Common in teenagers, usually mild, and few see a doctorStrong evidence
Neck pain is an uncommon complaint in young children and becomes commoner through the teens, especially in girls. In Finnish national surveys of 62,677 young people, neck and shoulder pain at least once a week affected 24% of girls and 12% of boys at 14, rising to 45% and 19% at 18. In Finnish twins aged 11 to 12, 16% had neck pain at least weekly, with no difference yet between boys and girls; in another Finnish group the gap had appeared by 13 to 16. In 643 Australian 14 year olds, 34.1% of girls and 23.5% of boys had had neck or shoulder pain in the past month.
Exact figures vary hugely with the age, the time asked about and how often pain has to happen to count: from 4.6% to 92.3% for spinal pain across four European birth cohorts. The honest summary is that neck pain is common in teenagers and usually mild. Few see a doctor for it: neck problems led to 45 general practice consultations per 10,000 children aged 3 to 17 a year in England, against about 100 each for the foot, the knee and the back.
Sources 1, 2, 3, 4, 5, 6
The usual causes, and how common each isEmerging evidence
Most neck pain in children comes from the neck's muscles and small joints, though no study gives the exact share. A sudden wry neck (acute torticollis) is common: the head is stuck tilted to one side and turned to the other, and it hurts to move. Leeds' children's emergency department says most children get it from sleeping in an unusual position, often waking with it, and Alder Hey's mentions sleepovers and naps on the sofa; minor knocks, and colds or throat infections with swollen glands, can cause it too.
Swollen glands in the neck usually come from colds, tonsillitis and ear or throat infections, can make the neck sore and stiff, and go down within 1 to 2 weeks; they are rarely caused by anything more serious, such as leukaemia or lymphoma, the NHS says. Glandular fever, with a sore throat, a high temperature and swollen glands, is most common at 15 to 24. A stinger, a burning or electric arm after a tackle or fall, usually lasts seconds to minutes. A serious neck injury is uncommon even among injured children: 433 of 22,430 (1.9%) brought to US children's emergency departments after a fall, crash or blow had an injury to the bones or ligaments of the neck. In children's emergency departments, injuries and infections are the commonest causes of the neck pain doctors see, a teaching resource for doctors says, which is one reason the warning signs come first.
Sources 7, 8, 9, 10, 11, 12, 13, 14, 15
A baby's tilted head: usually a tight neck muscleStrong evidence
A baby whose head tilts to one side and turns to the other, who mostly looks one way and may find it hard to turn to feed on one side, usually has congenital muscular torticollis: a tight sternocleidomastoid, the long muscle on the side of the neck. It is common, though figures range from 3.9% to 16% of newborns because studies define it differently, and most babies feel no pain from it; some have a soft swelling in the muscle that gradually goes down, and some a flattened head. The NHS says see a GP if a baby's head is always tilted to one side or they have difficulty turning their head.
A physiotherapist teaches gentle stretches, positioning and tummy time, and with treatment most babies regain full movement. Starting early matters: in one study that a US physiotherapy guideline reports, 99% of babies who started before 1 month had excellent results after an average of 1.5 months, against 89% starting at 1 to 3 months (5.9 months), 62% at 3 to 6 months (7.2 months) and 19% at 6 to 12 months (8.9 months). The guideline also lists reasons for a doctor's check as well as physiotherapy: a tilt that starts at 6 months or older or comes on suddenly, eye signs such as wobbly eyes or a squint, unusually floppy or stiff muscles, or a head that tilts and turns to the same side.
Sources 16, 17, 18, 19
A twisted neck that isn't the muscle: uncommon, with clear cluesEmerging evidence
In 352 children seen with a twisted neck in an Israeli children's emergency department, 59 (17%) had a cause that needed treatment: an infection in 35, a stuck joint at the top of the neck in 18 and a tumour in 6. Infection went with a younger age and a fever, and the stuck joint with longer-lasting symptoms and tenderness in the middle of the neck. This is one hospital sample, read from its summary, so it overstates the risk for a child at home who woke with a wry neck and is otherwise well; it is why a fever, an injury, long-lasting symptoms or nerve signs need checking.
