns about motor and cognitive development among infants with a history of NAS.


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