Collection
Intestinal Rehabilitation Fundamentals
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines. — Paul Wales, Intestinal rehabilitation: What is intestinal rehab? - Episode 1 · 3:03
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Watch →
We’re starting a new series about intestinal rehabilitation and all of its intricacies. We’re joined by Drs. Michael Helmrath and Paul Wales, leaders of the Intestinal Rehabilitation Program at Cincinnati Children’s. Hosted by: Todd Ponsky,
video14:33 · Dec 2021
Introduction to intestinal rehabilitation and intestinal failure in pediatric surgery
Listen →
Weâre starting a new series about intestinal rehabilitation and all of its intricacies. Weâre joined by Drs. Michael Helmrath and Paul Wales, leaders of the Int
podcast14:33 · Nov 2026
Intestinal rehabilitation in pediatric short bowel syndrome: expert strategies for autonomy
Listen →
In November 2023 we held the first Intestinal Rehabilitation webinar with Dr. Paul Wales & Dr. Michael Helmrath, 2 experts from the Intestinal Rehab Center at C
podcast12:14 · Nov 2026
Impact of multidisciplinary teams for management of intestinal failure in children
Read →
Purpose Of Review: To review the recent literature related to the impact of an intestinal rehabilitation program (IRP) on the management of intestinal failure in children. Recent Findings: As publication of a systematic review of pediatric
article · Nov 2026
The impact of multi-disciplinary intestinal rehabilitation programs on the outcome of pediatric patients with intestinal failure: a systematic review and meta-analysis.
Read →
Pediatric intestinal failure (IF) is a complex clinical problem requiring coordinated multi-disciplinary care. Our objective was to review the evidence for the benefit of intestinal rehabilitation programs (IRP) in pediatric IF patients. A
article · Nov 2026
Impact of Intestinal Rehabilitation Program and Its Innovative Therapies on the Outcome of Intestinal Transplant Candidates
Read →
Objectives: The outcome of children with intestinal failure has improved during the past decade following the introduction of novel therapies by dedicated intestinal rehabilitation programs (IRP). The aim of the present study was to assess
article · Nov 2026
Neonatal short bowel syndrome outcomes after the establishment of the first Canadian multidisciplinary intestinal rehabilitation program: preliminary experience
Read →
Background: A multidisciplinary intestinal rehabilitation team has been in place at our institution for 3 years. Our goal was to compare the preliminary outcomes of neonates with short bowel syndrome before with those after the establishmen
article · Nov 2026
Change of Outcomes in Pediatric Intestinal Failure: Use of Time-Series Analysis to Assess the Evolution of an Intestinal Rehabilitation Program
Read →
Background: The clinical picture of pediatric intestinal failure has changed over the past 15 years, while effectiveness evolving treatment options remains unclear. This study explored evolution in care and quantified independent effects of
article · Nov 2026
Researchers, Cincinnati Children's Hospital Medical Center
Read →
We believe in science and compassion. Learn how our scientists conduct breakthrough research to improve the lives of children every day.
article · Oct 2026
Support Services | Cincinnati Children's Research Foundation
Read →
Support services help design grant proposals, manage data, comply with regulations, protect intellectual property and assist with commercialization. Read more.
article · Oct 2026
Patient and Family Resources
Read →
Patient and Family Resources | Cincinnati Children's Schedule an Appointment Directions International Billing Sign in to MyChart Ways to Help Donate Now Navigation Patients and Families Patients and Family Home Schedule an Appointment Servi
article · Oct 2026
Resources for Healthcare Professionals
Read →
Resources for Healthcare Professionals Schedule an Appointment Directions International Billing Sign in to MyChart Ways to Help Donate Now Navigation Patients and Families Patients and Family Home Schedule an Appointment Services and Specia
article · Oct 2026
Summaries and takeaways+ Show
Summary of this collection+ Show
Key points+ Show
Featured picks for families are being prepared — the summaries above are written for you.
Takeaways+ Show
The doctors in this collection+ Show
All expert statements+ Show
Expert statements from the recordings in this collection.
Intestinal rehabilitation: What is intestinal rehab? - Episode 1
Until recently, there was no standardized definition for intestinal failure.
clinicalPaul Wales1:56 ↗
Intestinal failure is when gut function is insufficient to absorb enough nutrients, fluids, and calories to support survival and, in children, growth.
clinicalPaul Wales2:03 ↗
New guidelines define intestinal failure as requiring parenteral support for at least 60 days due to inadequate intestinal function.
