Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 We also asked Dr. Spencer about starting using some " head down " positions with Abby's CPT. She had a slightly positive reflux test at 5 mos. and was started on Zantac only a few mos. ago because of a conversation I had with one of the doctors. Precautionary measure. I don't think she has it now. He said to stop the Zantac and watch her for signs of reflux 20-30 min. after eating, like arching and crying for no other reason. If none show then it would be okay to do some head down. I asked him if there was more reflux in CF'rs and he said they aren't sure. I'd like to know hear other opinions on this. I never see any sign of mucous after or during Abby's CPT. When she had that bad cold a few weeks ago I heard her clear some and swallow it but it was up high. In other words I want to know if Abby would be getting any benefit with the head down at her age if reflux was not a concern. Thanks. Joe Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 Our Abby coughs during CPT. She has severe reflux and takes Zantac and Prilosec. We do not do the upside down CPT postions. Our clininc said that they don't think that it matters too much, as long as we are doing a good job on the upright positions. Abby had pnuemonia twice before she was 6 months old. The doctors think that the reflux made her throat raw and caused her swallowing difficulty. Some of what she swallowed entered her lungs. By the time that they figured this out, her upper right lobe was too damaged. She had surgery when she was 6 months old, to remove the damaged lobe. She has been fine since. We still have to thicken her liquids, give her the reflux meds and do upright CPT. Abby's a real trouper. Gale > We also asked Dr. Spencer about starting using some " head down " > positions with Abby's CPT. She had a slightly positive reflux test > at 5 mos. and was started on Zantac only a few mos. ago because of a > conversation I had with one of the doctors. Precautionary measure. > I don't think she has it now. He said to stop the Zantac and watch > her for signs of reflux 20-30 min. after eating, like arching and > crying for no other reason. If none show then it would be okay to do > some head down. I asked him if there was more reflux in CF'rs and he > said they aren't sure. I'd like to know hear other opinions on this. > I never see any sign of mucous after or during Abby's CPT. When she > had that bad cold a few weeks ago I heard her clear some and swallow > it but it was up high. In other words I want to know if Abby would > be getting any benefit with the head down at her age if reflux was > not a concern. Thanks. > > Joe Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 Joe, I don't know if reflux is more common among people with CF but it DOES seem like it is. My daughter has it. We were told that many people with CF have it. was diagnosed with CF at 9 months and we have never done PT without the head down positions- we started PT at Dx. She had the reflux surgery before she was 2 because she needed a g-tube and they didn't want to place it unless she had the reflux surgery. Mom of , 5 with CF Reflux We also asked Dr. Spencer about starting using some " head down " positions with Abby's CPT. She had a slightly positive reflux test at 5 mos. and was started on Zantac only a few mos. ago because of a conversation I had with one of the doctors. Precautionary measure. I don't think she has it now. He said to stop the Zantac and watch her for signs of reflux 20-30 min. after eating, like arching and crying for no other reason. If none show then it would be okay to do some head down. I asked him if there was more reflux in CF'rs and he said they aren't sure. I'd like to know hear other opinions on this. I never see any sign of mucous after or during Abby's CPT. When she had that bad cold a few weeks ago I heard her clear some and swallow it but it was up high. In other words I want to know if Abby would be getting any benefit with the head down at her age if reflux was not a concern. Thanks. Joe Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 We have decided not to use the head down positions for Zach. We discussed this with Zach's cf doc after I saw this article. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve & db=PubMed & list_uids=12567389 & dopt=Abstract I hope this link works. Sara > Joe, > I don't know if reflux is more common among people with CF but it DOES seem like it is. My daughter has it. We were told that many people with CF have it. was diagnosed with CF at 9 months and we have never done PT without the head down positions- we started PT at Dx. She had the reflux surgery before she was 2 because she needed a g-tube and they didn't want to place it unless she had the reflux surgery. > > > Mom of , 5 with CF > Reflux > > > We also asked Dr. Spencer about starting using some " head down " > positions with Abby's CPT. She had a slightly positive reflux test > at 5 mos. and was started on Zantac only a few mos. ago