Gastrostomy and Reflux -

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Gastrostomy and Reflux -

• Paediatric Feeding Interest Group

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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
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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.

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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?

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results
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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.

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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.

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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
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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?

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

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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

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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.

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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

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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

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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.