Chiropractic care in a 5-month-old female with vomiting, gastro-esophageal reflux, fussiness, frequent colds, and poor weight gain: A case report.
Tara Buchakjian, BS, DC, FICPA, CACCP
Abstract
Introduction:
The purpose of this case report is to investigate whether there is a possible correlation between chiropractic care and a reduction of fussiness and vomiting in an infant. Gastro-esophageal reflux disease (GERD) is found in as many as 18 percent of healthy children [1]. Treatment options for gastro-esophageal reflux include formula changes, thickening formula with rice cereal, positional changes, parental education, medication, and surgery [2]. About half of healthy infants between 3 and 4 months of age will vomit at least once per day [3]. The use of rice cereal to thicken formula and changes in formula are not shown to be of any benefit in reducing reflux [1] although thickened formula continues to be recommended for uncomplicated recurrent regurgitation in infants in order to reduce vomiting [2]. The type and composition of formula also does not reduce reflux [1]. Research supports that positional changes, specifically lying prone with or without head elevation, reduces acid reflux in infants [2]. Regurgitation appears to spontaneously resolve by 12-14 months of age in most healthy infants [2].
Case Presentation:
A 5-month-old female was presented to a chiropractic office by their parent for treatment gastro-esophageal reflux, diagnosed at age 2 months by her pediatrician. The patient was born 6 pounds 7.5 ounces and 20 inches long by emergency c-section. Mother was taking medication (Paxil) during her pregnancy and 5 ultrasounds were performed over the course of gestation. Symptoms as described by her parents included vomiting more than once per day, reflux, fussiness, poor weight gain, constipation, and frequent colds.
Parents were both mentally challenged and had a child against the advice of family and friends. The parents were concerned that their child was not reaching age appropriate developmental milestones. Parents sought chiropractic care for their child because current medical treatment had not been effective for the treatment of gastro-esophageal reflux.
The patient was diagnosed with gastro-esophageal reflux at 2 months old and a medical diagnosis of failure to thrive was considered at the time of presenting for chiropractic treatment. The parents were concerned about frequent vomiting associated with gastro-esophageal reflux, poor weight gain, constipation, and reaching age-appropriate developmental milestones. Previous medical treatment by the pediatrician and/or specialist for gastro-esophageal reflux included 4 different prescription medications between 2 months and 4 months old. Medications included Zantac (Rantidine) at 2 months old, then Reglan (Metoclopramide) a short time later, Prilosec (Omeprazole) at 3 months old, and Prevacid (Lansoprazole) at 4 months old. The pediatrician also recommended rice cereal which the parents began adding to the formula at 2 months old. Five changes in formula were also made between birth and 5 months of age. Formulas used since birth are as follows: Similac ready to feed, Similac Advanced powdered, Similac Isomil Soy, Similac Alimentum (began at 5 months old), Similac sensitive RS, and Enfomil AR Lipil. Minimal to no perceived improvements by her parents with medication, formula changes, or rice cereal thickened formula.
Method and Intervention:
At the time of evaluation at this office the patient’s weight was 12 pounds 1 ounce and length was 24 inches as reported by parents at a recent check-up. Examination revealed palpatory tenderness indicated by patient squirming or crying upon palpation at C2, T6 and the sacrum. Spinal subluxations were also noted at the right sacrum T12, T6, T5, and C2, associated with local hypertonicity, tenderness and decreased intersegmental motion. Overall muscle tone was slightly flaccid and poor eye contact was noted. Muscular hypertonicity was noted at the mid-thoracic paraspinal region. Normal gross cervical and lumbar ranges of motion were found. Cranial examination revealed right temporal-parietal bone overlap.
The patient was treated 19 times over the course of 2 months with combinations of “light-force” activator instrument and manual diversified techniques to the regions of the spine determined to be subluxated by palpation associated with reduced spinal intersegmental ranges of motion and increased muscle tension, which was also congruent with perceived tenderness by the patient. Frequent areas that were adjusted localized to the 2nd cervical and 6th thoracic vertebra, and the and right sacral base. Localized iIliocecal valve massage was also used on some visits to improve elimination. Using the fingertips over the lower right quadrant of the abdomen, gentle pressure was applied in a circular motion for up to 2 minutes over the iliocecal valve. Chiropractic cranial assessed some sutural compression at the left temporo-parietal suture and treatment consisted of using light manual separation forces/distraction. Home recommendations included changing formula to an organic form, discontinuation of rice cereal added to the formula, and belly massage to aid digestion and reduce constipation.
