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Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux
G E Phillips1, S E Pike, M Rosenthal
1Dept of Physiotherapy, Royal Brompton Hospital, London, UK.
Insights
Head-downwards physiotherapy positioning does not worsen gastro-oesophageal reflux (GOR) in infants with cystic fibrosis (CF). This study found no evidence to change current infant physiotherapy practices for GOR management.
Area of Science:
- Pediatrics
- Gastroenterology
- Respiratory Therapy
Background:
- Gastro-oesophageal reflux (GOR) is a concern in infants with cystic fibrosis (CF).
- The head-downwards tipped position during physiotherapy has been suspected to exacerbate GOR.
- Lower oesophageal pH monitoring is used to assess GOR events.
Purpose of the Study:
- To investigate whether head-downwards tipped positioning during physiotherapy exacerbates GOR in infants.
- To determine if current physiotherapy practices need modification for infants with respiratory disorders, particularly CF.
Main Methods:
- Twenty-one infants (1-27 months) with respiratory disorders (11 with CF) underwent lower oesophageal pH monitoring.
- Infants received two physiotherapy sequences (A/B or B/A) 12 hours apart, involving different positions and chest clapping.
- Physiotherapy included gravity-assisted head-downwards tipping and non-tipped positions.
Main Results:
- Head-downwards positioning did not induce or significantly aggravate GOR in either CF or non-CF infants.
- A slight, non-significant increase in reflux was observed in CF infants during one physiotherapy sequence (Episode A).
- The sitting position was more likely to show the lowest pH in CF subjects, but this did not indicate aggravated GOR.
Conclusions:
- Head-downwards tipped positioning for physiotherapy does not induce or aggravate gastro-oesophageal reflux.
- There is no evidence to support changing current infant physiotherapy methods regarding GOR.
- Current physiotherapy techniques can be safely continued for infants with CF and other respiratory disorders.
Abstract:
The head-downwards tipped position for physiotherapy has been claimed to exacerbate gastro-oesophageal reflux (GOR) in infants with cystic fibrosis (CF). This was investigated using lower oesophageal pH monitoring during physiotherapy. Twenty-one infants (age range 1-27 months) with respiratory disorders (CF=11), undergoing lower oesophageal pH monitoring were recruited. Subjects received two physiotherapy episodes in random order, A/B or B/A, 12 h apart. A began the gravity-assisted positioning head downward tip for: right lower lobe, middle lobe, left lower lobe and lingula; then supine with no tip for anterior segments of the upper lobes followed by apical segments of upper lobes in a sitting position. B was in the reverse order. Intermittent chest clapping was carried out for 4 min in each position by a physiotherapist blinded to the pH data. During episode A, the median change in pH from baseline was -0.32 (range -2.07 to +1.0) in non-CF subjects (NS) and -0.52 (range -2.7 to +0.52) in CF subjects (p<0.02). During episode B, the median change in non-CF subjects was -0.1 (NS; range - 1.7 to -0.15) and in CF subjects was -0.05 (NS; range -0.67 to +0.5). There was no order effect for positioning. In the CF subjects the sitting position was twice as likely to have the lowest pH measurement during physiotherapy than the other positions (p<0.04). In conclusion, the head-downward tipped positioning for physiotherapy treatment neither induces nor aggravates gastro-oesophageal reflux. There is no justification for routinely changing the way in which infant physiotherapy is carried out.