Neck Lump, Language Development, and ADHD – PediaCast 025

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  • Neck Lump
  • Language Development
  • ADHD
  • Torticollis



Announcer: This is PediaCast.

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Announcer: Hello moms, dads, grand moms, grandpas, aunts and uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, the pediatric podcast for parents. And now, direct from Bird House Studios here's your host, Dr. Mike Patrick Jr.


Dr. Mike Patrick: Hello everyone and welcome to PediaCast, the pediatric podcast for parents. This is Dr. Mike coming into you from Bird House Studio and I'd like to welcome everyone to the program this week. It's episode number 25 and on the old topic list we're going to discuss neck lumps, language development, ADHD and torticollis. Those are our topics this week. We do have interlude music between each of these topics and I only mentioned it because if there is a particular topic that you are interested in, if you've fast forward, and when you hear the music, and then you'll know that the next topic is coming.


Now some would say you know why would I suggest that? Because I know that parent out there are busy and you have things to do. So if there's something that doesn't interest you or you know is not relevant for you and there's a one of the topics, that a little bit later on that you're more interested, you're not going to offend me just go ahead and fast forward to the topic that you want to listen to.


Now you know if you don't have questions about of one of these topics though and you have the time, you might be interested in listening because you know we might cover some things you haven't heard before. And then if people are discussing these things even if they don't affect you, if you can sound smart.


So let's move on. First let me say, if you have a question that you'd like us to get to, contacting us easy. It's, that's the website and then you click on the contact link and you can submit your questions and comments that way. You can also email me at and of course there's our phone in line, 347404 KIDS that's 347404KIDS. Now speaking of writing in with questions boy we have really gotten a lot of listener questions. I think I'm about 35 questions that have still been unanswered. And usually when a new program comes out I have a sort of mini unsold of new ones.


Now that's fine, keep asking away and we still have a small enough audience that my goal is still to get everybody's question that I can. But it is a little bit of a dilemma because with so many questions still out there, there is a tendency to sort of short change the answers a little bit. And the problem with that is then it's just like my office practice you know I explained something for 5 minutes and then you know the nurse is knocking on the door because we have awaiting full of patients especially this time of the year.


And so I really still want to try to give the proper explanation so that parents can understand these things and not just get the answer that doesn't really make a whole lot of sense. So my goal is still to go into things with you know modern amount of detail but still get everybody's questions. And I know at some point as the audience grows we may not be able to do that, some things is going to have to give.


But for right now, we keep it like it is. Some people you know have emailed me and who also used mackintosh computers with you know congratulations on getting a Mackintosh. Let us know how it goes and that sort of thing. I have to tell you I just love my Mac and this is actually the first podcast right here that I am doing completely on the Mac because I have been using some software that I still need in my PC for but this would be the first production that is completely and totally Mackintosh. Not that you necessarily care but I am just so happy with it I had to mention it.


Of course the Mac is not the only new thing that's going to be common to our house. Today we had a little bit of snow on the ground and still had. So in my mind I have an idea of what I think this is. And this is really where we get into one of the downfalls of telephone medicine because just because Carol sought it a certain way and described it a certain way. She has a picture of what it's like in her mind and she describes it, I hear her description and I get a picture in my mind.


Now the question is, is the picture in my mind the same as the one in Carol's mind? And you know as professional you're banking on the fact that it is so that your advice you know makes sense in the context of what the problem is. But what if Carol's idea of it, if she describes it, I take the description and have the wrong impression on my mind. And then give the wrong advice because I think it's something that it's not. It's like the old game in telephone only the stakes you know are much, much higher.


So I'm going to talk about neck lumps but I would say that this sort of thing, if you're worried about it, you have to go see your doctor. Because nothing, nothing, nothing can replace your doctor feeling it with his own hands, seeing exactly where it's located, seeing something that sparks a question or two that helps with the history of the thing.


So you know the most likely thing in this case and the thing that I kind of pictured in my mind is something called a dermal cyst. And this basically, It's a cyst-like structure that's deep in the skin so it looks like, it's not in the epidermis the outer thinner layer of the skin, but the deeper skin, but it's still not so deep that it doesn't move very easily. You know usually they do move. It's just a little fluid filled cyst. Usually they're present at birth and they're small, they move around easily, again a typical location form is the back of the neck by the hair line and off to one side.