because of a > conversation I had with one of the doctors. Precautionary measure. > I don't think she has it now. He said to stop the Zantac and watch > her for signs of reflux 20-30 min. after eating, like arching and > crying for no other reason. If none show then it would be okay to do > some head down. I asked him if there was more reflux in CF'rs and he > said they aren't sure. I'd like to know hear other opinions on this. > I never see any sign of mucous after or during Abby's CPT. When she > had that bad cold a few weeks ago I heard her clear some and swallow > it but it was up high. In other words I want to know if Abby would > be getting any benefit with the head down at her age if reflux was > not a concern. Thanks. > > Joe > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 I tried the link and it didn't work. Here is what it said: Chest physiotherapy in infants with cystic fibrosis: to tip or not? A five-year study. Button BM, Heine RG, Catto- AG, Olinsky A, Phelan PD, Ditchfield MR, Story I. Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia. b.button@... There is controversy about the need for postural drainage physiotherapy in asymptomatic infants with cystic fibrosis (CF). We aimed to compare the effectiveness of standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy regimen without head-down tilt (MPT) in young infants with CF. Twenty newly diagnosed infants with CF (mean age, 2.1 months; range, 1-4) were randomized to SPT or MPT. Parents kept a detailed symptom and treatment diary for the following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2(1/2) years, and 5 years after diagnosis, were assessed using the Brasfield score. Pulmonary function tests were compared between groups after 5 years. Of the 20 infants, 16 (80%) completed the review at 12 months, and 14 (70%) at 2(1/2) and 5 years. Patients receiving SPT had more days with upper respiratory tract symptoms than those on MPT (70 +/- 32.8 vs. 37 +/- 24.9 days; P = 0.04) and required longer courses of antibiotics (23 +/- 28.5 vs. 14 +/- 11.2 days; P = 0.05). Chest x- ray scores were similar at diagnosis but were worse at 2(1/2) years for those receiving SPT (P = 0.03). Forced vital capacity and forced expired volume in 1 sec (FEV(1)) at 5-6 years was lower for SPT than for MPT (P < 0.05). In conclusion, MPT was associated with fewer respiratory complications than SPT in infants with CF. Copyright 2003 Wiley-Liss, Inc. Pediatr Pulmonol. 2003 Mar;35(3):208-13. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2003 Report Share Posted November 8, 2003 Joe, I know that Piper had a lot of reflux issues when she was smaller. Hers was severe enough that they did a Nissen Fundoplication to correct it, but she is still on Zantac and Reglan. I don't know if there have been any studies on the correlation of Reflux and CF, but most of the people that I have met that have a kid with CF also said that their kids also had reflux. As far as postural drainage goes, all I know about it is that it is recommended so that the mucous that is loosened up will drain out and not go back into their lungs. Piper hasn't really had any mucous come up but I have also heard that some kids don't really start " producing " mucous until they are a little older. I hope that this helps!! Katy mom to Austin 4 no CF & Piper (almost 16 mos) w/CF Joe wrote: We also asked Dr. Spencer about starting using some " head down " positions with Abby's CPT. She had a slightly positive reflux test at 5 mos. and was started on Zantac only a few mos. ago because of a conversation I had with one of the doctors. Precautionary measure. I don't think she has it now. He said to stop the Zantac and watch her for signs of reflux 20-30 min. after eating, like arching and crying for no other reason. If none show then it would be okay to do some head down. I asked him if there was more reflux in CF'rs and he said they aren't sure. I'd like to know hear other opinions on this. I never see any sign of mucous after or during Abby's CPT. When she had that bad cold a few weeks ago I heard her clear some and swallow it but it was up high. In other words I want to know if Abby would be getting any benefit with the head down at her age if reflux was not a concern. Thanks. Joe ------------------------------------------- The opinions and information exchanged on this list should IN NO WAY be construed as medical advice. PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2003 Report Share Posted November 9, 2003 Here is an article that describes how CPT head down may have negative side effects. Published Online: 31 Jan 2003 Copyright © 2003 Wiley-Liss, Inc Diagnostic and Therapeutic Methods Chest physiotherapy in infants with cystic fibrosis: To tip or not? A five-year study M. Button, Dip Phty, PhD 1 2 *, Ralf G. Heine, MD, FRACP 3 5, G. Catto-, MD, FRACP 3 5, Olinsky, MD, FRACP 4, D. Phelan, MD, FRACP 5, R. Ditchfield, MD, FRANZCR 6, Ian Story, PhD 2 1Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia 2School of