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Pediatric Functional Gastrointestinal Disorders

Herman & Wallace Pelvic Rehabilitation Institute

Objectives

Upon completion of this continuing education seminar, participants will be able to:
1. Understand digestive anatomy and physiology
2. Understand the function of the pelvic floor muscles as it relates to defecation
3. Understand functional gastrointestinal disorders in children and be able to identify potential medical “red flags” requiring referral to the physician.
4. Review tests and measures for functional gastrointestinal disorders
5. Understand medications used for bowel dysfunction and titration for long term bowel health
6. Assess bowel diaries and provide education for diet/medication/supplement titration
7. Recognize the psychosocial and behavioral component for proper referral and rectal balloon treatment
8. Observe use of perianal surface electromyography (sEMG) and identify pelvic floor muscle discoordination in the pediatric patient
9. Understand how to use sEMG biofeedback to increase or decrease pelvic floor muscle activity
10. Complete an evaluation of a pediatric patient diagnosed with bowel disorders
11. Assess and provide exercises and techniques for diastasis recti.
12. Learn techniques to stimulate BM and rectal sensation using rectal balloon training and OTC medications
13. Treatment progressions for children with pediatric bowel disorders using manual therapy and breathing techniques
14. Implement an appropriate plan of care based on a patient’s symptoms and physical examination

Target Audience

This course is appropriate for physical therapists, occupational therapists, pediatric nurse practitioners and medical doctors.

Confirmation Notes

For the lab please bring TheraBand medium resistance 4-5 feet long and 10 cuff pound weight or equivalent.

Be sure to wear loose fitting pants for external PFM palpation. Jeans and tight fitting yoga pants are not acceptable.

Agenda

Day One
5:30 Registration 6:00 PFM Anatomy as it related to bowel bladder function with visual assessment of pediatric PFM function video demonstration 6:30 Internal anorectal exam lab 7:30 Review and discussion 8:00 Adjourn

Day Two:
8:00 Introduction 8:30 Digestive anatomy and physiology 10:00 Break 10:15 Anatomy palpation Lab – identifying the digestive structures and related sphincters 11:30 The Brain-Gut Axis 12:00 Lunch 1:00 Normal bowel patterns from infancy through early childhood 1:30 Functional Gastrointestinal Disorders (FGID) in children, abdominal pain, IBS, vomiting disorders; organic causes of constipation –such as Hirshsprungs disease, neurologic bowel and imperforate anus 3:00 Break 3:15 SEMG of the pediatric patient for coordination of the PFM with defecation video demonstrations and lab(not sure we will have EMG units or not for each participant) 4:45 Questions and review 5:00 Adjourn

Day Three:
8:00 Types of constipation and treatment for constipation and fecal incontinence including; medication/supplements and titration for long-term bowel management. 9:30 Anorectal Disorders 10:15 Break 10:30 Rectal balloon training lab 12:00 Lunch 1:00 Diagnostic Testing for bowel dysfunction- anorectal manometry, radiographic studies – indications and assessment. Psychological &QoL Scores 2:00 Manual treatments of bowel dysfunction- Lecture/lab connective tissue releases, sphincter release and bowel massage 3:00 Break 3:15 Case studies 4:15 Questions and review 4:30 Adjourn

Description

This two-and-a-half day class is the next step for therapists those who focus on the pediatric pelvic floor patient population. It is designed to expand your knowledge of development of normal bowel patterns in children, introduce the new Rome IV criteria (Zeevenhoovenet al. 2017), and review the anatomy and physiology of the GI system with emphasis pediatric Functional Gastrointestinal Disorders (FGID).
According to van den Berg et al, up to 30 percent of children suffer from constipation and account for approximately 3% to 5% of all visits to pediatricians. Early intervention can avoid stool-withholding patterns with worsening constipation leading to prolonged bowel issues into adulthood (Chase, Lewina, 2017) with psychosocial consequences.
This course will delve into the most common types of functional constipation and tests and measures used to assess it. Special emphasis on constipation with coexistence of fecal incontinence (Nurko, Scott. 2011) and the psychological effects of these disorders will also be presented.
Additionally, participants who have not yet been trained will learn external and internal anorectal PFM evaluation of the pediatric perineum. Indications for rectal balloon training and determining the appropriate patient will be instructed with lab. Functional defecatory positions for breathing and PFM relaxation, manual therapy techniques of the abdominal wall and viscera will be taught. Video demonstrations of pediatric patients are also presented. Treatment techniques and progressions, including management of supplements and dietary influences will be discussed.
Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Date And Locations
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