The high school junior woke with a sore, stiff neck, a complaint which tends to worry parents and pediatricians alike. The girl was quite sure she hadn't done anything to injure herself that week, and managed to get dressed and head off to school. She made it through each and every class, but afternoon PE really did her in.
Exhausted by evening, the student fell into a deep sleep but woke in the middle of the night to take acetaminophen for her ongoing neck discomfort. The neck pain worsened again after a fitful night in bed, prompting mom's morning call to the answering service.
In the Emergency Medical Journal, British researcher A. Natarajan and colleagues explain that while adult neck pain is often linked to degenerative diseases of the spine, the most common causes of neck pain in pediatric emergency department patients are infection, trauma, and underlying eye/vision conditions.
Since my teenage patient had no fever and no complaints of throat pain or even a cold, it seemed unlikely that her stiff neck was due to a serious infectious process such as meningitis or a tonsillar abscess. Without a history of any recent injury, significant spinal trauma was also not high on my list.
I felt comfortable telling the mom that her daughter was most likely suffering from acute wry neck or acquired torticollis, a common, very uncomfortable condition which can come on very suddenly and, if uncomplicated, takes just a few days to completely resolve.
Experts at the National Institutes of Health note on MedlinePlus that day-to-day activities are often the source of the muscle strain causing neck pain. Students who spend hours hunching over deskwork, using electronics at poorly designed work stations, slouching in front of the TV, or sleeping in awkward positions can end up suffering from uncomfortable, sore, stiff necks.
The American Academy of Orthopedic Surgeons also finds that improper backpack use can contribute to neck pain. The specialists encourage kids to carry no more than 15 percent to 20 percent of their own body weight and to use both backpack shoulder straps to more evenly distribute the pack's weight.
For minor, uncomplicated neck pain, the NIH recommends using over-the-counter pain medications and applying ice to the affected area for the first two to three days, then carefully applying heat for any additional days of discomfort. Rest and massage can also help treat neck pain, while sleeping on a firm mattress without a pillow may help avoid overnight neck strain.
The group cautions that neck pain "red flags" include severe pain, lack of response to over-the-counter pain relievers, persistence of symptoms beyond one week of home management, numbness or tingling or weakness in the upper extremities, and any accompanying complaints of swallowing or breathing difficulties.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.