Physiotherapy, University of Melbourne, Melbourne, Australia 3Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia 4Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia 5Department of Paediatrics, University of Melbourne, Melbourne, Australia 6Department of Radiology, Royal Children's Hospital, Melbourne, Australia email: M. Button (http://groups.yahoo.com/group/cfparents/post? protectID=014242250182175134112158203140247016039248015046183239241150 077211) *Correspondence to M. Button, Department of Respiratory Medicine, Alfred Hospital, Commercial Road, Prahran, Melbourne, 3181, Australia. Funded by: Royal Children's Hospital Research Foundation, Melbourne Physiotherapy Research Foundation of Australia Keywords cystic fibrosis . gastroesophageal reflux . physiotherapy . postural drainage . infant . aspiration . pulmonary function . treatment Abstract There is controversy about the need for postural drainage physiotherapy in asymptomatic infants with cystic fibrosis (CF). We aimed to compare the effectiveness of standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy regimen without head-down tilt (MPT) in young infants with CF. Twenty newly diagnosed infants with CF (mean age, 2.1 months; range, 1-4) were randomized to SPT or MPT. Parents kept a detailed symptom and treatment diary for the following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2½ years, and 5 years after diagnosis, were assessed using the Brasfield score. Pulmonary function tests were compared between groups after 5 years. Of the 20 infants, 16 (80%) completed the review at 12 months, and 14 (70%) at 2½ and 5 years. Patients receiving SPT had more days with upper respiratory tract symptoms than those on MPT (70 ± 32.8 vs. 37 ± 24.9 days; P = 0.04) and required longer courses of antibiotics (23 ± 28.5 vs. 14 ± 11.2 days; P = 0.05). Chest x-ray scores were similar at diagnosis but were worse at 2½ years for those receiving SPT (P = 0.03). Forced vital capacity and forced expired volume in 1 sec (FEV1) at 5-6 years was lower for SPT than for MPT (P < 0.05). In conclusion, MPT was associated with fewer respiratory complications than SPT in infants with CF. Pediatr Pulmonol. 2003; 35:208-213. © 2003 Wiley-Liss, Inc. Received: 11 December 2001; Accepted: 1 October 2002 Digital Object Identifier (DOI) 10.1002/ppul.10227 About DOI References are available in the Enhanced Abstract > We also asked Dr. Spencer about starting using some " head down " > positions with Abby's CPT. She had a slightly positive reflux test > at 5 mos. and was started on Zantac only a few mos. ago because of a > conversation I had with one of the doctors. Precautionary measure. > I don't think she has it now. He said to stop the Zantac and watch > her for signs of reflux 20-30 min. after eating, like arching and > crying for no other reason. If none show then it would be okay to do > some head down. I asked him if there was more reflux in CF'rs and he > said they aren't sure. I'd like to know hear other opinions on this. > I never see any sign of mucous after or during Abby's CPT. When she > had that bad cold a few weeks ago I heard her clear some and swallow > it but it was up high. In other words I want to know if Abby would > be getting any benefit with the head down at her age if reflux was > not a concern. Thanks. > > Joe > > > > ------------------------------------------- > The opinions and information exchanged on this list should IN NO WAY > be construed as medical advice. > > PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. > > ------------------------------------ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2003 Report Share Posted November 9, 2003 Gee I wish I had known the negative effects of the head down positions in kids with reflux when we were using them for !!!!! Fortunately we use the vest now and no postural drainage. Re: Reflux Here is an article that describes how CPT head down may have negative side effects. Published Online: 31 Jan 2003 Copyright © 2003 Wiley-Liss, Inc Diagnostic and Therapeutic Methods Chest physiotherapy in infants with cystic fibrosis: To tip or not? A five-year study M. Button, Dip Phty, PhD 1 2 *, Ralf G. Heine, MD, FRACP 3 5, G. Catto-, MD, FRACP 3 5, Olinsky, MD, FRACP 4, D. Phelan, MD, FRACP 5, R. Ditchfield, MD, FRANZCR 6, Ian Story, PhD 2 1Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia 2School of Physiotherapy, University of Melbourne, Melbourne, Australia 3Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia 4Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia 5Department of Paediatrics, University of Melbourne, Melbourne, Australia 6Department of Radiology, Royal Children's Hospital, Melbourne, Australia email: M. Button (http://groups.yahoo.com/group/cfparents/post? protectID=014242250182175134112158203140247016039248015046183239241150 077211) *Correspondence to M. Button, Department of Respiratory Medicine, Alfred Hospital, Commercial Road, Prahran, Melbourne, 3181, Australia. Funded by: Royal Children's Hospital