Reflux symptom burden and duration of physical therapy in infants with congenital muscular torticollis: Prospective cohort analysis

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OBJECTIVES: To determine the prevalence of provider-diagnosed gastroesophageal reflux disease (GERD) and clinically significant reflux symptoms in infants evaluated for congenital muscular torticollis (CMT) and their association with physical therapy duration. METHODS: In this prospective cohort, 323 infants <12 months of age were enrolled and evaluated by physical therapists for CMT management. GERD status was established by medical record documentation and/or an infant gastroesophageal reflux questionnaire revised (I-GERQ-R) score >16. Demographic, clinical, and musculoskeletal characteristics were compared between infants with CMT alone and those with CMT plus reflux. Outcomes included time to achieve midline head posture, time to treatment discharge, and changes in I-GERQ-R scores over time. RESULTS: GERD was identified in 93 infants (28.8%). Baseline demographic and musculoskeletal characteristics were similar between groups. The I-GERQ-R identified an additional subset of infants (5.6%) with clinically significant reflux symptom burden beyond those with a prior provider diagnosis. Head posture and muscle function improved gradually in both groups. Median time to discharge did not differ significantly; however, infants with CMT and reflux had a longer median duration of physical therapy (144 vs. 119 days, p = 0.08). I-GERQ-R scores decreased significantly over time in infants with (15-5; p < 0.0001) and without (8-4; p < 0.0001) reflux. CONCLUSIONS: Reflux symptoms were common among infants with CMT and were associated with a modestly longer duration of physical therapy. Although this association should not be interpreted as causal, awareness of reflux symptoms during CMT evaluation may inform counseling regarding the anticipated course of therapy.

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