They're usually a stable size over a long period of time so you know they're about a centimeter. And to measure a centimeter, centimeter is about the size of an adult's pinky fingernail, the width of it. So that's about a centimeter you know of course you might have wide fingers or shorter fingers but you know it's just a rough cage. So it's about that size and it moves around easily. It's not tender. Usually they do disappear over time but when I say over time we're talking that it can take months or even years.


They usually do go on their own in vellum as we say in medicine. And also some fat may surround the cyst as the kid gets older and that may make it seem like it disappear. The cyst may still be there but it just maybe sort of in case in fat as kids grow and then you don't feel it as well, so it seems like it disappear.


So there's really nothing you need to do for these at all. They're not worrying some. However you know is that really what it is or is it something else because there are other possibilities. One of those possibilities is a lymph node, now remember that lymph nodes sort of act like a filter system in your body. So lymph is a fluid that gets made as plasma from blood vessels as they get into smaller and smaller capillary, sort of get squeezed out of the blood vessel and it forms lymph's.


And the knees we returned to a circulation through the lymphatic system and as it does so it passes through the lymph nodes. Well any infection or other you know agents particularly biological agents fires those bacteria in particular sort of get trapped on these lymph nodes. It's like a filter as I've said and then that's where the white blood cells come to fight the infection and that's why you get swollen glands as people say. Our swollen lymph nodes are just where the body is fighting the infection that gets filtered out through the blood.


Now in this lymphatic tissue or this lymph system you can sometimes have a situation where the bacteria, if that's what was trapped there is actually winning and then you call it a lymphangitis or an inflammation or infection in that lymph node. And those are usually tender to the touch you know are quite a bit bigger usually get a little bit bigger than the cyst hat I was talking about and those are going to require an antibiotic.


Also scalp lesions, if you have a kid who has a bad cradle cap or which is subarea oftentimes yeast can be a tribute can cause that but then some skin bacteria can get in. And again the lymph node can get big as the blood coming from the scalp gets filtered through the lymph nodes at the back of the neck. So these are things you know that can cause in a large lymph node in that area.


The lymph node usually don't last nearly as long as dermoid cysts you know they're not going to last years. Sometimes it can last a couple of months. And if it's just lymph node doing its job, that's not going to be too tender. But if it does have infection associated with it and it can be tenderer. So again if it's something that's been there for many, many, many months you know and not getting any bigger, it's unlikely that it's a lymph node that's at least anything that's significant.


But again your best bet's to have the doctor take a look. Now a tumor in that area is going to be a lot less likely, but not impossible. Now tumors are typically harder, more fixed, not so mobile, usually they're not too tender. But they do get larger you know over time and it would be an unusual place to see a tumor. But as I said not impossible so again you probably want to take your doctor to take a look.


By the way Carol, I did want to mention too that if your baby is 12 months old, in the United States we usually do well child check-ups with immunization at 12 months and then again at 15 months. So hopefully it's going to be time for you to take your baby and to see the doctor anyway and you could bring it up then. But you know if it's getting larger, it's tender or you know you're worried about it at all, just doesn't wait until the well check-up. Give your doctor a phone call. Let him know you're worried about something you want to make a sick office visit appointment going. Have him check it out. Don't browbeat him in doing the well check-up when you go in for that just wait until it's scheduled cause it's probably squeezing you in till you take a look at the neck.


But if you're worried about something there's no sense in waiting a couple of weeks you know if it's going to provide you a peace of mind. I did want to mention one other thing about neck lumps in the back of the neck and that is if it's in the mid line you do worry about meningocele and myelomeningocele. These are basically spina bifida, they're birth defects another name for the spina bifida.


Birth defects that involve the brain and spinal cord if it's meningocele it's just involves in out pocketing of the membrane that surrounds the spinal cord, if it's a myelomeningocele then some of the actual central nervous system tissue itself is inside that meningocele and they can be large, they can be small, they can happen really anywhere down the spine although the lower spine down just above the hip bones in the middle is more common place for him.


But you can see him on the back of the neck as well. Usually you know they're fairly significant and cut at birth but smaller ones are maybe some questioned as to whether that lumps is especially if it's mid line in the middle of the back of the neck you know is a meningocele. And you diagnosed that basically with CAT scanner and MRI. But so again there are potential serious things that can cause lymph at the back of the neck. But it's probably not one of those more serious things. It's probably a little cyst but again you should have it checked out.


