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The Stepping Stones Group - Transforming - February 2021

Short Gut Syndrome

Abby Mathews, MA, CCC-SLP, Luann Stevens, MA, CCC-SLP

January 30, 2017

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Question

What is short gut syndrome and how is it managed?

Answer

Short gut or short bowel syndrome is a condition that occurs when a large portion of the intestines does not work normally. Either a large section of the bowel has been surgically removed, or a baby is born with abnormal intestines. The complications that frequently occur include failure to thrive, dehydration, and central line infections for patients on TPN (Total Parenteral Nutrition). These dangers are the reason that these patients require close medical and nutritional follow-up.

Intestinal failure is a side effect of short gut syndrome and is defined as the inability to sustain adequate nutritional, electrolyte or hydrational status in the absence of specialized nutritional support (Buchman, 2006). Research conducted by Buchman found that the largest single group of patients who receive home TPN were those with short bowel syndrome. Many medically fragile children require TPN for a variety of reasons, however a child with short guy syndrome will have the TPN for much longer. Of course, the longer the patient needs a PICC line or central line for their TPN, the higher the risk of complications and challenges for the family and patients. Therefore, it is important to transition a patient off of TPN as quickly as possible.

The purpose of intestinal rehabilitation is to help the child grow at an adequate pace. Strategies and therapies are designed to make the bowel work better, including nutrition support, nutritional rehabilitation, medical management or restorative surgery. This is done by using specialized formula, manipulating the rate and schedules of enteral feeds, and balancing feeds, fluids, TPN, IV fluids and enteral feeds. Medications are integrated as needed and surgeries are coordinated when needed as well.  Therapies are constantly readjusted based on whether or not the child is gaining weight, if they have had any additional surgeries, and if their oral skills are advancing.  

In summary, the goal of intestinal rehabilitation is to transition the child off TPN, for the child to tolerate enteral feeds, and maximize oral interest. 

Please refer to the SpeechPathology.com course, The Speech Pathologist's Role with the Pediatric Intestinal Rehabilitation Population, presented in partnership with Cincinnati Children's for more in-depth information about speech pathology services that are beneficial to pediatric patients with short bowel syndrome.


abby mathews

Abby Mathews, MA, CCC-SLP

Abby Mathews is a graduate of the University of Toledo and has been working as a Speech Language Pathologist at Cincinnati Children’s Hospital Medical Center for 7 years.  She currently works as an inpatient therapist on the Gastrointestinal/Colorectal Surgery unit, Complex Surgery and Transplant unit, Oncology/Hematology unit, and Bone Marrow Transplant unit. She treats patients with a variety of feeding and language disorders.  She has previously worked as an outpatient therapist at Cincinnati Children’s Hospital Medical Center and outpatient therapist at a pediatric private practice. 


luann stevens

Luann Stevens, MA, CCC-SLP

Luann Stevens is a graduate of the University of Cincinnati and works as an inpatient Speech Language Pathologist at Cincinnati Children’s Hospital Medical Center, Main Campus.  Her area of interest and expertise is working with patients with feeding difficulties related to complex airway issues, tracheostomy, and aspiration. Another area of specialty is evaluation and treatment of feeding disorders for children with gastrointestinal problems including bowel resection, transplant, reflux and failure to thrive. Luann also performs video swallow studies and FEES examinations. She has been with the Division of Speech Pathology since 1999.


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