Research Foundation, Melbourne Physiotherapy Research Foundation of Australia Keywords cystic fibrosis . gastroesophageal reflux . physiotherapy . postural drainage . infant . aspiration . pulmonary function . treatment Abstract There is controversy about the need for postural drainage physiotherapy in asymptomatic infants with cystic fibrosis (CF). We aimed to compare the effectiveness of standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy regimen without head-down tilt (MPT) in young infants with CF. Twenty newly diagnosed infants with CF (mean age, 2.1 months; range, 1-4) were randomized to SPT or MPT. Parents kept a detailed symptom and treatment diary for the following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2½ years, and 5 years after diagnosis, were assessed using the Brasfield score. Pulmonary function tests were compared between groups after 5 years. Of the 20 infants, 16 (80%) completed the review at 12 months, and 14 (70%) at 2½ and 5 years. Patients receiving SPT had more days with upper respiratory tract symptoms than those on MPT (70 ± 32.8 vs. 37 ± 24.9 days; P = 0.04) and required longer courses of antibiotics (23 ± 28.5 vs. 14 ± 11.2 days; P = 0.05). Chest x-ray scores were similar at diagnosis but were worse at 2½ years for those receiving SPT (P = 0.03). Forced vital capacity and forced expired volume in 1 sec (FEV1) at 5-6 years was lower for SPT than for MPT (P < 0.05). In conclusion, MPT was associated with fewer respiratory complications than SPT in infants with CF. Pediatr Pulmonol. 2003; 35:208-213. © 2003 Wiley-Liss, Inc. Received: 11 December 2001; Accepted: 1 October 2002 Digital Object Identifier (DOI) 10.1002/ppul.10227 About DOI References are available in the Enhanced Abstract > We also asked Dr. Spencer about starting using some " head down " > positions with Abby's CPT. She had a slightly positive reflux test > at 5 mos. and was started on Zantac only a few mos. ago because of a > conversation I had with one of the doctors. Precautionary measure. > I don't think she has it now. He said to stop the Zantac and watch > her for signs of reflux 20-30 min. after eating, like arching and > crying for no other reason. If none show then it would be okay to do > some head down. I asked him if there was more reflux in CF'rs and he > said they aren't sure. I'd like to know hear other opinions on this. > I never see any sign of mucous after or during Abby's CPT. When she > had that bad cold a few weeks ago I heard her clear some and swallow > it but it was up high. In other words I want to know if Abby would > be getting any benefit with the head down at her age if reflux was > not a concern. Thanks. > > Joe > > > > ------------------------------------------- > The opinions and information exchanged on this list should IN NO WAY > be construed as medical advice. > > PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. > > ------------------------------------ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 12, 2006 Report Share Posted January 12, 2006 Jayne - could not have said it any better - so, I'm not going to repeat anything. I'm glad you felt comfortable enough to share your concerns - please make the GI appointment and let us know the results. Thinking of you lot's. - H > > hi thanks for the thoughts on tube feeding.i feel excactly as you > described, I feel she doesnt need it then she definatly does. Lily > started to eat again 2 days ago and then this am she has refused > everything. I managed to get 15mls of milk down her but she vomited. > And there was much more than 15mls.she even started shaking her head > when she saw a spoon and bowl.. Could this be reflux??? she seems to > not be able to tolerate anything, as if she is full...... I know that > RSS is the reason for it most of the time but she has been so eager to > eat over the last few days. She has even woke up for the past 2 nights > and hasnt settled back down til after she has had a 4oz bottle each > time. The the dramatic change. Is it reflux...??? jayne x > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2006 Report Share Posted January 13, 2006 > hi thanks for the thoughts on tube feeding.i feel excactly as you > described, I feel she doesnt need it then she definatly does. Lily > started to eat again 2 days ago and then this am she has refused > everything. I managed to get 15mls of milk down her but she vomited. > And there was much more than 15mls.she even started shaking her head > when she saw a spoon and bowl.. Could this be reflux??? she seems to > not be able to tolerate anything, as if she is full...... I know that > RSS is the reason for it most of the time but she has been so eager to > eat over the last few days. She has even woke up for the past 2 nights > and hasnt settled back down til after she has had a 4oz bottle each > time. The the dramatic change. Is it reflux...??? jayne x > > > > > > Quote Link to comment Share on other sites More sharing options...
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