Okay so Carol in Hongkong, have you been to the Hongkong Disney yet by any chance Carol? Just if you have, if you wouldn't mind dropping me an email and let me know how that place is. I'm kind of Disney fanatic and I'd be interested in knowing your impressions if you've been to the Hongkong Disney. Of course with the new baby at home you're probably busy. If you ever get there though let me know.


Okay, we're going to move on to language development and we'll get to that right after this.



Okay our second question comes from Debbie in Pennsylvania. She says, hi Dr. Mike, my 14-month old is impressing us by knowing what we are saying and doing it. Specifically if she picks something up and you tell her to give it to Bobby she'll go find him and give it to him. She also put in the trash or put it on the table. She doesn't talk in words yet but she gabbers all the time. She'll say mommy and daddy regularly but other than that she mimics on occasion but doesn't really talk.


Anyway, is she early on following directions like this or do I just not remembering it from my others? Alright Debbie thanks for your question. You do bring up a good point about language development. And that is the receptive language usually does come first. Now well actually, let me take a step back, really imitation comes first. You know you make a sound and then your baby makes a sound. I mean there's no meaning to that sound at first. It's just cause and effect. You know they hear it, they imitate it, and they do it. You know you may say, mommy loves you, ma ma ma mommy loves you, mommy loves you, you know. And then they say mama, it doesn't mean mommy yet. It doesn't mean daddy yet. Da da da da doesn't mean daddy. It is just the sound they're imitating.


But you know you react to that sound in a really positive way. Oh look she said mama. You said mama that's so great! And you know that of course reinforces your baby's desire to imitate because when your baby makes a sound that you just made and then you go crazy with the love and then the kisses and hey that's going to be cool.


But there's no meaning behind it yet. It's just repetition. It's just imitation, what I was trying to say. But if you imitate long enough, connections start to get made. And then it begins to have meaning. Like oh okay, like something's clicks on their brain. It's like oh yeah, mama means mommy. That means you; it's not just the sound, that's your name. So you know it does take some time. Language is like a code or like that.


I mean as they start to learn words then it translates into meaning. And that's when we say that they have good receptive language. And then once they are able to start talking and using that code you know then they're beginning to communicate. And that's more spoken language.


Now as I've said again to recap, imitation then receptive language and then language. So as I've said before the range of what is normal in this process is wide. And often follows family pattern so if their kids and your family you know who are late speakers then that's okay in your family, that's what everyone seems to do or if you know everyone else is really early in speaking and you have a kid that's really late you know then that maybe a concern whereas to the next neighbor's family if everyone was that late then it's probably not a concern.


So you have to look at it in the context of what's normal for your family. Also it's going to depend on language exposure. You know the more language that baby's are exposed to, and the more repetition, the more chances that they have for imitation, and for reaction to their imitation, then development is probably going to happen little bit quicker.


So their language exposure, their stimulation that they get is really going to help their development. Also I think there is a difference between boys and girls. You know and again this is my personal experience in the office talking. When I have kids with speech delays, it's definitely boys much more often than girls. And I think that girl's brains; the language center does develop a little bit quicker than it does in boys.


Now it doesn't mean that it's superior in the end. It's just; you know it's just that. It's their language center develops sooner as a generalization. You know certainly there are going to be some boys who talk earlier than some girls do. Also if there are older kids around oftentimes that causes, well it can do a couple of things. You know if there's a lot of other kids around, they may have earlier receptive language just because they're being exposed to more language. I mean the more people you have in the house talking to the baby the more likely it is that they're going to get it a little bit sooner.


So I think that it helps with receptive language. However, having older siblings oftentimes delays the spoken language part because they have less of a need to speak. You know if they want their bottle, there's usually some other kids that say hey Joey wants his bottle, Joey's looking for his bottle. You know or hey Joey just went poo poo, you know Joey needs a diaper you know. So there are a lot of kids when there are older children in the family lots of these toddlers are going to be a little more delayed with their speech because other people are talking for him.


So you know Debbie, sounds like things are progressing well. You know your daughter is imitating and starting to get the code and I'm sure she's just excited about that as you are. It does seem early you know you're a proud mom, and it shows through. But it does, it does seem a little bit early for her to a degree of understanding and cooperation. I mean at 14 months you know and to a degree that does speak loudly for your effort in providing her with loads of stimulation.


