Causes of vertebral displacement in a child
Most often, displacement of the cervical vertebrae occurs as a result of birth trauma.
The displacement of a vertebra is correctly called a subluxation. One or more vertebrae are displaced from their places, but without rupture of ligaments and muscles. This can occur in any part of the cervical spine, but the most vulnerable is the articulation of the atlas and the axial vertebra. This joint is one of a kind; it is subject to heavy loads when the head rotates. Its complete dislocation can cost the patient his life.
The most common types of subluxations in newborns:
- Rotational – associated with a sharp turn of the head in any direction. The neck takes a forced position, most often turning in one direction and tilting in the other, or just turning.
- Active - occurs due to an insufficiently tight connection between two adjacent vertebrae, the head can take any position, movement is painful.
The reasons for this phenomenon are congenital defects of connective tissue or incorrect actions of obstetricians during childbirth. The baby can get injured in the first days and months of life if parents allow themselves to treat him too harshly. A combination of several factors is possible - with congenital defects, displacement may not occur immediately, but it will easily develop against the background of any sudden impact.
In children beyond infancy, the main cause of subluxation is injuries during active games and sports.
There are several riskiest periods. When the baby begins to explore the world around him and tries to get out of the crib, he may fall to the floor upside down. The second period is 3-4 years, when the child learns to run and climb, then early school age, when children are often left unattended for a long time, and adolescence, which is conducive to active games and breaking prohibitions.
Causes of damage
The period of gestation and birth of a baby is an unpredictable time, during which it is very difficult for doctors to correctly predict the behavior of the mother and her baby. The causes of cervical spine injuries may be related to failures on both sides. All reasons can be combined into two large groups: internal and external.
The causes of injuries caused by the mother may be as follows.
- Age. At a more mature, or, on the contrary, too young age, there is a high risk of injury to the newborn.
- The effect of hazardous substances on the body. This may be due to living in an area with an unfavorable environmental climate or near chemical plants, or if the woman has worked in hazardous conditions.
- Active toxicosis.
- Post-term childbearing.
- Disease and infection of the genital organs.
- Narrow pelvis.
- Genital pathologies, which include: vaginitis, salpingitis and endometritis.
- Venereal diseases.
- Diseases of the cardiovascular system.
- The small uterus or its cervix and body bend forward, resulting in an acute angle.
The expectant mother should carefully monitor her health and often consult a doctor to avoid such problems.
Often there are problems with the fetus that provoke injuries to the spinal cord. Among them are the following.
- Premature birth.
- The fetus is large, which makes it difficult to pass through the pelvic opening.
- Incorrect position of the child, i.e. feet down. Correctly, the head should be at the bottom.
- Hypoxia (some organs and tissues receive insufficient oxygen).
- Asphyxia, which appears as a result of entanglement, which provokes changes in the cervical vertebrae.
- A small amount of amniotic fluid.
And this is not the entire list of reasons that contribute to neck injuries in an infant. Prolonged or, on the contrary, protracted labor, weak and hyperactive labor process most often provoke injuries.
Manifestations and danger of displacement
A child's unreasonable crying and poor sleep are reasons to have the baby checked by a traumatologist or orthopedist.
The first signs of displacement do not appear immediately. The baby's head is more mobile than usual, but unless the parents have enough experience, they will not notice this. A forced position or uneven mobility of the head does not always occur, so they cannot be considered a reliable diagnostic sign.
The first sign by which parents may suspect something is wrong is the baby’s behavior. The child cries and sleeps poorly, does not suck the breast and bottle well. Whims occur for no apparent reason - the baby is fed, in a clean diaper, warm, and outwardly healthy.
About 1.5-2 months, when children begin to hold their head up, the sick child does not do this on time and lags behind his peers. You can notice a difference in weight - a baby suffering from displacement gains weight worse. The more time passes, the more noticeable the lag is - first in growth and activity, then in mental development.
In older children, the signs of displacement are more pronounced - the head is in a forced position due to dislocation or because this is the only position when pain is minimal. Movements of the head are painful, but at the same time its mobility is abnormally large, sometimes asymmetrical. For example, when turning left, a child can look behind himself, but when turning right, mobility is normal or reduced.
The possible consequences of displacement of the cervical vertebrae in a child depend on how quickly measures were taken. If the injury is treated quickly, there are no negative consequences. If left untreated, the blood supply to the brain and the innervation of the arms and chest provided by the cervical nerves will gradually deteriorate. This is expressed by tingling in the fingers, impaired fine motor skills, and chest pain. Brain hypoxia leads to emotional instability, decreased performance, drowsiness, and poor performance.
In the long term, subluxation has an extremely negative effect on the mental and physical development of the child.
Consequences of birth damage
Even if the vertebrae of the neck are slightly injured, the damage will affect the child’s future life. In the worst case scenario, the spinal cord ruptures and the baby dies. But most of the consequences of injury manifest themselves in the form of cerebral palsy, decreased sensitivity, and loss of limb mobility.
The first signs of violations are invisible at first. But this does not mean that they do not exist at all, and the child recovered from the trauma he suffered.
Terrible, irreversible problems can arise in the SHOP due to birth trauma.
