What are the discharge instructions for an 11-year-old patient with torticollis?

Discharge Instructions for 11-Year-Old with Torticollis

Provide multimodal analgesia with NSAIDs as first-line therapy, initiate heat therapy and gentle stretching exercises, ensure written discharge instructions at an appropriate reading level, and schedule follow-up within 1-2 weeks with clear return precautions for neurological red flags. 1

Immediate Pain Management

• Administer NSAIDs (ibuprofen or naproxen) as first-line agents for pain control and inflammation reduction 1
• Consider acetaminophen for additional pain relief during the first 24-48 hours 1
• Avoid benzodiazepines for muscle relaxation as they are not recommended for musculoskeletal pain conditions 1
• For severe pain cases, a short course of oral corticosteroids may be considered to rapidly reduce inflammation 1

Home Care Instructions (Must Be Written)

Critical: Provide written instructions as patients rarely remember verbal discharge instructions alone 2

Heat Therapy and Positioning

• Apply heat to the affected neck area for 15-20 minutes, 3-4 times daily to relax tense muscles and improve blood circulation 1
• Ensure proper positioning during rest and sleep to prevent worsening of symptoms 1
• Avoid positions that exacerbate the head tilt 1

Stretching and Exercise Program

• Begin gentle stretching exercises to gradually restore normal range of motion 1
• Implement supervised postural exercises focusing on gentle stretching and strengthening of neck muscles 1
• Avoid aggressive manipulation or forced movements 1

Red Flags Requiring Immediate Return to ED

Parents must understand these warning signs warrant urgent evaluation:

• Progressive neurological symptoms including weakness, numbness, or tingling in arms or legs 1
• Signs suggesting spinal cord compression 1
• Fever with persistent torticollis (may indicate inflammatory process such as retropharyngeal abscess, cervical adenitis, or atlantoaxial subluxation) 3
• Worsening pain despite medication 1
• Inability to move the neck at all or severe restriction developing acutely 4
• New onset headache, visual changes, or altered mental status 3

Note: Posttraumatic torticollis requires strict follow-up as atlantoaxial subluxation can lead to permanent deformity 4

Follow-Up Care Coordination

• Schedule appointment with primary care physician or pediatric orthopedist within 1-2 weeks to assess response to conservative management 5
• If no improvement within the first week, consider referral for physical therapy evaluation 1, 5
• For cases not responding to conservative management within 3-6 months, specialist evaluation may be needed 5

Special Considerations for This Age Group

• At 11 years old, if this represents congenital muscular torticollis that was previously undiagnosed, surgical release may ultimately be required if conservative management fails 6, 4
• Ensure ocular causes have been ruled out, as eye muscle weakness can present as torticollis 1
• Consider imaging if no improvement with initial management or if neurological symptoms develop 1

Activity Restrictions

• Avoid contact sports or activities that could result in neck trauma until cleared by physician 4
• May attend school but should avoid physical education class until follow-up evaluation 1
• Limit screen time and activities requiring prolonged neck positioning 1