HOLDING THE BABY - HEAD DOWNWARDS POSITIONING FOR PHYSIOTHERAPY DOES NOT CAUSE GASTROESOPHAGEAL REFLUX

The head-downwards tipped position for physiotherapy has been claimed to exacerbate gastro-oesophageal reflux (GOR) in infants with cystic f ibrosis (CF), This was investigated using lower oesophageal pH monitor ing during physiotherapy. Twenty-one infants (age range 1-27 months) w ith respiratory disorders (CF=11), undergoing lower oesophageal pH mon itoring were recruited. Subjects received two physiotherapy episodes i n random order, A/B or B/A, 12 h apart. A began the gravity-assisted p ositioning head down ward 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 si tting position. B was in the reverse order. Intermittent chest clappin g was carried out for 4 min in each position by a physiotherapist blin ded to the pH data. During episode A, the median change in pH from bas eline was -032 (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) an d in CF subjects was -0.05 (Ns;range -0.67 to +0.5), There was no orde r 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 t ipped positioning for physiotherapy treatment neither induces nor aggr avates gastro-oesophageal reflux, There is no justification for routin ely changing the way in which infant physiotherapy is carried out. (C) ERS Journals Ltd 1998.