Research Team Determines Co-Prevalence of Congenital Muscular Torticollis (CMT) and Gastric Reflux Disease (GERD) in Infants
By Randolph Fillmore
Congenital muscular torticollis (CMT) is a common infant postural deformity of the neck evident at birth or shortly after. CMT causes the infant’s head to tilt to one side while the neck is rotated to the other side due to a shortness in the neck muscle. The causes for CMT are unclear, but fetal mal-positioning, uterine compression and birth trauma are among the suspected causes.
It has been estimated that three in 100 infants will have CMT at birth.
According to Laura Bess, P.T., D.P.T., P.C.S., a physical therapist at Johns Hopkins All Children's Hospital, CMT is the most common reason for infants (babies that are younger than 12 months) to be referred to physical therapy.
“Treating infants with CMT comprises about 75 percent of my case load,” Bess says. “We hope to get them into treatment as soon as possible to get them normalized.”
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Bess adds that physical therapy for infants with CMT has produced good outcomes, especially with early intervention, even in infants as young as one month.
She cites treatment protocols outlined in the 2018 practice guidelines published by American Physical Therapy Association Academy of Pediatric Physical Therapy on the management of CMT. The guidelines note that the incidence of CMT ranges from 3.9 percent to 16 percent of newborns, and when treatment is initiated before age 1 month, 99 percent of infants with CMT achieve excellent clinical outcomes with an average treatment duration of less than two months. The quality of outcomes, however, decreases substantially when the initiation of treatment is delayed. If treatment is initiated at age 3 months, only 89 percent of infants achieved excellent outcomes.
Treating Infants with Both CMT and GERD
“Over the last 10 years of treating infants with CMT, I was finding that some presenting with CMT also had a history of gastroesophageal reflux disease, or what’s referred to as ‘GERD,’” explains Bess. “GERD’s symptoms may include regurgitation or vomiting, irritability, anorexia or feeding refusal, poor weight gain, painful swallowing and arching the back when feeding.”
Looking for information on the co-prevalence of CMT and GERD in infants, Bess searched the medical literature but found very few research articles that addressed the issue. A knowledge gap had been identified. “High quality research has shown that an early diagnosis of CMT and an early referral to physical therapy has the best outcome of resolving CMT,” Bess says. “However, this recommendation does not include CMT when accompanied by GERD. Our clinical experience has shown that infants receiving physical therapy intervention for CMT, but who also had symptoms of GERD, take longer to achieve a midline head posture, which is one of our goals.”
Interested in drawing attention to the prevalence of GERD in infants receiving physical therapy for CMT, Bess and her colleagues developed a poster for an upcoming research symposium at Johns Hopkins All Children’s.
Michael Wilsey, M.D., who specializes in pediatric gastroenterology, hepatology and nutrition and is vice chair of the Division of Gastroenterology in the Johns Hopkins All Children’s Department of Medicine, refers cases of CMT to physical therapy. He attended the symposium and saw the poster. He was intrigued.
“I think you are on to something,” Wilsey told Bess. They agreed to develop an observational study to investigate the prevalence of GERD in infants with CMT, compare the clinical characteristics between CMT infants with and without GERD, and identify infants with previously undiagnosed GERD.
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