Pediatric myotonic squint, also known as congenital squint, primary squint, commonly known as “crooked neck”, is characterized by head tilting to the affected side, forward tilt, and face rotating to the healthy side. Clinically, in addition to the rare compensatory postural squint due to visual impairment, bony squint due to spinal deformity and neurological squint due to neck muscle palsy, it generally refers to myoclinal squint caused by contracture of the sternocleidomastoid muscle on one side. The cause of this disease is not fully understood, but it is related to injury, such as contracture of the sternocleidomastoid muscle due to bleeding from the birth canal or forceps extrusion during delivery, or ischemic change of the muscle due to obstruction of blood supply to the sternocleidomastoid muscle due to fetal malposition during delivery, or ischemic change of the muscle due to head deviation to one side in the uterus, or myositis due to infection of the sternocleidomastoid muscle during cesarean section. In addition, there is also the suggestion of abnormal development during embryonic period. The pathology of pediatric myotonic obliquity is mainly a fibrous contracture of the sternocleidomastoid muscle. Initially, fibroblastic hyperplasia and myofiber degeneration are seen, and eventually other soft tissues of the neck, such as the trapezius and deep fascia, also develop myofiber contractures due to adaptive malformations. After birth, the child can be found with a pyknotic swelling on one side of the neck (some swellings can subside on their own after six months), and later the sternocleidomastoid muscle on the affected side is gradually contracted and tense, protruding like a stripe, and its direction is consistent with that of the sternocleidomastoid muscle, and there is pain when pressing the swelling or pulling with head movement. The child’s head is tilted to the affected side, while the face is rotated to the healthy side. There is difficulty in neck movement, rotation to the affected side and lateral bending to the healthy side. In a small number of children, there are hard lumps of warty changes around the attachment point of the sternocleidomastoid muscle on the affected side of the clavicle. If not corrected in time, the head and face will be deformed in a few months, the affected side will be relatively smaller, the cranial development will be asymmetrical, and there may be compensatory thoracic scoliosis in the late stage. Treatment Treatment purpose: to correct the head distortion deformity, improve and restore the function of neck activities. Treatment principle: relaxing tendons, activating blood circulation, softening swelling and dispersing knots. Pushing and rubbing method: The child is in sitting or supine position, and the doctor applies the pushing and rubbing method to the sternocleidomastoid muscle on the affected side, using the ribbed surface of the thumb to rub, or the ribbed surface of the ring finger for 5~6 minutes. Pinch the affected side of the sternocleidomastoid muscle round trip 3 ~ 5 minutes, the force should be gentle. Pulling the neck method: the doctor holds the affected shoulder with one hand, the other hand holds the top of the child’s head, so that the child’s head is gradually pulled toward the healthy side of the shoulder, gradually elongating the affected sternocleidomastoid muscle, the amplitude from small to large, repeated several times in the physiological range. Then push and knead the sternocleidomastoid muscle on the affected side for 3~5 minutes. Finally, the procedure should be completed with lightly holding the shoulder well for 3~5 times. Caution: The earlier the treatment of pediatric oblique neck, the better, it is generally better to start treatment within 3 months of birth. For short cases, it only takes 1~2 courses of treatment, but as long as one and a half years, so you should be prepared for long-term treatment. Parents should pay attention to correcting the head position of the child. Parents should adopt the opposite direction of the sloping neck when feeding, carrying, sleeping on pillows or using toys to attract the child’s attention in order to correct the sloping neck. The child should not be held directly too early to prevent the occurrence of postural squint. Parents can press and knead the affected area with gentle techniques to make the contracted muscles relax frequently, and it is better to use medium (lubricant, etc.). Pregnant women should pay attention to pregnancy checkups and correct bad fetal position; pay attention to sitting posture during pregnancy and do not bend the waist and press the abdomen to prevent adverse effects on the fetus, which may lead to oblique neck. It is best to seek medical attention early. Acupuncture and massage physicians and orthopedic surgeons are good at treating pediatric myelopia.