Now on the other hand, you know if you're a parent there and you have a 20-month old and you know they're lucky to get two words in the same hour you know. And they may listen to what it is that you're telling them to do. Oh you know twice a day maybe. Don't get too concerned. You know a parent can put in their best effort and if your child's brain isn't ready to get it then it's not going to happen. But it doesn't mean that it won't happen, it just hasn't happen yet.


So you know that doesn't mean those kids, who are delayed in their language, are going to grow up with less smarts or lower IQ. It just means that their brain, may be on a different developmental schedule. Now that what I get a digress a little bit and give you my opinion on this. It may not be a popular opinion but it's one that has merit. And it's just not being said as often as it should. And Debbie this is by no means aimed at you, in fact I appreciate your question and the opportunity that you gave me to express this opinion.


So here it goes, there's much emphasis placed on the importance of early development these days. I mean if kids aren't walking by the time they're 12 months old or they're not talking in complex paragraphs by the time they're 3, everyone's concerned and rushing to diagnose a developmental disorder particularly autism spectrum disorder, pervasive developmental disorder. But the truth is that some kids are on a slower developmental path than others. And it does not mean that the end result would be less intelligence.


It doesn't mean you're failing as a parent because you're not giving them enough stimulation if you happen to have a slow developer at home. Now are some kids delayed because of a lack of parental stimulation? Sure! Are some kids delayed because their manifesting the early stages of a developmental disorder? You bet. But the vast majority of these kids have adequate stimulation and they'll go on to develop just fine on their own schedule.


So how do you know? I mean how do you know if your child is a slow developer or if he or she is showing early signs of a problem? Well there's no easy answer to that question. I mean you have to look at your family pattern. You have to maximize the stimulation you provide. Talk to your doctor. If the delay persists and you're worried you know find out what resources are available in your community. Early intervention programs, physical therapies, speech pathology I mean all those things can help you focus your stimulation strategy so that things happen hopefully on a little bit of a quicker schedule.


But keep in mind at the end of the day that the majority of these kids are going to develop just fine. And their brain lying down connections and patterns on its own time schedule and no amount of parental or professional dragging is going to make that happen any faster.


So again Debbie in Pennsylvania thanks so much for your question. Actually Debbie's sending in 2 questions and since I kind of pick on her a little bit. I'm going to go ahead and answer her 2nd question in this episode. And we'll get to that right after this.


We're back at PediaCast and ready to answer Debbie's 2nd question which is really more of some comments but they're good ones. Again this is Debbie in Pennsylvania. She says, my 14-year old daughter, 8th grade, has just been diagnosed with ADHD. I was very surprised when they diagnosed her mostly because she is never been on a behavioral issue. I now know that acting out is not really the indicator and thought your listeners would be interested to know that also.


When the doctor started to asking me questions I quickly realized that all the little annoying things that I attributed to her personality or life situation were really indicators of a processing disorder. Always just a little late, unable to organize, avoiding activities that requires sustained thought, interrupting others, making up things just to have something to talk about changing topics frequently, complaining of classroom distractions, that sort of thing.


We begin this test now because she has always been good student until 7th grade. Then she started getting sad and distracted in class. We took her to a psychologist, oh no a physiologist I think you mean psychologist or psychiatrist maybe? I'm sorry; anyway it was someone who wanted to prescribe anti depressants. You said physiologist I think it's probably psychologist or psychiatrist. So anyway I wanted to prescribe anti depressants and have the school test her for learning disabilities.


It was nearly summer and we were hesitant on the anti- depressants so dad refused to do that. Oh I have that happened a lot. She had a great summer then after a few months of demands of 8th grade, her mood started sliding and so did her grades. The school finally tested her. Yes sometimes you have to brie beaten him into doing it. I'm sorry if you notice that some of these sides are mine. Okay.


We haven't confirmed by a doctor as well. We thought that depression was causing the grade slide but we came to find out that the lack of ability to remain focused during class and the fear of starting a project that would require sustained thought were causing anxiety and depression. Let me also, again this is me talking side here, not only would the fear of starting something that would require their sustained thought causing anxiety depression but the other thing is that Debbie's daughter probably really wants to do well.