A painful twisted neck after a cold, a throat infection or an operation on the tonsils or adenoids should be treated as Grisel's syndrome, a rare slipped joint at the top of the neck, until proven otherwise, a 2026 review says, because early treatment prevents a fixed deformity. An abscess behind the throat is rare (0.10 to 0.22 hospital cases per 10,000 US children a year) and mostly affects children under 5: in 64 children with one, difficulty looking up (45%) and a twisted neck (36.5%) were common. Kawasaki disease is rare too (8.9 per 100,000 children under 5 a year in England), with a high temperature for 5 days or more, often with swollen neck glands. Very rarely, a twisted neck that keeps getting worse, with headaches and being sick or with unsteadiness, comes from a tumour in the spine or at the back of the brain.
Sources 20, 21, 22, 23, 24, 25, 15
Meningitis: rare, and the signs that matterStrong evidence
Bacterial meningitis is rare: about 1.5 cases per 100,000 people a year in England, most often in babies under 3 months (55.6 per 100,000). Most stiff necks in children come from the muscles; what matters is the company a stiff neck keeps. A high temperature with a stiff neck, a rash that doesn't fade under a glass, dislike of bright lights, a first fit, or a drowsy or confused child is a 999 call, the NHS says.
In children, a reported stiff neck was one of the stronger clues to meningitis (a likelihood ratio of 7.7, from 10 studies), but no single sign rules it in or out. The National Institute for Health and Care Excellence (NICE) warns that classic signs such as a stiff neck, a bulging soft spot or a high-pitched cry are often missing in babies, so a baby who is floppy, not feeding, has a weak or high-pitched cry or is hard to wake needs 999 whether or not the neck is stiff.
Sources 26, 27, 28, 29, 30, 31
Juvenile arthritis and Down syndromeEmerging evidence
Juvenile arthritis affects at least 10,000 young people under 16 in the UK, more often girls, with joints that are swollen and stiff, especially in the morning or after rest. It rarely affects the neck: the neck was involved in 3.9% of 155 children in one clinic. In 9 children whose first sign of it was arthritis in the neck, a twisted neck was the commonest symptom, diagnosis took about 7 months on average, and 7 needed specialist medicines.
In Down syndrome, extra movement at the top of the neck shows on X-rays in 10% to 27% of people, but symptoms are very rare. UK guidance advises against routine neck X-rays for children without symptoms and says they shouldn't be barred from sport, but neck pain, a tilted head, less neck movement, a change in walking, more falls, tiring on walking or clumsier hands need checking promptly (the warning signs).
Sources 32, 33, 34, 15, 35
When a scan or test helpsStrong evidence
Usually not at all: a sudden wry neck or ordinary neck pain is recognised from the story and an examination. Leeds' children's emergency department says it is extremely rare for a child with a wry neck to need tests, and a Royal Berkshire leaflet says X-rays are usually not needed.
After a head or neck injury, NICE sets out which children need imaging: neck X-rays for neck pain or tenderness after a dangerous fall or crash (more than 1 metre or 5 stairs, a dive, a high-speed or rollover crash, or a bike collision), or if the child can't turn the neck 45 degrees each way; computed tomography (CT) for a reduced level of consciousness, nerve signs, tingling in the arms or legs, or a strong suspicion of injury despite normal X-rays. A US checklist of similar signs picked out the injured children who needed imaging. Specific worries get specific tests: an ultrasound scan for a lump in a baby's neck muscle that persists; blood and urine tests and a heart scan for suspected Kawasaki disease; a blood test for glandular fever; a CT scan for a suspected abscess behind the throat; and a magnetic resonance imaging (MRI) scan for suspected arthritis in the neck. Routine neck X-rays aren't advised in Down syndrome without symptoms.
Sources 8, 36, 37, 14, 18, 24, 12, 23, 34, 35
How it usually goesEmerging evidence
A sudden wry neck usually starts to ease after a day of rest and is better within about a week, though it can take 7 to 10 days to go completely; see a GP if it isn't better within 7 days. Most neck problems improve within 8 weeks, NHS inform says. Swollen glands go down within 1 to 2 weeks, and most young people start to feel better from glandular fever within 2 to 4 weeks.
Over months and years, children's neck pain tends to come and go: of 1,756 Finnish 9 to 12 year olds followed for 4 years, 24% never had weekly neck pain, 71% had it on and off and 5% had it persistently, more often those who also had frequent other aches or signs of stress. Weekly neck and shoulder pain rose from 17% to 28% between the late teens and the mid twenties in 394 Finnish students. A baby's tight neck muscle usually resolves with physiotherapy, faster when it starts early, and the physiotherapist can refer to a specialist if there's no improvement in 3 months. No one can promise a timescale.
Sources 9, 8, 7, 11, 12, 38, 39, 18
