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Gastrostomy and Reflux

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Effect of Gastrostomy on Growth in Children with Neurodevelopmental Disabilities ... Gastrostomy feeding versus oral feeding alone for children with cerebral palsy. ... – PowerPoint PPT presentation

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Title: Gastrostomy and Reflux


1
Gastrostomy and Reflux -
  • Paediatric Feeding Interest Group

2
Evidence Based Practice
  • Evidence based practice is the integration of

Research evidence
Clinical Experience
EBP
Patient values and goals
Evidence based practice in Occupational Therapy
an introduction Sally Bennett, Division of
Occupational Therapy, The University of Queensland
3
1. Why Gastrostomy???
  • Regression in oral skills post gastrostomy
    reported by speech pathologists
  • Families often concerned about what impact a
    gastrostomy will have on oral skills, how to
    transition from gastrostomy to oral feeding.

4
The Clinical Question
  • Initial topic was What impact does a gastrostomy
    have on the feeding skills of children. Due to
    a lack of articles this was broadened to…….
  • What impact does a gastrostomy have on the
    feeding and health status of children?

5
results
7
6
Study Conditions
  • Participants included preterm infants, infants,
    children and parents with varying degree of
    ability and disability.
  • Articles focused on
  • Medical outcomes weight, head/ arm
    circumference, nutritional
  • Surgical outcomes complications of gastrostomy
  • Health Outcomes eg.respiratory status,
    gastrointestinal, seizures.

7
Gastrostomy clinical bottom line
  • The search results yielded insufficient high
    level evidence.
  • No research and evidence specifically regarding
    oral and feeding skills post gastrostomy.
  • There is evidence to suggest that gastrostomy
    feeding positively affects feeding outcomes -
    weight increases and improved respiratory status
    were reported in various studies.

8
Clinical Implcations
No research and evidence specifically regarding
oral and feeding skills post gastrostomy
Research evidence
Clinical Experience
EBP
Patient values and goals
Therapist observes regression in oral skills post
gastrostomy
Parent concerns regarding oral skills regressing
post gastrostomy
9
2. Why Gastro-Oesophageal Refulx??
  • GOR is common with the children on our caseloads
  • Positioning is often a recommendation to help
    manage reflux, therefore we wanted to appraise
    the evidence.
  • CLINICAL QUESTION
  • In children is sleep positioning effective in the
    management of gastro-oesophageal reflux?

10
results
1
  • One systematic review therefore did not need to
    critically appraise any of the other articles as
    they were included in the systematic review.

11
Study Conditions
  • All studies were randomised control trials and
    looked at positioning
  • All participants between 2 weeks to 12 months old
  • All studies used pH monitoring to diagnose and
    determine GOR outcomes
  • Frequency and duration
  • Number of episodes gt 5 minutes
  • of time pH lt 4 (reflux index)
  • Relationship of reflux activity and symptoms

12
Reflux clinical bottom line
  • Elevating the head of the crib in the supine
    position does not have any effect in reducing the
    symptoms of GOR.
  • There is no significant difference between supine
    horizontal and supine elevated position in the
    management of GOR.

13
Clinical Implications
  • Being placed in an infant seat (supported so that
    head and body were at least 60 degrees elevated)
    was associated with more reflux than the
    horizontal prone position
  • There is a significant clinical improvement in
    reducing GOR when infants are placed in prone
    position, however this management is not
    recommended as the risk of SIDS is higher.
  • Further research is required to look into
    positioning in the managing of reflux in children
    who are
  • Older than 12 months
  • Have a disability eg. Cerebral palsy

14
acknowledgments
  • Jenny Wood
  • Dorothea Gray
  • Sudi Veerabangsa
  • Lenore Scali
  • Liora Ballin
  • Helen McLaren
  • Harriet Korner
  • Alison Wu
  • Lisa Hanley
  • Meily Choi
  • Anna Bech
  • Alana Lum
  • Jenny Lee

15
references
  • Gastrostomy references
  • Cook, Stephanie. Effect of Gastrostomy on Growth
    in Children with Neurodevelopmental Disabilities
    in Canadian Journal of Dietetic Practice and
    Research 20056619-24
  • Craig, G. M., Carr, L. J., Cass, H., Hastings, R.
    P., Lawson, M., Reilly, S., Ryan M., Townsend, J.
    and L. Spitz, Medical, surgical, and health
    outcomes of gastrostomy feeding, Developmental
    Medicine Child Neurology 2006, 48 353-360
  • Mason, S. J., Harris, G. Blissett, J. Tube
    Feeding in Infancy Implications for the
    Development of Normal Eating Drinking Skills.
    Dysphagia, 2005, 20, 46-61.
  • Sleigh G, Brocklehurst P Gastrostomy feeding in
    cerebral palsy a systematic review Arch Dis
    Child 2004 89 6 534-9
  • Sleigh G, Sullivan PB, Thomas AG. Gastrostomy
    feeding versus oral feeding alone for children
    with cerebral palsy. Cochrane Database of
    systematic Reviews 2004, Issue 2. Art.
    No.CD003943. DOI1002/14651858.CD003943.pub2.
  • Sugarman Isaacs, J., Georgeson, K.E., Cloud, H.H.
    Woodall, N. Weight gain and triceps skinfolds
    fat mass after gaststomy placement in children
    with developmental disabilities. Journal of the
    American Dietetic Association 1994, 94 (8),
    849-856.
  • Sullivan, PB Juszczak, E Bachlet, A, M, E
    Lambert, B Vernon-Roberts, A Grant H, W
    Eltumi, M McLean, L Alder, N and Thomas, A, G.
    Gastrostomy tube feeding in children with
    cerebral palsy a prospective, longitudinal
    study Developmental Medicine Child Neurology
    2005, 47 77-85
  • Sullivan, PB Morrice, JS Vernon-Roberts, A et
    al. Does gastrostomy tube feeding in children
    with cerebral palsy increase the risk of
    respiratory morbidity? Arch Dis Child 2006
    91478-482
  • GOR reference
  • Craig WR, Hanlon-Dearman A, Sinclair C, Taback S,
    Moffatt M. Metoclopramide, thickened feedings and
    positioning for gastro-oesophageal reflux in
    children under two years. Cochrane Database of
    Systematic Reviews 2004. Issue 3. Art. No.
    CD003502. DOI10.1002/14651858.CD003502.pub2.
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