I mean she wants to be passed. She wants to do well and knowing that she's not going to do it because she has trouble focusing and having sustained attention is going to create failure and she knows it's going to happen. Even with her best effort she knows it's going to happen and that causes the anxiety and depression that goes along with ADHD, very common.


Okay so Debbie goes on to say, so all that's said here is my question. I have always heard the ADHD is more prevalent in boys than girls. Is it possible that it is just diagnosed more often in boys because they tend to have less ability to control themselves in the classroom or structured environment. And girls tend to want to be more pleasing. I am trying to speak plainly and not trying to sexes here. I have read many articles that indicate that boys have more trouble than girls when it comes to sitting still.


As well as articles about our girls wanting to be pleasing, I have even read that boys should be allowed to do their work standing up because it aids in their ability to think since they aren't using their brains to remind themselves to sit still. Okay, what are your thoughts on any of that? The difference in boys and girls and how that impacts the early diagnosis of ADHD even if you don't want to touch that question, I think it would be good for parents to know that a child who doesn't act out, that has this other problems might have ADHD. Thanks and keep the podcast coming, Debbie.


Debbie, no great! Thanks for the question. I really appreciate it. My laughing at some point is not laughing at you. It's more of a realization and understanding of what you're talking about. When I was reading the part about the boys, just let him stand up because they're, because their brains need to move. You know and I just thought yeah, they need to stand up, they do. No question about it. Lot of boys like that.


You know I don't mind touching this question at all. For this one though, I'm not going to turn to research but rather my own practice observations with regard to ADHD in boys versus girls. First you know I don't feel like I see it in boys more than girls. I really think if I counted the numbers on how many kids that I see on a routine basis with ADHD, I really think it be about equal.


Now remember, ADHD is Attention Deficit Hyper-activity Disorder but another major component of ADHD that is not evident in the name is a problem with impulse control. So kids with ADHD think of something and then they do it, without any right or wrong filter being applied. You know it comes into their brain, bam, they said it. And an example is you know, especially in the winter when things in the office are really, really busy.


You know I have a kid, the kid and the mom's been out in the waiting room for you know 45 minutes or an hour. And then they get called back to their room and then they're back in the room for 20 minutes. I knew you've been there. I've been there. We both hate it. But you know a lot of the times, it's because parents are asking questions in as you might be able to tell. I sometimes have trouble stopping my talking.


But anyway, so I get a little bit behind and then when I walk in the room you know more of the times that I could even begin to tell you, the kid will blur out. Where do you been or what took you so long? Didn't you know that we already been here for an hour? And you know the moms just want to sort of shrink down on the chair. And then no, that is classic ADHD. It is impulse control because the mom or dads were thinking the same thing. I mean they just didn't say it you know.


But the kid with ADHD, they're going to be the ones to, it comes into their mind bang it's out of their mouth. And that goes along with impulse control. It's not just in their speech; it's in their actions as well. Now the impulses that boys have typically are different than the impulses that the girls have. Boys impulses you know, boys might be the constantly pull the hair of the girl in front of him. I mean that hair is there and bang I'm going to pull it. I see it, I pull it then I remember Oh I should have not done that.


So their kind of impulse things are more likely to be obvious, to be noticeable and results them into getting in trouble and results in them seeing their doctor and probably being diagnosed with ADHD a little bit sooner whereas girls impulses you know and again I'm not the only one. You know your examples Debbie you're saying I don't mean to be sexes in just on degree on being sexes here as well. But there is some truth to it that girl impulses, you know a girl's might be I'm going to drop pictures of a flower real quick before I start my test.


Okay no I'll just draw one more. One more little flowers, okay. Oh no I have an impulse to draw. A garden yeah let's draw a garden. And you know I'll put a little butterfly here and the sunshine, and the grass, and next thing you know, you know you spend 10 minutes drawing a picture instead of taking your test. And it's just, it's that kind of impulse issue is going to be more typical of a girl and you know to have a pretty picture on their page, they didn't finish their test. But they didn't really get in trouble because the teacher may not even have noticed that she was drawing a picture.


So I do think that boys typically sort of act out more. It's more physical, more aggressive, and that's just the difference between boys and girls. Again I'm generalizing. I mean there are girls who are aggressive in physical and there are boys drawn pretty pictures. You know but just as the generalization I think that more boys than girls get diagnosed with ADHD earlier. I mean it's noticed earlier than it is with girls. But the ends of the day I think just as many boys and girls have it. And any of my practice I probably see it in equal number.


