Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux

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.

Postural drainage techniques and gastro-oesophageal reflux in infants with cystic fibrosis

“…Eighteen of the infants were <3 months, 15 of those were #2 months; the other two were 4.4 and 5.6 months [4]. This large group of very young infants with CF is different to the group of 11 infants and toddlers with CF aged up to 27 months of PHILLIPS et al [1].…”

“…Recently PHILLIPS et al [1] added to the body of knowledge relating to gastro-oesophageal reflux (GOR) in cystic fibrosis (CF). I noted with interest the high incidence of GOR (73%) found in their study of 11 children with CF of <2.5 yrs.…”

“…In their article, PHILLIPS et al [1] state that "holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux". This is different to the findings of three independent studies on this topic over the past fifteen years [2±4].…”

Efeito da cisaprida e da fisioterapia respiratória sobre o refluxo gastroesofágico de lactentes chiadores segundo avaliação cintilográfica

“…A fisioterapia respiratória clássica consiste na utilização de estímulos físicos na região torácica e de posturas corporais somadas a forças gravitacionais, para favorecer e otimizar a drenagem de secreções brônquicas impactadas 25,26,38 . Vandenplas e col. 39 , utilizando as técnicas convencionais de fisioterapia respiratória como drenagem postural na posição corporal de Trendelenburg, percussão, vibração e tosse provocada, observaram episódios de RGE em três grupos de lactentes: com RGE, com insuficiência respiratória aguda e grupo controle.…”

“…Esta terapia tem por objetivo aumentar a depuração mucociliar, desobstruir as vias aéreas e facilitar a ventilação e as trocas gasosas 23 . É uma terapia complementar para atelectasia, bronquiectasia e desordens respiratórias complicadas por excesso e/ou retenção de secreção brônquica e pulmonar como a fibrose cística, SLC e bronquite crônica [24][25][26] .…”