Under the best circumstances, poor blood circulation in the brain occurs, causing the child's mental abilities to slow down compared to his peers. Difficulties may arise later, when the child goes to school. At this time, as a rule, parents do not even realize that the cause lies in a neck injury.
Problems may appear as:
Diagnosis and treatment
An image of the cervical spine in an infant after a natal injury.
To identify a displacement of C1, C2, C3 or another cervical vertebra in an infant, two main methods are used - examination and MRI. The queue for instrumental examination can be quite long, so the doctor sometimes prescribes treatment without waiting for the analysis, only according to the examination data, and then adjusts it. This allows you not to waste time.
In schoolchildren and adolescents, X-rays are used for diagnosis - it allows you to see the displacement of the vertebra without dislocation or fracture. In infants, this method is used extremely rarely to avoid radiation exposure.
The main method of treatment is the Gleason loop. This is a device that fixes the neck in the desired position and stretches it. Infants use the exercise machine with the help of their parents, older children can perform exercises under the supervision of adults, and teenagers practice independently. Exercises with a Glisson loop in water give a good effect, if possible. Duration – 10-15 minutes a day. The result is that the neck muscles learn to support the spine in the correct position that it occupies.
General massage reduces muscle tone and restores the position of the vertebrae
To enhance the effect, the child is prescribed physical therapy. He does the exercises himself or his parents do it (for infants). The goal is to increase muscle tone so that they can hold the spine in the correct position. They enhance the effect of the Gleason loop and can be performed at home.
Massage and manual therapy are ways to restore normal muscle tone and relieve excess tension. Mechanical placement of the vertebra into the appropriate place also occurs. All these manipulations must be done by a specialist, otherwise there is a risk of damaging the neck. Parents can learn the basics of massage and use it to maintain the effect.
During periods when the child is not performing treatment procedures, he is recommended to wear a Shants collar. The duration of wearing depends on the amplitude of the displacement and the effectiveness of the treatment. The more the vertebra is displaced and the worse it is adjusted, the longer you need to wear the collar during the day. In severe cases, the small patient is prescribed to wear a plaster splint. This is done after the vertebrae have returned to their normal position.
The prognosis with timely initiation of treatment is favorable - the neck returns to its normal state, no consequences remain. If treatment is started late, the spine can be straightened, but neurological symptoms often remain.
Can a C-section prevent injury?
Cesarean delivery rarely results in cervical trauma. At first glance, it may seem that unnatural childbirth is a cure for trauma, but this is not entirely true. Injuries during caesarean section can occur due to the following reasons:
- Caesarean sections are not performed on women in excellent health;
- not prescribed to women who can easily give birth on their own.
It is a mistake to believe that a cesarean section can help avoid problems with a newborn’s cervical spine.
A caesarean section is prescribed in cases where a threat to the baby’s life is detected. Even at the time of surgery, the fetus is subjected to mechanical stress. To extract the baby, an incision is made in the uterus measuring 25 cm in length, despite the fact that the baby's shoulders reach approximately 35 cm or more. As a result, obstetricians must deliver the newborn using their own efforts. When the fetus moves through the birth canal of the mother, all its organs, including the lungs and heart, automatically work in the body. If the child is removed through surgery, such processes do not occur. Therefore, obstetricians start the functioning of organs through other methods that can affect the baby’s nervous system.
According to statistics, a caesarean section is considered as dangerous as a natural birth. In many cases, babies born this way are diagnosed with skull trauma, displacement of the vertebrae in the neck and blood flow into the eyeball. Therefore, it can be argued that it is almost impossible to avoid birth damage with surgical intervention.
Prevention of vertebral displacement in children
Older children need to monitor their posture if there has been a previous neck injury.
To avoid displacement of the cervical vertebrae in newborns and not to treat them, you need to prepare for childbirth, undergo regular examinations and treat emerging pathologies. The main responsibility during childbirth lies with the medical staff - improper medical care is dangerous for the baby.
For parents of older children, the main means of prevention is to monitor their behavior. The older the child, the more important it is for him to know and follow safety rules, regardless of whether he is supervised by adults. It is also the parents' responsibility to explain these rules. A careful child is unlikely to get into a dangerous situation and get hurt.
Signs of torticollis in newborns
Signs of torticollis in an infant can be noticed not immediately after birth, but by 2-3 weeks of age. If the violations are minor, then it is possible that only the doctor will notice them. There is no need to try to justify seemingly minor changes; if you have the slightest suspicion, come and see a doctor for an examination.
Closer to the first month, the muscles in the neck area become denser. As a rule, the process is observed on one of two sides and the pathology gradually worsens. When the muscle is felt, the baby begins to wince and show dissatisfaction. Attempts by adults to turn the head in the other direction do not bring results or cause pain in the baby. In case of serious disorders, the head deviates towards the affected neck, and the face turns towards the healthy muscle. And this position of the head becomes permanent. If nothing is done, the muscles may gradually atrophy. It is possible to develop defects of the skull - asymmetry and smoothing on the affected side. In some cases, the shoulder rises and the shape of the eye changes. Possible cervical scoliosis.
The main method for diagnosing torticollis is a thorough examination by an orthopedist, external assessment, and palpation of the muscles.