Now has parents and teachers, and doctors sort of become savvier at recognizing all the varieties of ADHD in both boys and girls? You know I think more kids are getting the help that they deserve. So again Debbie thanks for both of your questions and you'd make some great observations and none of my laughing was directed at you.


Okay so we will and if you stick around for the end of the show, some of my laughter was just my own mistakes which if you listen at the end you'll hear those. So alright we're going to move to our final topic and we get started with that right after this.



Okay welcome back to the program. And question number 4 this week is on torticollis and this comes from Steve in Indiana. And Steve says, Dr. Mike as the first time father of a 3-month old son I find your podcast to be a great resource. Please keep up the good work! I do have a question for you when my son, 3 months old, is looking around the room, he seems to spend 90% of his time looking to his right and very little time looking straight or do his left. Any idea why he would prefer looking to his right? Thanks, Steve.


Okay Steve thanks for your question. I do appreciate it very, very much. So why would a child always look to one side especially in an infant. We're talking about a 3-month old here. Why would a baby look to one side all the time? And this is another question that deserves a visit to the doctor because there are so many things that could cause this. Really are you had to do a physical examination and ask lots more historical type of questions to get to the bottom of it? But let's look at 5 potential causes and explain what those are and what we see.


Now this is part of the most common thing and again this is one of those things you describe it. I kind of have a picture on my mind of what it is. And this would be where I will bet that it is. But again I would want to see the child before making that determination. And that is just primary infantile torticollis. And the torticollis is just a fancy name for a head turned all the way to the one side and usually it's a little bit on the stiff side. So that their neck, they have contracted strap muscles on one side of the neck. So it's not quite like a Charlie horse but that's still there. The muscles on one side are contracted down and really tight.


And so these kids, pretty much all the time have their heads turned in the direction that the muscle contraction is on. And if you try to turn their head the other way, you're going to meet some resistance. They're going to cry. They're going to act like it hurts. They're just upset. They want to look the way that they normally look. And generally what you do for this is once you determine that that's what it is, is a general stretching over time usually will end up correcting it. It may take many months for it to go away completely. Physical therapies oftentimes very helpful and encouraging the parents to do the stretching that they're supposed to do to show him how to do it properly. To give them support and encouragement you know in doing this.


It's frustrating and oftentimes there's no quick fix. But almost all the time that resolves on its own. It just may take months, and months, and months before it goes away completely. Now even though torticollis is the most common, there are other things that can do it that have to be addressed because even though they're rare, they're not nearly as common, they can be much more serious and need addressed you know a little bit more promptly. So this is again definitely something that you want to take your baby to the doctor to see.


Now one of the things that can do it is acid reflux. Now how in the world does that happen? Well this is rare but I do see it in practice from time to time which one of those things you don't see very often but every now and then you do. And that's a baby with acid reflux. They're not really spitting up that much which is why you don't always think about acid reflux right from the beginning. But basically what's happening is that some stomach acid is leaking up into the esophagus and we talked about this in past episodes.


So the valve between the stomach and the esophagus is kind of loose and some of the stomach acid is able to make its way up into the esophagus. You get, it causes heart burn, goes up into the upper esophagus and then up into the airway after that. And that results in burning and irritation. And this results in brief episodes of spasmodic torticollis. So now we're talking severe spasm on one side of the neck like a Charlie horse.


And the exact mechanism for this is unknown. But you know what the torticollis is. You know as we've described this one their heads are turned on one side. So this is just a severe case. I mean that muscles' just clamp down oftentimes they're arching their back, they're crying, they really act like they're on a lot of pain. And sometimes it's even mistaken for seizure because their head is jerked to the side, they're arching their back, they're stiff, they're crying you know. So sometimes people think it looks like a seizure.


Now in between these really severe episodes of this spasmodic torticollis, they tend to have just a milder torticollis almost like they're normal infantile one that I've talked about before and this may persist dearing in between these acute episodes. And basically with this, my feeling of it is being and again you can't ask a baby hey why are you doing this? You know you just have to kind of guess based on what you know about the situation, what's your observations are.


