Pediatric Physical Therapy and Reflux
The children we treat have a plethora of difficulties. Due to their ages, they cannot verbally explain what they are experiencing. It is up to us to figure out what is causing them pain or discomfort. For the purpose of this article, I am writing primarily about Gastroesophageal Reflux (GER). I have had the opportunity to work with many children who suffer from GER. In some cases, the reflux was mild and actually helped bring about some gross motor skills. I have worked with other children who had more clinical implications due to GER. We will focus on one such case and interventions that helped make a difference in her daily life.
I’ve been looking for a way to have a greater impact in the world of pediatric physical therapy. I’m tired of seeing parents come to me saying that their child is in pain every day. I have seen children whose parents are so frustrated because they are at their wits end and just want to help their child to no avail. I want to help these families, families like yours who’s child is suffering, find some relief.
Let’s begin with the basics. What is Gastroesophageal Reflux?
Gastroparesis is a condition in which the stomach is unable to empty itself of food. This occurs for a variety of reasons such as diabetes, neurological disease, and even medication usage. Gastroesophageal reflux (GER) is the backward flow of stomach contents up into the esophagus or the mouth. It happens to everyone. It is both normal and non-problematic. However, for certain individuals the frequency and degree of reflux can become a source of concern.
It is important to remember that reflux is common in babies and almost always normalizes on its own. Newborns have immature esophageal sphincters and that causes regurgitation along with the reflux. The acidity in the stomach doesn’t usually affect the actual esophagus of a newborn so it isn’t as measured in GERD screening. Children with symptoms of reflux can be a challenge to treat. The child often has trouble focusing due to discomfort, parents worry about the pain their child is experiencing and therapists must address the concerns of both. While treatment for reflux can be quite effective, there are many strategies we can implement in order to make treatment sessions more pleasant for everyone.
The negative publicity about the disorders stem from the condition's association with incontinence, suffocation, and anxiety. However, according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) these are not issues and can be avoided with appropriate therapy in physical therapy westwood. There are numerous causes for regurgitation and vomiting in infants, and every child can present with a unique set of symptoms. By knowing the different treatment options available and their efficacy, both parents and pediatric specialists will be better equipped to handle this incredibly frustrating problem.
POSITIONING
1. Head of Bed elevation to 30 degrees:
Head of bed elevation is recommended in a variety of texts, articles and guidelines as the first intervention when evaluating an infant with reflux symptoms, particularly when paired with positioning. There is no solid evidence that head of bed elevation should be routinely used in infants diagnosed with reflux.
Head of Bed Elevation (HOBE) is currently common practice in many hospitals, relying on the belief that this promotes superior respiratory effort in young premature infants. Although HOBE does improve the work of breathing, HOBE does not seem to promote respiratory effort any more than placing the infant in the supine or right lateral position. HOBE may contribute to an increased incidence of bradycardia and hypoxemia in some populations and, therefore, should not be used without evaluating the risks involved.
2. Positioning upright seated in car seat:
Even though you may have never noticed it since infancy, GER (gastroesophageal reflux) is part of your child’s life, especially when he or she is lying down. When your child lies on his or her back, gravity causes the stomach contents to flow toward the esophagus. A number of factors determine whether or not food and liquids actually come up the esophagus and into the mouth.
3. Left Sidelying and Prone Position:
Reflux is often a symptom of poor posture. An important part of treating reflux is to have your child sit upright when eating rather than slouching. Today, I’d like to share the results of a study from the British Medical Journal that assessed how prone, left sidelying and right sidelying position in terms of reflux severity, number of reflux episodes and duration of longest episode. The authors of the study state, “The identification of a non-pharmacological treatment which reduces the severity of GER in this group-position-therefore has important implications for the management of these infants.”
Infants with GER usually have symptoms such as reflux and coughing when lying on their back. In fact, 80% of infants with GER have to sleep propped up. When a baby sleeps in a propped up position, he is less likely to spit up or cough because the acid that is regurgitated will go back into his stomach instead of all over himself.
MEDICATION
Anti-reflux medications, known as proton pump inhibitors or PPIs, are commonly prescribed for infants with gastroesophageal reflux disease, or GERD. PPIs inhibit gastric acid secretion and reduce damage to the esophagus which is typically caused by excessive gastric acid. The effectiveness of PPIs remains a hot topic of debate in pediatric gastroenterology because treatment response and long-term outcome depends on proper compliance and medical follow up. If you’re looking for the best gastroesophageal reflux disease (GERD) treatment for your baby, a reflux medication is probably something you’ve considered. In fact, a recent study published in the journal Pediatrics reveals that anti-reflux medications are among the most common medications used for infants in neonatal intensive care units (NICUs).
According to a 2015 article in the Journal of Perinatology, metoclopramide is known as the “workhorse of gastric motility agents”. It can be used for gastroparesis, reflux esophagitis, diabetic gastroparesis, and gastroesophageal reflux disease. The article also noted that metoclopramide is absorbed into breast milk. Such news is not welcomed by pediatric physical therapists, especially those who treat infants and children. To them, the findings of this review are a blow to their profession. They have come to rely on proton pump inhibitors (PPIs) as part of the plan to help clients with gastroesophageal reflux disease.
GERD is not an uncommon condition in babies. It occurs when there is too much stomach acid, resulting in heartburn and other uncomfortable symptoms. It’s a common problem that many doctors look to treat with medications called proton pump inhibitors or PPIs. Children Physical Therapy (CPT) is the most trusted resource on the web for parents and healthcare professionals looking for answers to their questions about Gastroesophageal Reflux (GER) in infants and children. Established in 1995 as a source for reliable information on infant GER, CPT has grown to become the go-to source for all infants with difficulties swallowing.
Most symptoms of GER are self-resolving in time and most infants will outgrow what remains by 6 months. There is no evidence that thickened feedings benefit these newborns and thickened feedings may increase risk for necrotizing enterocolitis in preterm infants. Yet, the perception that thickened feedings provide some benefit continues because, historically, they have been prescribed. The purpose of this report is to provide information about non-pharmacologic interventions for GER symptoms and how physicians and health care providers can support breastfeeding mothers while keeping the infant healthy by promoting exclusive breastfeeding.
Physical therapy interventions shown to demonstrate clinical significance to diminish symptoms of GER include: stomach retraining, frequency reduction/prevention training, a positional change from supine (face up) to upright position, standing and water training, head of the bed elevation and increased fluids. Physical Therapy of children consists of children's physical therapy, pediatrics, pediatric physical therapy. Such as physical therapy exercises for children, exercises for children with cerebral palsy, Down syndrome and autism and much more. Physical therapists work with infants, toddlers, children with special needs, and adolescents in a family-centered atmosphere.
Emerson Physical Therapy & Rehab Center
45 Emerson Plaza East #102, Emerson, NJ 07630
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