Red flags present Choose any
fever midline spine tenderness numbness or weakness in both arms or the legs headache with neck stiffness trouble swallowing or drooling
Red flags absent Choose any
feverDefault midline spine tendernessDefault numbness or weakness in both arms or the legsDefault headache with neck stiffnessDefault trouble swallowing or droolingDefault
Exam Choose one
Full strength and sensation in the armsDefault
Assessment Choose one
Likely muscular neck strainDefault Likely acute torticollis from muscle spasm Likely burner (stinger) from a stretch injury of the nerves to the arm Neck pain with features that need further evaluation
Imaging Choose one
Exam reassuring; x-ray deferred after shared decision makingDefault No imaging needed given no midline tenderness, a normal neurologic exam, and no high-risk mechanism Cervical spine x-rays (3 views) ordered given midline tenderness X-rays without fracture or malalignment
Labs Choose any
CBC, CRP, and ESR ordered
Plan Choose any
Heat, gentle stretching, and range of motion exercisesDefault Stay active as tolerated, avoiding activities that cause painDefault
Sports Choose any
No contact or collision sports until full strength, sensation, and neck motion return
Collar Choose any
Soft collar for comfort only
Physical therapy Choose any
Physical therapy referralDefault
Referral Choose one
Orthopedics referral Sports medicine referral
Disposition Choose one
Sent to the emergency department given numbness or weakness concerning for a spinal cord injury Sent to the emergency department given headache with neck stiffness, concerning for meningitis Sent to the emergency department given neck pain with trouble swallowing, concerning for a deep neck infection
Follow-up Choose one
if worsening or not improvingDefault in 1-2 days in 2 weeks after the results after the specialist visit
Counseling paragraph Choose one Paragraph
Most neck pain in children and teens comes from a muscle strain or spasm and improves over several days to a few weeks. Recommended supportive care with heat and tylenol or motrin as needed, with an emphasis on gentle stretching and staying active. Return precautions given including fever, numbness, tingling, or weakness, trouble swallowing, headache with a stiff neck, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.Default A wry neck from muscle spasm usually loosens over a few days to a week. Recommended supportive care with heat and tylenol or motrin as needed, with an emphasis on gentle stretching toward the tight side as comfort allows. Return precautions given including fever, numbness, tingling, or weakness, trouble swallowing, headache with a stiff neck, a tilt that is not improving, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions. A burner is a stretch or pinch of the nerves to the arm; symptoms usually clear within minutes to days, and the nerves are easier to injure again until they fully recover. Recommended supportive care with ice to the base of the neck and tylenol or motrin as needed, with an emphasis on no contact sports until strength, sensation, and neck motion are back to normal. Return precautions given including numbness or weakness that comes back, symptoms in both arms or the legs, neck pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions. The findings today need further evaluation, and the plan will be updated with the results. Recommended supportive care with tylenol or motrin as needed, with an emphasis on rest from sports and activities that cause pain. Return precautions given including fever, numbness, tingling, or weakness, trouble swallowing, headache with a stiff neck, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
Counseling Not in the note with these choices
Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.
Note when inserted as is
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Neck pain
• No fever, midline spine tenderness, numbness or weakness in both arms or the legs, headache with neck stiffness, or trouble swallowing or drooling
• Full strength and sensation in the arms
• Likely muscular neck strain
• Exam reassuring; x-ray deferred after shared decision making
• Heat, gentle stretching, and range of motion exercises
• Stay active as tolerated, avoiding activities that cause pain
• Physical therapy referral
• Follow up if worsening or not improving
Most neck pain in children and teens comes from a muscle strain or spasm and improves over several days to a few weeks. Recommended supportive care with heat and tylenol or motrin as needed, with an emphasis on gentle stretching and staying active. Return precautions given including fever, numbness, tingling, or weakness, trouble swallowing, headache with a stiff neck, pain that keeps getting worse, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.