So I think probably what's happening is that babies are learning to keep their head to one side because it occludes the esophagus. I mean if you really twist your head over to one side you are going to be able to sort of cut off the upper esophagus a little bit. And this keeps the stomach acid from coming up and decreases their discomfort. So they kind of learn, if I keep looking straight ahead that hurts and if I look over to the side then it doesn't hurt, that kind of thing.


And so when I see a baby with a torticollis, this is one of the things that comes to mind and usually we use Zantacs or you could use prevacid, some kind of medicine that decreases the amount of acid that the stomach is making, and then over time that usually get better if that's what the cause is. By the way this does have a name. It's called sandifer syndrome, when the baby has these episodes of spastic or spasmatic torticollis in these episodes that we've discussed.


Also some ticking feeding oftentimes will help with the reflux as well and can help sort of absorb the stomach acids that is left down there. So there's not as much leaking up. Now so this is a sort of thing again, I've said this before for you don't want to diagnose this and try these things at home. You got to go and see your doctor. I mean you don't dissolve some of over the counters Zantacs 75 and a little you know juice and give it to your baby. We don't want you doing any of that when I say ticking the feedings or some rice cereal, we're not talking about putting rice crispies in your baby's bottle. And don't laugh at those things because I've seen it done.


So again see your doctor. You know it's like on the packages it says remove from package priority eating and what does that mean? You know lawn mowers, there's one I saw not for use on hedges okay. So this is a don't try it at home. You know don't give your babies Zantacs. Don't ticking their feedings without talking to your doctor and making sure that that's what's going on. Because again acid reflux, that's the cause for torticollis is not something you see every day. But it's something to keep in the back of your mind.


Vision issues could do this. You know if you have, if a baby has blindness in one eye or one eye vision compared to the others significantly different. Then the baby might actually take their head to one side as they bring their good eye toward the midline so they're really still looking straight ahead but their head is turned a little bit because their looking with their good eye.


Now this is usually more subtle than torticollis. It's not like their head really jerked over to the right, they're just kind of looking off to one side and it doesn't really seem to matter how you position him or what you do, they're always keep doing that. There's not really a muscle spasm with this. No resistance when you turn the head to the other way. They're just you know, they're just move it back to the way they wanted to be. And it's just again, so they can see a little bit better and it give the appearance that they're looking to side all the time.


So kids do that where it's not really as spastic torticollis and, but they always look to one side and I see that in the office. Usually we're for the pediatric ophthalmologist just to make sure that their eyes are okay. It would be important. Then you know there can be a structural abnormality that could cause a head to turn or cause their baby to turn their head to one side or the other all the time.


You know they can have structural problems in the cervical spine so the actual vertebrae. There can be some abnormalities that can cause it. They could have tumors and neck muscles. They could have hemangiomas which is a little collection of blood vessels in one of the neck muscles or even trauma from birth. They can have hemorrhages inside the muscle that has formed a little cyst. Those things usually go around on their own. Also the treatment is the stretching but you want to make sure that if it's a tumor you know that it's not anything that is going to be malignant.


So you know those are all possible structural issues that could cause a baby to turn their head to one side. Very large lymph nodes, a ligament tendon problems, all these are possible. They all are rare. But you know if a baby is doing it and you know parents are concerned, the doctor's concerned, imaging studies you know in that sense you know like plain films, cat scans, MRI's, cat scans are going to be good in looking at the bones. MRI's better at looking at the soft tissues, looking at the muscles, ligaments, tendons, all that things.


So some of these things as I've said are serious and require surgical intervention. Other sounds serious but really is not and typically go away over time and again physical therapies still going to be beneficial to provide the muscle stretching and prevent worsening and longer term chronic torticollis from setting in. So again does every kid looks to one side have to have an MRI of their neck, no. Again you want to talk to your doctor and it's just you know depends on what the exact clinical situation is. And what your doctor's concerned about and what sort of things are going to do,


And then finally, and this one, I saved it for last but it's probably the answer for a lot of kids. It's just habit. I mean some kids just prefer looking one way compared into the other. And what you could do is reverse the direction that they are in at night time or during their nap time so that the thing that they're used to seeing is now on the other side. When I first started doing this, when I was a resident, I remember this distinctly. You are so concerned about getting the medical part of it right and how you're explaining things to parents, and you want a make sense, and yeah you know. You're fresh out to medical school and you're young and you get the; hey you look like, how's this kind are common?


And so you know you're really paying attention to the important things and sort of your stumble over the things that seemed obvious. And I remember one time telling a mom whose baby looked one way all the time that she should take the crib and turn it. So you know turn it a 180 degrees so that it's facing the other way so that when she lays her baby down in it he'll be facing the other direction. And then when he's used to looking at all of these things on the other side maybe he'll turn his head. And she said instead of turning the crib a 180 degrees, she said why I don't just put him in the other way.


Oh yeah I guess that would be a little easier. You know you stumble over the easy stuff that you shouldn't stumble over. Okay so you want to make the other side more interesting and give him a reason to look the other way you know during play time and during nap time. So when you're down the floor plan with them you know make all the interesting things happen on the other side.


Now I do want to mention a word about flat heads with this. If you have a baby who likes to be on one side more than the other, oftentimes the head gets a little bit flat on the side that they liked to be on. And when you put babies to bed on their back, as you're supposed to do for most babies, either the back or the head can get flat as well. And all I can do you know, when I see parents who are concerned about this, it's just to offer reassurance to him. Because most of the time, these kids as they get older and they start flipping around in their sleep back and forth, in this direction, that direction and you know not lying flat on their back all the time as they get over the skull usually remodels itself just fine and everything looks really good at the end no, especially how many months are needed or anything like that.


But I did want to mention that because a lot of times babies with torticollis would get a little bit of flat to one side compared to the other because they're always turning in their head that way when they're lying down flat. I did in researching this one come across in an interesting link from the National Infant Torticollis Association. And the stuff at their website you know ranged through to my own feelings and my own training. I thought it was really well done.


I opened a link to the show notes. It's, that's T O R T I C O L L I S and then dot org. So it's and again if you go to in the show notes for episode 25 I'll provide a link there for you. So thanks Steve from Indiana, I appreciate your question and we'll be back to wrap up this episode right after this.



Alright well that wraps up episode 25 of PediaCast. I'd like to thank everybody for taking the time out of your busy day to listen the program. I really appreciate all the listeners out there. I really also want to thank my family for letting me do this crazy project cause it takes a lot of time. It really does in addition to all the hours I spent at the office so thanks to them.


Also thanks to vladstudio at for providing the art work for our website. And don't forget you can submit a question or comment and just bare with me in getting to your answers. I said before about 35 behind but I'm going to try to get everybody, really I am. And as soon as the flu rushes in you know hopefully be able to start getting out couple of programs a week.


Don't forget though, you can submit a question or comment, view the show notes, take our listeners survey and sign up for a news letter, which hasn't come out in a while. So if you signed up and you haven't got anything I'm sorry. It's just really a bad time of the year. It's so busy at the office so but I would get a news letter out soon. I'm going to; it's got to be a priority. You can also read the blog, which hasn't been updated since the middle of December but you know I'm going to get to that too folks really I am, oh boy.


So anyway all those things are available for you at And if you like PediaCast please spread the word by telling your friends, relatives and neighbors about the program. You can download free promotional materials on the poster page of our website. And reviews in iTunes are always most, most, most helpful. Probably that's one of the, you know I'm on the front page of the featured section. I really appreciate it folks at Apple and most of all the listeners out there for getting me there.


But the more reviews that you have at iTunes, the higher up you go. It's part of the formula so positive reviews in iTunes is always most, most helpful if you take the time out to do that. Also diggs in the new podcast directory at, that's digg with 2 g's. And then podcast pickle in podcast alley all those places as well but the iTunes music store usually the most important.


Okay so until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So on everybody.



Okay so, boy forgot to turn my audio monitor on, on this new recorder. Okay here we go. Yes here we go now.



Okay this is, what this, second topic language development is okay. Let's get started. Okay this question, oh wait that wasn't a very good start. Let's start it again. Okay our second question this week is from Debbie in Pennsylvania and she says hi Dr. Mike, my 14-month



Okay our second question this week is from Debbie in Pennsylvania. And she says hi Dr. Mike, my 14th month old is impressing us by knowing what we are saying and doing. Specifically if she, okay. Oh boy! By knowing what we are saying and doing it okay. She wrote it right? That's cracked. Okay let's try this again. Okay our next question comes from Debbie in. She says hi Dr. Mike, my 14th month old is impressing us by knowing what we are saying and doing. I'm sorry Debbie. You did not write this bad at all. It's me. It's all me. Let's try this again.


The tripod network. What's on?

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