Document Detail


Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux.
MedLine Citation:
PMID:  9817174     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
G E Phillips; S E Pike; M Rosenthal; A Bush
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The European respiratory journal     Volume:  12     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1999-02-04     Completed Date:  1999-02-04     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  954-7     Citation Subset:  IM    
Affiliation:
Dept of Physiotherapy, Royal Brompton Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Cystic Fibrosis / rehabilitation*
Esophagus / chemistry
Female
Gastroesophageal Reflux / diagnosis,  epidemiology,  etiology*
Head-Down Tilt / adverse effects*
Humans
Hydrogen-Ion Concentration
Incidence
Infant
Infant, Newborn
Male
Monitoring, Physiologic
Physical Therapy Modalities / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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