Results:
The patient had a reduction of vomiting, improved eye contact, reduction of flaccid muscular tone, and was keeping more food down after 10 treatments. She also had no colds or illnesses over the course of treatment. In addition there was decreased joint fixation and spasm and improved on Thermographic scans, which noted less heat (inflammation) and greater symmetry.
After 4 treatments less vomiting was noted by parents. After 6 treatments the parents changed her formula to organic Similac and also noted no vomiting for 2 days, was sleeping better, and consuming more. Observations included increased interaction, less fussiness, and reduced flaccid muscle tone. After 10 visits eye contact was improved and vomiting was no longer daily.
On her 11th visit, vomiting was not present that day and bowel movements were normal. Mother also stated that the pediatrician did not agree with her treatment option of chiropractic care however the parent noted that since care was instituted the “baby was healthier than she’s ever been.” After 13 visits the parents continued to report that their child was sleeping for longer periods of time. The patient’s condition regressed slightly over the next 4 weeks. On her 15th visit, the patient vomited twice while in the office and the parents were under obvious distress. The parents discontinued care after 19 visits as they felt their daughter had plateaued and would not improve any further while under chiropractic care.
Discussion:
The parents desired to raise their child without outside assistance, but were surrounded by the pressures of family and friends to raise a healthy child according to “typical” standards. They were under tremendous stress while raising their child and constantly concerned that the child was developing normally and on schedule. This parental distress may have been a contribution to the child’s condition.
There was a significant temporal relationship between the child’s improvement and the care rendered at this office. The parents noted that by the 6th visit (the 2nd or 3rd week) the child was clearly improved compared to any other time in her life. During the treatments (1-14) the parents and doctor found that the child became more aware, interactive, and had increased general body muscle tone.
A search of chiropractic care and GERD revealed a similar case of a 3 month old that presented for chiropractic care with regurgitation after each feeding. After 7 chiropractic treatments it was reported that the patient’s regurgitation was reduced to once per day. Other improvements include sleeping for 4-5 hours, reduced painful cry, and more efficient nursing via a better latch on the breast [4]. Another case discussed a 3-year-old male being treated medically for gastroesophageal reflux disease with various antacids (Prilosec) since the age of 2 months and Prilosec since the age of 24 months. In this case the child received 5 office visits and on the fifth visit, two weeks after the initial treatment, the mother reported no reflux and that she had discontinued the Prilosec after the second treatment. Follow-up contact 12 months later upon a return visit found the patient was stable without reflux pain or symptoms nor taking any medications [5].
It is difficult to determine specifically whether chiropractic and cranial care alone contributed the child’s successful response to care. Other factors may have also played a part in the child’s response to care are: (1) It is possible that the change in formula may have been responsible for the child’s positive response, (2) The doctor’s and/or parental reassurance may have played a significant role in the patient’s improvement, and (3) It is possible that the child’s natural gastrointestinal and nervous system development were taking place at the same time as treatment was instituted.
Conclusion:
The patient began to have reduced vomiting following 4 chiropractic treatments, which coincided with a 7th change of formula, however formula changes generally do not improve vomiting or reflux symptoms. This case suggests that chiropractic care and/or parental reassurance may help in the reduction of vomiting and regurgitation in infants. Further research in the non-musculoskeletal conservative chiropractic care in pediatrics should be performed to determine whether more children with vomiting, gastro-esophageal reflux, fussiness, frequent colds, and poor weight gain might be helped without the risk of pharmaceutical or surgical interventions.
References:
- Carroll AE, Garrison MM, Christakis DA. A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants. Arch Pediatr Adolesc Med. 2002 Feb;156(2):109-13.
- Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009 Oct;49(4):498-547.
- Martin AJ, Pratt N, Kennedy JD, Ryan P, Ruffin RE, Miles H, Marley J. Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics. 2002 Jun;109(6):1061-7.
- Alcantara J, Anderson R. Chiropractic care of a pediatric patient with symptoms associated with gastroesophageal reflux disease, fuss-cry-irritability with sleep disorder syndrome and irritable infant syndrome of musculoskeletal origin. J Can Chiropr Assoc. 2008 Dec;52(4):248-55.
- Klingensmith RD, Blum CL. Chiropractic manipulative reflex technique (CMRT) treatment for GERD of a 3 year old male child: A case report. Proceedings of the 1st Sacro Occipital Research Conference: Las Vegas, Nevada. Oct 2010: 53-5.