Host summaryRod Gerardo summarizing the discussion — not the host's own clinical position2:24 ↗
Earlier recognition and taking advantage of the gut's biology to adapt are time dependent.
clinicalMichael Helmrath2:40 ↗
An intestinal rehabilitation program is a multidisciplinary collaborative patient care paradigm that brings coordinated care for children with intestinal failure through comprehensive management of their specialized nutrition and other associated needs, as defined in recent ASPEN guidelines.
guidelinePaul Wales3:03 ↗
Intestinal rehabilitation requires managing comorbidities including sepsis and liver disease that challenge infant growth.
Host summaryRod Gerardo summarizing the discussion — not the host's own clinical position3:33 ↗
The intestinal rehabilitation approach streamlines care and improves communication with families and between care providers.
clinicalPaul Wales3:44 ↗
Intestinal rehabilitation depends on nutrition in the gut, nutrition in the body, and healing.
clinicalMichael Helmrath4:07 ↗
Pattern recognition from multiple experienced clinicians observing patients over time is essential in intestinal rehabilitation.
clinicalMichael Helmrath4:19 ↗
Causes of intestinal failure divide into three categories: short bowel syndrome, motility disorders, and congenital enteropathies.
clinicalPaul Wales4:39 ↗
Short bowel syndrome is by far the most common category of intestinal failure in pediatric patients.
epidemiologicalPaul Wales4:50 ↗
Causes of short bowel syndrome include congenital anomalies (intestinal atresia, malrotation, volvulus, gastroschisis, long segment Hirschsprung disease) and acquired neonatal diseases (necrotizing enterocolitis).
clinicalPaul Wales5:06 ↗
Motility disorders occur when abnormalities of intestinal muscle or the nerves controlling that muscle prevent coordinated propulsion of food and stool.
clinicalPaul Wales5:45 ↗
Congenital enteropathies are conditions where patients have all their bowel but the mucosal lining does not digest or absorb properly.
clinicalPaul Wales6:17 ↗
Mucosal defects in enteropathies lead to hypersecretion and profuse fluid losses, preventing nutrient absorption.
Host summaryEllen Encisco summarizing the discussion — not the host's own clinical position6:30 ↗
Some patients have elements of two or all three categories of intestinal failure in their presentation.
clinicalPaul Wales7:11 ↗
Gastroschisis can involve all three categories: short bowel from nonviable tissue, inflammation affecting absorption, and motility issues.
Host summaryEllen Encisco summarizing the discussion — not the host's own clinical position7:22 ↗
Most intestinal failure patients are infants or babies, but some older pediatric patients develop intestinal failure from inflammatory bowel disease, Crohn disease complications, trauma, malignancy, or vascular thrombosis.
epidemiologicalPaul Wales7:45 ↗
Access and availability to intestinal rehabilitation programs is still very rare.
Host summaryRod Gerardo summarizing the discussion — not the host's own clinical position8:41 ↗
Three time points exist for diagnosis and referral to intestinal rehab: prenatal diagnosis (atresia with cystic fibrosis, gastroschisis), postnatal acquired problems (volvulus, NEC), and later presentations after discharge when patients fail to progress.
clinicalMichael Helmrath8:53 ↗
Innovation in intestinal rehabilitation comes from multiple approaches to problems and different visions, with more expertise leading to better outcomes.
opinionMichael Helmrath10:15 ↗
Transitioning older children with intestinal failure into their late teen years and beyond is a major obstacle currently not being adequately addressed.
clinicalMichael Helmrath10:51 ↗
The intestinal rehabilitation team includes dietitians (for nutritional needs), social workers, nurse practitioners, pharmacy, interventional radiology, pathology, endocrinology, and nephrology.
clinicalMichael Helmrath11:52 ↗
Overall long-term survival in major intestinal rehabilitation programs is usually over 90%.
Host summaryRod Gerardo summarizing the discussion — not the host's own clinical position12:34 ↗
Long-term survivors now develop chronic comorbidities not previously seen to the same extent because patients did not live long enough, including renal dysfunction, metabolic bone disease, neurocognitive issues, and quality of life problems.
clinicalPaul Wales12:46 ↗
Intestinal rehabilitation in pediatric short bowel syndrome: expert strategies for autonomy
Young infants, babies, infants, and young children have tremendous gut growth potential, with the gut growing for the first several years of life.
clinicalPaul Well0:49 ↗
A term baby will have 160 centimeters of small bowel, and by the time the child is 5 years old, it almost triples to about 425 to 450 centimeters.
clinicalPaul Well1:17 ↗
Residual bowel should be discussed as a percentage of what is normal for a child of that age, not in absolute centimeters.
clinicalPaul Well1:02 ↗
A patient can achieve enteral autonomy with as low as 10% expected gut length if they have the majority of their colon in continuity.
clinicalPaul Well1:51 ↗
The more important factor is the presence or absence of the distal small bowel or ileum and right colon that can act as a reclamation of bile and support the enterohepatic circulation.
clinicalMichael Helmrath2:30 ↗
What's new+ Show