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Neck Pain or Stiffness

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Definition

  • Pain or discomfort in the back, side or front of the neck
  • Stiff neck (limited movement) is also common
  • Minor muscle strain from overuse and neck injury are included
  • Pain in the front of the neck often is from a sore throat. It can also be from a swollen lymph node.

Causes of Neck Pain

  • Strained Neck Muscles. In teens, new neck pain is mostly from stretched neck muscles (muscle overuse). The most common modern cause is working with the head flexed down. Such head bending occurs with texting or looking at smartphones and mobile devices. Reading lying in bed or working on a computer for hours can trigger neck pain. The neck likes to keep the head in a neutral position. This is because the head is heavy (12 pounds or 5.4 kilograms). Other triggers are sleeping in an awkward position or fixing something on the ceiling.
  • Infected Lymph Node. At all ages, it can be from a swollen lymph node. That can irritate and cause spasm of the neck muscle it lies against.
  • Whiplash Injury. Caused by sudden movement of the head and neck. The head snaps back and forth. Neck muscles, nerves and ligaments are stretched. Can occur with a rear-end auto collision. Can also be from a sports injury. Needs to be examined.
  • Major Neck Injury (Serious). The neck protects the spinal cord. A fracture or other injury of the neck can damage the cord. Therefore, all neck injuries need to on a spine board until they are cleared.
  • Meningitis (Very Serious). A bacterial infection of the membrane that covers the spinal cord and brain. The main symptoms are a stiff neck, headache, confusion and fever. A stiff neck means your child can't touch the chin to the chest. Younger children are lethargic or so irritable that they can't be consoled. If not treated early, child can suffer brain damage.

Symptoms

  • Neck pains due to strained muscles cause these symptoms:
  • The head is often cocked to one side
  • Can't bend the head backward or put the chin to each shoulder. Often, can still bend the neck forward (touch the chin to the chest).
  • 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.

 

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When To Call

Call 911 Now

  • Pain starts after a major injury such as with contact sports or car crash
  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Fever and stiff neck (can't move neck normally)
  • Headache with fever
  • Numbness, tingling or pain in arms, upper back or legs
  • Muscles in the arms or legs are weak (loss of strength)
  • Not alert when awake ("out of it")
  • Acts or talks confused

Call Doctor or Seek Care Now

  • Pain started after a minor injury
  • Severe pain
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Can't move neck normally and no fever
  • Headache without fever
  • Fever lasts more than 24 hours
  • Age is less than 5 years old
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Cause of neck pain is not clear (no history of overuse)
  • Neck pain (from lots of turning) lasts more than 2 weeks
  • Neck pains are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Strained neck muscles (from turning or overuse) present less than 2 weeks
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Care Advice

What You Should Know About Neck Pain:

  • Most new neck pain is from stretching and turning the neck muscles too much. Muscle overuse causes strained neck muscles.
  • Long periods of looking down is a common cause of neck pain. Seen mainly with texting or looking down at other mobile devices.
  • When muscle pain starts without reason, it can be from sleeping in an awkward position.
  • Here is some care advice that should help.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.

Cold Pack for Pain:

  • During the first 2 days, use a cold pack or 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.

Use Heat After 48 Hours:

  • If pain lasts over 2 days, put heat on the sore muscle.
  • Use a heat pack, heating pad or warm wet washcloth.
  • Do this for 10 minutes, then as needed.
  • Reason: increase blood flow and improve healing.
  • Caution: avoid burns.

Sleep Position:

  • Sleep on the back or side, not the stomach. Reason: sleeping face down puts 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.

Activity:

  • Protect the neck. Avoid any activity that increases the pain.
  • Avoid any sports or work that increase the pain.
  • After 48 hours, start a gentle stretching program.

Stretching Exercises:

  • Do 3 minutes of gentle stretching exercises each day. Reason: improve the tone of the neck muscles.
  • Touch the chin to each shoulder. Touch the ear to each shoulder. Move the head forward and backward.
  • Don't apply any resistance during these stretching exercises.

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
  • Stiff neck occurs
  • Pain starts to shoot into the arms, upper back or legs
  • Pain lasts more than 2 weeks
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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