Definition

• Pain or discomfort in the back, side or front of the neck
• Stiff neck (limited range of motion) is also common
• Includes minor muscle strain from neck overuse

Health Information

Causes

• In teens, new neck pain is mostly from strained neck muscles (muscle overuse).
• The most common modern cause is working with the head down in a flexed position. Such head tilting occurs with texting or looking at smart devices.
• Other triggers are sleeping in an awkward position or fixing something on the ceiling. Reading in bed or working on a computer for hours can also be causes.
• At all ages, it can be from a swollen lymph node. That can cause spasm of the neck muscle it lies against.
• Pain in the front of the neck often is from a sore throat. It can also be from a swollen lymph node.

Symptoms of Strained Neck Muscles

• The head is often cocked to one side
• Can’t bend the head backward or put the chin to each shoulder. Usually bending it forward is not limited.
• The neck muscles are often sore to the touch

Pain Scale

• Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

Care Advice

1. Overview:
   • Most new neck pain is from stretching and turning the neck muscles too much.
   • This causes strained muscles (also called muscle overuse).
   • Long periods of looking down is the most common cause of unexplained neck pain in back. Seen mainly with texting or using other mobile devices.
   • Looking up or to the side for too long is also a common trigger.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
3. Cold Pack:
   • During the first 2 days, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the sore muscles for 20 minutes.
   • Repeat 4 times on the first day, then as needed.
   • Reason: Reduces pain and any spasm.
   • Caution: Avoid frostbite.
4. Heat Pack:
   • If pain lasts over 2 days, put heat on the sore muscles.
   • Use a heat pack, heating pad or warm wet washcloth.
   • Do this for 10 minutes, then as needed.
   • Caution: Avoid burns.
5. Sleep:
   • Sleep on the back or side, not the stomach. Sleeping face down puts the most stress on the neck muscles.
   • Sleeping with a neck collar helps some people.
   • Use a foam neck collar (from a drug store). If don’t have one, wrap a small towel around the neck.
   • Reason: Keep the head from moving too much during sleep.
   • Do this for a few nights.
6. Stretching Exercises:
   • Protect the neck for 48 hours.
   • Then start a gentle stretching program.
   • Improve the tone of the neck muscles. Do 2 or 3 minutes per day of gentle neck stretches.
   • Touch the chin to each shoulder. Hold for 10 seconds.
   • Touch the ear to each shoulder. Hold for 10 seconds.
   • Move the head forward and backward.
   • Don’t apply any resistance during these stretching exercises.
7. Prevention of Strained Neck Muscles:
   • Avoid triggers that overstress the neck muscles. Common triggers are listed below:
   • Keeping the neck turned or bent for a long period of time. The most common cause is bending forward to text or look at a mobile device. Another example is painting a ceiling.
   • The neck likes to keep the head in a neutral position because it is heavy (12 pounds or 5.4 kg).
   • Carrying heavy objects on the head
   • Carrying heavy objects with one arm (instead of both arms)
   • Standing on the head
8. What to Expect:
   • New neck pain without a reason most often goes away in a few days.
   • Neck pain from muscle overuse (strained neck muscles) goes away in 1 to 2 weeks.

Call Your Doctor If

• Neck pain becomes severe
• Pain starts to shoot into the arms, upper back or legs
• Unexplained neck pain persists over 3 days
• Pain lasts more than 2 weeks
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC