inflammatory medication, and close follow-up may be necessary A soft cervical collar and NSAIDs may provide comfort If the onset of torticollis is acute and the patient does not respond to the above measures, diagnoses may include benign paroxysmal torticollis in infants and migraine headache in older children Other diagnostic considerations include pneumomediastinum, Grisel syndrome, and IDC which can be identified through further laboratory and imaging studies In conclusion, neck stiffness and/or malposition may indicate a wide array of medical and traumatic conditions, from life threatening to relatively benign A careful examination must be performed to exclude the presence of spinal cord involvement Trauma, space-occupying lesions, and infections are the most important causes of neck stiffness in children, and a thorough history and physical examination will help guide the evaluation and decision making Suggested Readings and Key References Beier AD, Vachhrajani S, Bayerl SH, et al Rotatory subluxation: experience from the Hospital for Sick Children J Neurosurg Pediatr 2012;9(2):144–148 Bochner RE, Gangar M, Belamarich PF A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscess Pediatr Rev 2017;38(2):81–92 Cheng JC, Tang SP, Chen TM, et al The clinical presentation and outcome of treatment of congenital muscular torticollis in infants—a study of 1,086 cases J Pediatr Surg 2000;35(7):1091–1096 Chi H, Lee YJ, Chiu NC, et al Acute suppurative thyroiditis in children Pediatr Infect Dis J 2002;21(5):384–387 Cirak B, Ziegfeld S, Knight VM, et al Spinal injuries in children J Pediatr Surg 2004;39(4):607–612 Dai LY, Ye H, Qian QR The natural history of cervical disc calcification in children J Bone Joint Surg Am 2004;86(7):1467–1472 Fafara-Les´ A, Kwiatkowski S, Maryn´czak L, et al Torticollis as a first sign of posterior fossa and cervical spinal cord tumors in children Childs Nerv Syst 2014;30(3):425–430 Fernandez Cornejo VJ, Martinez-Lage JF, Piqueras C, et al Inflammatory atlanto-axial subluxation (Grisel’s syndrome) in children: clinical diagnosis and management Childs Nerv Syst 2003;19(5–6):342–347 Leonard JC, Browne LR, Ahmad FA, et al Cervical spine injury risk factors in children with blunt trauma Pediatrics 2019;144(1):e20183221